7-4. CLASSES OF ESSENTIAL HYPERTENSION
a. Stage I Hypertension. Stage I hypertension is characterized by sustained,
documented systolic pressure 140 to 159 mm Hg and or diastolic pressure
measurements 90-99 mm Hg. Signs of this type include increased heart rate
(tachycardia) and increased cardiac output with normal total peripheral vascular
resistance, however the majority of patients cannot tell that they have hypertension.
b. Stage II Hypertension. Stage II hypertension is characterized by sustained,
systolic elevation (160 to 179 mm of Hg) and or diastolic pressure (100 to 109 mm Hg).
Symptoms are the same as noted in Stage I. Patients with Stage I or II DO NOT show
signs of target end organ damage. The organs of most concern are the heart, kidneys,
and eyes. Stage I and II hypertension may be treated nonpharmacologically with diet
and exercise or pharmacologically with antihypertensive medications.
c. Stage III Hypertension. Stage III hypertension is characterized by a
persistent elevation (systolic >180mm Hg; diastolic >110mm Hg) with target end organ
damage. Damage to the heart may include strain or enlargement of the left ventricle.
Kidney damage may appear as abnormal laboratory values that indicate inefficiency.
Damage to the eyes may appear as small hemorrhages due to the sustained blood
pressure in these small vessels. This stage is often treated immediately with
d. Hypertensive urgency is a condition of persistent elevation in blood
pressure without target end organ damage. However, the pressure is high enough that
the patient presents for treatment because of symptoms of dizziness, chest pain, or
confusion. The goal in treatment of this condition is to normalize the blood pressure as
quickly as possible (usually over 1-3 days). Hypertensive crisis is a similar condition,
however the patient has symptoms of target end organ damage. This may be a life-
threatening condition. The goal of therapy is to normalize the blood pressure in 12-24
hours. Both conditions are usually treated with intravenous (IV) antihypertensives.
7-5. REVIEW OF IMPORTANT FACTORS RELATING TO HYPERTENSION
Essential hypertension is a process of variable course and severity. Several
options are open to the physician depending upon the severity of the drug therapy.
Condition weight reduction and diet control may be adequate treatment; however, drug
therapy is sometimes needed. When drug therapy is required, it usually begins with a
diuretic followed by the addition of the other agents based on the patient's response.
However, certain classes of drugs may be more advantageous (fewer side effects)
when patients have other diseases. It is not unreasonable to see patients treated by the
same provider on different drugs.