Hypertension, or high blood pressure, affects approximately 1.28 billion adults worldwide and is a leading risk factor for cardiovascular disease. It's often called the 'silent killer' because many people have no symptoms until serious complications develop. According to the American College of Cardiology and American Heart Association guidelines, hypertension is defined as blood pressure readings of 130/80 millimeters of mercury or higher. The diagnosis requires accurate measurement using proper technique, with the patient seated quietly for 5 minutes before taking readings. Blood pressure is classified into different categories based on severity, ranging from normal to hypertensive crisis, which helps determine appropriate treatment approaches.
The diagnostic workup for hypertension begins with accurate blood pressure measurement. This requires multiple readings on different occasions, as blood pressure naturally fluctuates. A comprehensive medical history is essential to identify risk factors like family history of hypertension, cardiovascular disease, diabetes, or kidney disease. The physical examination should include assessment of body mass index, heart and lung sounds, abdominal examination for renal artery bruits, and examination of the optic fundi for hypertensive changes. Laboratory tests typically include complete blood count, basic metabolic panel to assess kidney function, lipid profile, and urinalysis. An electrocardiogram is performed to check for left ventricular hypertrophy. Additional tests may be ordered based on initial findings to rule out secondary causes of hypertension, such as renal artery stenosis, pheochromocytoma, or primary aldosteronism.