Hypertension

Hypertension is sustained elevation of arterial pressure that gradually injures blood vessels and target organs. In Canadian adults, hypertension is defined as systolic BP or diastolic BP of 130/80 mm Hg or higher when measured with a validated device under standardized, optimal conditions. One casual reading is not usually enough to establish the diagnosis; ambulatory or home monitoring helps confirm persistent hypertension and identify white-coat or masked hypertension. The BP number and the patient’s condition answer different questions. A markedly elevated reading without acute organ injury usually calls for confirmation, medication review, and timely adjustment rather than rapid intravenous treatment. A less dramatic reading with acute neurologic, cardiac, renal, or obstetric injury can still be an emergency. Pharmacotherapy is recommended for adults with BP of 140/90 mm Hg or higher and for those with systolic BP 130–139 mm Hg who have high cardiovascular risk, such as established cardiovascular disease, diabetes, chronic kidney disease, a 10-year Framingham Risk Score of 20% or higher, or age 75 years or older. The usual treatment target is systolic BP below 130 mm Hg when...