Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Chronic Hypertension

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In one line

·Blood pressure stays high for months or years, quietly damaging the heart, brain, kidneys, and eyes.

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Normal physiology

·Blood pressure is the push of blood against artery walls. It equals how much blood the heart pumps each minute times how tight the blood vessels squeeze. The kidneys control how much water and salt stay in the body, which sets how much fluid fills the vessels. The nervous system and hormones (especially the renin-angiotensin-aldosterone system, or RAAS) tighten or relax vessel walls second by second. Together these parts keep pressure in a safe range — usually below 120 over 80.

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What goes wrong

·In nine out of ten people with chronic high blood pressure, no single cause is found — doctors call this essential or primary high blood pressure (hypertension). It comes from a mix of aging, genes, eating too much salt, carrying extra weight, not moving enough, drinking too much alcohol, and chronic stress. In the other one out of ten, a specific cause drives the pressure up: narrowed arteries feeding the kidneys (renal artery narrowing (stenosis)), a tumor in the adrenal gland making adrenaline (pheochromocytoma), too much aldosterone hormone (primary aldosteronism or Conn syndrome), too much cortisol (Cushing syndrome), thyroid hormone that is too high or too low, sleep pauses in breathing (apnea) that stops breathing at night, or medicines like birth control pills, NSAIDs, decongestants, or steroids. Doctors miss these fixable causes if they do not look for young age at onset, very high pressure that does not respond to medicine, low potassium, or a belly a whooshing sound over a vessel (bruit) (whooshing sound over the kidney arteries).

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Hallmark signs

·Blood pressure reading stays at 130/80 mmHg or higher
·No symptoms at all (most common)
·Headache (dull, on both sides of the head, often in the morning)
·Blurred vision or seeing spots
·Chest pain or pressure
·Shortness of breath with activity or when lying flat
·Nosebleed that won't stop easily
·Fatigue or feeling unusually tired

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Red flags · escalate now

·Blood pressure 180/120 mmHg or higher (hypertensive crisis—the vessels and organs are at risk of tearing or failing right now)
·Sudden, severe headache with confusion, trouble speaking, or weakness on one side (possible stroke from a burst or blocked brain vessel)
·Chest pain with sweating or nausea (possible heart attack—not enough blood reaching the heart muscle)
·Sudden trouble breathing or coughing up pink, frothy spit (fluid flooding the lungs because the heart can't pump well)
·Sudden vision loss or double vision (bleeding or swelling in the eye or brain)

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Workup

·Home blood pressure monitoring over 1–2 weeks
·Basic metabolic panel (sodium, potassium, creatinine, eGFR)
·Urinalysis and urine albumin-to-creatinine ratio (UACR)
·Lipid panel (total cholesterol, LDL, HDL, triglycerides)
·Hemoglobin A1c
·Electrocardiogram (EKG)
·Plasma aldosterone-to-renin ratio (if resistant high blood pressure (hypertension) or low potassium)
·Renal artery ultrasound with Doppler or CT angiography (if young onset, sudden worsening, or resistant high blood pressure (hypertension))

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Treatment

·DASH diet (lots of fruits, vegetables, whole grains, low-fat dairy) with sodium under 2.3 grams daily, lose 5–10% body weight if overweight, exercise 150 minutes weekly, limit alcohol to 1–2 drinks daily, quit smoking
·ACE inhibitor (lisinopril, enalapril) or ARB (losartan, valsartan) — use first if chronic kidney disease, diabetes, heart failure, or albuminuria is present
·Calcium channel blocker (amlodipine, nifedipine) — first choice for Black patients without chronic kidney disease, or add to any regimen if blood pressure is not controlled
·Thiazide or thiazide-like diuretic (chlorthalidone, hydrochlorothiazide, indapamide) — often added to any regimen
·Start two medicines at once if blood pressure is 20/10 mmHg or more above goal (for example, 150/90 or higher when goal is 130/80)
·Screen for secondary causes: check plasma aldosterone-to-renin ratio, kidney artery imaging, 24-hour urine metanephrines or plasma free metanephrines (if pheochromocytoma suspected), sleep study (if snoring or daytime sleepiness), review medicines (NSAIDs, decongestants, oral contraceptives, steroids)
·Target blood pressure below 130/80 mmHg; recheck every month until at goal, then every 3–6 months once stable

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NCLEX trap

·Chronic high blood pressure (hypertension) damages organs silently for years. Lifestyle changes are first, but most patients need medicine too, especially if the blood pressure is far above goal (130/80 mmHg or higher for most adults). Silent damage is still damage — the heart thickens, kidneys scar, and arteries stiffen even when you feel perfectly well.
·In chronic high blood pressure (hypertension) without emergency signs (no chest pain, no stroke symptoms, no shortness of breath), bring the pressure down slowly over weeks to months. If you drop it too fast, the brain and heart — used to high pressure — suddenly do not get enough blood. In a true emergency (organs being hurt right now), yes, lower it faster — but match the speed to the danger.
·A headache with very high blood pressure (usually above 180/120 mmHg) is a red flag for with high blood pressure (hypertensive) emergency — brain swelling, bleeding, or stroke risk. Check for organ damage right now: look at the eyes, do an EKG, check kidney function. High blood pressure with symptoms means danger, not just the usual slow disease.
·Match the medicine to the person. A Black patient without kidney disease often does better on a calcium channel blocker (CCB) or thiazide diuretic because ACE inhibitors work less well in this group. A patient with diabetes or kidney disease needs an ACE inhibitor or ARB to protect the kidneys. A patient with heart failure needs an ACE inhibitor plus other heart medicines. Chronic high blood pressure (hypertension) treatment is personal, not one-size-fits-all.
·Always ask: Does this patient have kidney artery narrowing (renal artery narrowing (stenosis)), a hormone tumor (pheochromocytoma, aldosterone tumor), obstructive sleep pauses in breathing (apnea), or use medicines that raise blood pressure (birth control pills, NSAIDs, decongestants)? Secondary causes hide if you do not look. Missing them means the real problem never gets fixed, and blood pressure stays high no matter how many pills you add.
·Chronic high blood pressure (hypertension) keeps damaging organs even when the pressure looks controlled. Check the heart (EKG, echo if needed), kidneys (creatinine, urine protein), and eyes (retinal exam) regularly — at least yearly, more often if damage is already there. The goal is to catch damage early, before the heart fails, the kidneys shut down, or a stroke happens.

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