Diagnosis, pathogenesis, and management of essential hypertension

Hypertension, defined as systemic blood pressure equal to or exceeding 140/90 mm Hg, is a common health problem afflicting approximately 20% of the adult population of the United States. Ninety-five percent have "essential hypertension" for which the pathogenesis is unknown, although both genetic and environmental factors probably are important. Using proper technique, multiple blood pressure determinations made both inside and outside the physician's office are used to diagnose hypertension and assess the effects of treatment. The goal of therapy is to reduce the morbidity and mortality attributable to high blood pressure, which is accomplished by reducing blood pressure to below 140/90 mm Hg. Treatment involves both nonpharmacologic and pharmacologic modalities. Because noncompliance remains a major problem, proper selection of therapy is important. Cooperation of all health care professionals who deal with hypertensive patients is important to ensure control of this common health problem.