Primary Hypertension
Pathophysiology & Risk Factors
Primary (essential) hypertension accounts for roughly 90-95% of all hypertension and has no single identifiable cause. Chronic pressure elevation damages the vascular endothelium, accelerates atherosclerosis, and raises left-ventricular workload. Contrast with secondary hypertension (younger onset, treatment-resistant) caused by an identifiable trigger such as renal artery stenosis or pheochromocytoma.
Signs & Symptoms
Primary hypertension is overwhelmingly asymptomatic — the "silent killer" — which is why adherence and screening matter. Symptoms generally appear only with severely elevated pressure or established target-organ damage.
Diagnostics & Labs
Diagnosis requires elevated readings on multiple separate occasions. Current ACC/AHA staging starts at 130/80 — do not apply the old JNC 7 cutoff of 140/90.
Interventions & Priorities
For Stage 1 without elevated ASCVD risk, trial lifestyle modification first for 3-6 months before pharmacotherapy.
Treatments & Medications
Class selection is comorbidity-driven. Thiazides or CCBs are first-line for uncomplicated hypertension (thiazides preferred in African American clients due to lower plasma renin); ACE inhibitors/ARBs are preferred with diabetes or CKD for renal protection.
Patient Teaching
Complications
Escalate immediately for these — abrupt beta-blocker withdrawal and acute severe elevation are true report-now events.
Clinical Pearl
The silent killer gives no symptom reminders — anchor each pill to a habit the client already has, because they stop taking meds precisely when they feel fine.