Terminologies of Hypertension

There are various terminologies used to describe hypertension which may overlap and are a source of confusion to the medical students and health professionals.

Essential or Primary or Idiopathic hypertension

• Hypertension in which secondary causes have been excluded.
• Identifiable etiologic factors of essential hypertension:
  • Obesity
  • Insulin resistance
  • High alcohol intake
  • High salt intake (in salt-sensitive patients)
  • Aging
  • Sedentary lifestyle
  • Stress
  • Low potassium intake
  • Low calcium intake

Secondary hypertension

• Hypertension due to secondary causes like:
  • Renovascular disease
  • Renal failure
  • Pheochromocytoma
  • Endocrinopathies
  • Mendelian inheritnace, etc.

Pre-hypertension

• Systolic Blood Pressure 120-139 mmHg OR
• Diastolic Blood Pressure 80-89 mmHg

Stage I hypertension

• Systolic Blood Pressure 140-159 mmHg OR
• Diastolic Blood Pressure 90-99 mmHg

Stage II hypertension

• Systolic Blood Pressure ≥160 mmHg OR
• Diastolic Blood Pressure ≥100 mmHg

JNC 8, rather than classifying the hypertension has provided the cut-off value for Blood pressure, at which the pharmacotherapy must be started and below which the target of therapy should be:

1. ≥60 years old: ≥150/90 mmHg
2. All others: ≥140/90 mmHg

Pregnancy Induced Hypertension and Hypertensive emergencies

Hypertensive Disorders in Pregnancy

Isolated Systolic hypertension

• Systolic Blood Pressure ≥140 mmHg AND
• Diastolic Blood Pressure <90 mmHg

Isolated systolic hypertension may be seen in cases of Patent Ductus Arteriosus, Atherosclerosis, Aortic regurgitation or Hyperthyoroidism.

White-coat hypertension

• Office or Clinic systolic/diastolic blood pressure readings of ≥140/90 mm Hg AND
• 24-hour or ambulatory blood pressure <130/80 mm Hg

Isolated ambulatory or Masked hypertension

• Elevated ambulatory blood pressure AND
• Normal clinic blood pressure (BP)

Pseudohypertension

• Indirect blood pressure measured by the cuff method overestimates the true intra-arterial blood pressure, i.e. falsely elevated blood pressure due to stiff non-compliant vessels usually seen in elderly.
• Also known as Osler’s sign or Noncompressibility artery syndrome

Resistant hypertension

Conventional blood pressure remains uncontrolled by 3 classes of antihypertensive agents, including a diuretic.

Hypertensive Urgency

• Systolic Blood Pressure >180 mmHg OR
• Diastolic Blood Pressure >120 mmHg
• No new-onset target organ damage

Hypertensive urgency has not been mentioned in JNC 8.

Hypertensive Emergency

• Systolic Blood Pressure >180 mmHg OR
• Diastolic Blood Pressure >120 mmHg
• With new-onset target organ damage:
  • Hypertensive encephalopathy
  • Dissecting aortic aneurysm
  • Acute left ventricular failure with pulmonary edema
  • Acute myocardial infarction
  • Eclampsia
  • Acute renal failure
  • Symptomatic microangiopathic hemolytic anemia

Accelerated Hypertension

Hypertensive emergency with grade III retinopathy

Malignant Hypertension

Hypertensive emergency with grade IV retinopathy

Since, the clinical outcome doesn’t depend upon the fundoscopic findings – now, the preferred term is accelerated-malignant hypertension.

Hypertensive Crisis

The term hypertensive crisis encompasses both the hypertensive urgency and emergency.