HYPERTENSION (HTN)
Hypertension
is an elevated blood pressure leading to end-organ damage,
or a sus-tained diastolic pressure >90 mm Hg and/or systolic pressure
>140 mm Hg.
Hypertension
is very common, affecting 25% of the U.S. population. African Ameri-cans tend
to be more seriously affected than Caucasians, and the risk increases with age.
Approximately 95% of cases of hypertension are idiopathic (essential); the
remainder are due to secondary hypertension related to renal disease,
pheochromo-cytoma, or other disease processes.
Mild to moderate elevations in
blood pressure cause end-organ damage by damag-ing arterioles with hyaline
arteriolosclerosis. Late manifestations of hypertension include concentric left
ventricular hypertrophy; congestive heart failure; accelerated atherosclerosis;
myocardial infarction; aneurysm formation, rupture, and dissection;
intracerebral hemorrhage; and chronic renal failure.
Malignant (accelerated) hypertension accounts
for 5% of the cases and is charac-terized by markedly elevated pressures (e.g.,
systolic pressure >180 mm Hg and/or diastolic >120 mm Hg), which can
rapidly cause end-organ damage. Funduscopic examination may demonstrate retinal
hemorrhages, exudates, and papilledema. Malignant hypertension is a medical
emergency; if untreated, most patients will die within 2 years from renal
failure, intracerebral hemorrhage, or chronic heart failure.
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