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.

hypertension-terms

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.

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