Hypertension and Acute Hypertensive Crisis

Abstract

Hypertension prevalence is more than 30% in the general population and may be as high as 50% in some populations with mental illness. It is defined using cutoffs for systolic and diastolic blood pressure (SBP and DBP) that vary based on age and certain medical conditions.

Appendix

Guidelines from Joint National Commission (JNC-8) [6]

Thiazide diuretics , calcium channel blockers (CCBs) , angiotensin-converting enzyme inhibitors (ACEIs) , or angiotensin receptor blockers (ARBs) are all considered first-line medications for hypertension treatment

For black patients, including those with diabetes, CCBs or thiazide diuretics should be first-line medications

For all patients with chronic kidney disease, regardless of race or diabetes status, ACEIs or ARBs should be included in antihypertensive treatment

Beta blockers should only be considered after thiazine diuretics, CCBs, ACEIs, ARBs, unless other indications like ischemic heart disease or heart failure are present

If BP is not at goal after 1 month on medication, dose should be raised or second agent added; medications should be added until goal BP is reached

Commonly used medications for hypertension

Medication class	Mechanism of action	Comments
Thiazide diuretics Hydrochlorothiazide Chlorthalidone	Inhibit sodium transport in the distal renal tubule	Serum potassium should be monitored
ACEI Lisinopril Enalapril Captopril	Inhibit conversion of angiotensin I to II resulting in vasodilation and reduced sympathetic activity	Renal function and serum potassium should be monitored
ARB Losartan Candesartan Valsartan	Block angiotensin II receptors in blood vessels resulting in vasodilation and reduced sympathetic activity	Generally only indicated if ACEIs are not tolerated (e.g., cough occurs with ACEIs and not ARBs)
CCBs Dihydropyridine Amlodipine Nondihydropyridine Verapamil Diltiazem	Regulate calcium influx into vascular smooth muscle cells and reduce vascular resistance	No lab monitoring required Nondihydropyridines generally used only with additional indications (e.g., atrial fibrillation)
Beta blockers Metoprolol Atenolol Carvedilol	Block beta receptors in blood vessels and reduce sympathetic tone	Not used unless additional indications (e.g., atrial fibrillation, angina, heart failure) and first-line agents already used Metoprolol and atenolol are cardioselective and preferred in obstructive lung disease