Molecular structure pattern

Hypertension Disease Summary

Last updated: 28 October 2025
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Overview

Hypertension is high blood pressure requiring confirmation with repeated measurements, assessment for secondary causes and target-organ damage, cardiovascular risk stratification, and individualized treatment.

Key Presenting Symptoms

  • Sweating

    May suggest pheochromocytoma

  • Headache

    May suggest pheochromocytoma

  • Palpitations

    May suggest pheochromocytoma

  • Muscle weakness

    suggest hyperaldosteronism

  • Snoring

    May suggest sleep apnea

Red Flags

  • Accelerated or malignant hypertension — Screen for secondary hypertension[3][9]

Assessment Workflow

View More on Disease Algorithm

  1. 1. Take history

    Assess BP history, symptoms, drugs and comorbidities.

  2. 2. Examine patient

    Measure BP and assess BMI, organs and pulses.

  3. 3. hypertension

    Repeat office BP or use out-of-office measurement.

  4. 4. complications

    Evaluate secondary causes and target-organ damage.

  5. 5. Stratify risk

    Classify BP stage and total cardiovascular risk.

Diagnosis

  • Confirm with average readings from ≥2 occasions or visits.
  • Office hypertension: ≥130/80 or ≥140/90 mmHg, depending on guideline.
  • Use out-of-office BP to confirm diagnosis.
  • Classify BP stage and assess organ damage and cardiovascular risk.[3][4][6]
View More on Diagnosis

Differential Diagnosis

Differential diagnosisKey Distinguishing Feature
Acromegaly[6]
Aortic coarctation[6]
Chronic kidney disease[6]
Drug-induced hypertension[6]
Obstructive sleep apnea[6]
View More on Differential Diagnosis

Diagnostics: Lab Tests and Imaging

Test / AssessmentClinical Purpose
Urinalysis and urine ratiosAssess renal disease and albumin or protein loss.[6][9]
Renal function testsAssess eGFR and target-organ damage.[6][9]
Fasting glucose or HbA1cScreen for diabetes and comorbidity.[2][6]
Lipid profileIdentify additional cardiovascular risk factors.[6][8]
12-lead ECGAssess cardiovascular effects and target-organ damage.[6][9]

Pharmacological Management

Treatment roleTherapyKey note
First-line agentsACE inhibitors or ARBsRecommended first-line classes; include in CKD treatment.[1][3][5]
First-line agentsCalcium antagonistsOne of the recommended first-line antihypertensive classes.[1][3][5]
First-line agentsThiazide diureticsOne of the recommended first-line antihypertensive classes.[1][3][5]
Combination therapyTwo separate drug classesRecommended when BP is ≥140/90 mmHg or >20/10 above target.[3][6]
Resistant hypertensionAldosterone antagonistPreferred after excluding secondary hypertension.[6]

Dosage Guidelines

  • Benazepril

    ACE inhibitors

    Dosage: Initial dose: 10 mg PO 24 hourly. Maintenance dose: 20-40 mg/day PO. Max dose: 40-80 mg/day.

  • Doxazosin

    Alpha-blockers

    Dosage: Regular release: Initial dose: 1 mg PO 24 hourly; may increase at 1-2-week intervals to 2 mg and then 4 mg PO 24 hourly. Max dose: 16 mg/day.

  • Azilsartan medoxomil

    Angiotensin II antagonists

    Dosage: Initial dose: 40 mg PO 24 hourly. May increase up to 80 mg PO 24 hourly.

  • Sacubitril/Valsartan

    ARNI

    Dosage: 200-400 mg PO 24 hourly.

View More on Dosage Guidelines

Non-pharmacological management

  • Promote weight reduction and maintenance of healthy body weight.
  • Recommend reduced salt intake and a Mediterranean or DASH diet.
  • Encourage regular aerobic and resistance exercise.
  • Advise smoking cessation and limit alcohol consumption.
  • Encourage home BP measurement with validated devices.[5][7][8]
View More on Non-pharmacological Management

Specialist Referral

  • Referral Indication: Secondary cause of hypertension is found or suspected.

    Suggested Specialist: specialist

  • Referral Indication: BP goals cannot be achieved despite treatment strategies.

    Suggested Specialist: hypertension specialist

  • Referral Indication: Complicated patients requiring additional consultation.

    Suggested Specialist: hypertension specialist

References

  1. Al-Makki A, DiPette D, Whelton PK, et al. Hypertension pharmacological treatment in adults: a World Health Organization guideline executive summary. Hypertension. 2022 Jan;79(1):293-301. doi: 10.1161/HYPERTENSIONAHA.121.18192. PMID: 34775787
  2. ElSayed NA, Aleppo G, Aroda VR, et al. Cardiovascular disease and risk management: standards of care in diabetes – 2023. Diabetes Care. 2023 Jan;46(Suppl 1):S158-S190. doi: 10.2337/dc23-S010. Accessed 26 Mar 2023. PMID: 36507632
  3. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025 Aug 14. doi: 10.1161/CIR.0000000000001356. Accessed 16 Aug 2025. PMID: 40811497
  4. Kaplan NM. Ambulatory and home blood pressure monitoring and white coat hypertension in adults. UpToDate. Mar 2017. Accessed 19 Apr 2017.
  5. Malaysian Society of Hypertension, Ministry of Health Malaysia, Academy of Medicine of Malaysia. Clinical practice guidelines. Management of hypertension. 5th edition (2018). Academy of Medicine of Malaysia. 2018. Accessed 07 Dec 2018.
  6. Mancia G, Kreutz R, Brunstrom M, et al. 2023 ESH guidelines for the management of arterial hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023 Dec 1;41(12):1874-2071. doi: 10.1097/HJH.0000000000003480. Accessed 16 Mar 2024. PMID: 37345492
  7. National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults - 2016. National Heart Foundation of Australia. 2016. Accessed 19 Apr 2017.
  8. Visseren FLJ, Mach F, Smulders YM, et al; ESC National Cardiac Societies, ESC Scientific Document Group. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021 Sep 7;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484. Accessed 15 Dec 2021. PMID: 34458905
  9. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-e248. doi: 10.1016/j.jacc.2017.11.006. Accessed 16 Nov 2017. PMID: 29146535
View More on References