Geriatric Considerations
Isolated systolic HTN is common. Therapy is effective at preventing stroke, CV morbidity and all-cause mortality (2)[A]. Target SBP for seniors is higher than in younger patients (~150 mm Hg systolic), and adverse reactions to medications are more frequent, especially in those who are very old. The benefit of therapy has been conclusively demonstrated in older patients for SBP ≥160. The strongest evidence of benefit has been shown with use of thiazide diuretics.
Pediatric Considerations
Defined as SBP or DBP ≥95th percentile on repeated measurements; measure BP during routine exams beginning at age 3 years; pre-HTN: SBP or DBP between 90th and 95th percentile
Pregnancy Considerations
Elevated BP during pregnancy may represent chronic HTN, pregnancy-induced HTN, or preeclampsia. Preferred agents: labetalol, nifedipine, methyldopa, or hydralazine with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) being contraindicated. Maternal and fetal mortality are reduced with treatment of severe HTN (see “Preeclampsia and Eclampsia [Toxemia of Pregnancy]”).
Prevalence
32–46% of adults in the United States have HTN; incidence and prevalence higher in men
>90% of cases of HTN have no identified cause. For differential diagnosis and causes of secondary HTN, see “Hypertension, Secondary and Resistant.”
Family history, obesity, alcohol use, excess dietary sodium, stress, physical inactivity, tobacco use, insulin resistance, obstructive sleep apnea (OSA) and other causes of sleep disruption
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