1. Hypertension

Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, blurry vision,

Assessment:

0. Asymptomatic
1. Occipital headache
2. Blurry vision
3. Headache upon wakening
4. Look for AV nicking
5. LVH

Exam:

1. Carotid bruits
2. Abdominal bruits
3. Kidney bruits

Diagnostic studies: to look for secondary causes of HTN like target organ damage and establish

ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP (electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria).

Diagnosis: Measure BP 5 minutes apart. Average of 2 or more BP readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN.

If Stage 1 (ASCVD <10%) then non-pharmacologic management only:

• First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week.
• Limit alcohol
• stop smoking
• stress management.
• DASH
• Medication compliance
• Reduce sodium intake
• Measure BP daily

If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic

Management:

• Alone: hydrochlorothiazide (HCTZ) 25 mg/day (chlorthalidone is preferred over HCTZ)
• Alone: lisinopril 10mg/day complicated HTN first line
• Combo: thiazide + ACE or ARB
• Alternative CB (especially in isolated HTN seen mainly in older adults)
• Black population: thiazide + CCB is recommended first line

Follow up:

• 2-4weeks

Referral:

• Cardiology if EKG is abnormal

Differential:

1. Secondary hypertension
2. Pregnant
3. Pregnancy induced hypertension

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