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(Show Disclaimer) Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.

Show Definition

Table: Whelton 2017 High Blood Pressure Clinical Practice Guideline

Blood Pressure Classification SBP (mmHg) DBP (mmHg)
Normal < 120 AND < 80
Elevated BP 120 - 129 ≥ 80
Stage 1 HTN 130 - 139 80 - 89
Stage 2 HTN ≥ 140 OR ≥ 90

Source: Whelton P. K., et al. (2017). High Blood Pressure Clinical Practice Guideline. A guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, DOI: 2017; HYP.0000000000000065.


Likely not important for the NAC OSCE Exam:

(If you're a keener click here)


Majority (90%) have no identifiable cause, and thus are considered primary or essential HTN.

The remaining 10% of cases have secondary cases:

  1. Renal Causes:
    1. Glomerulonephritis.
    2. Pyelonephritis.
    3. Polycystic Kidney Disease.
  1. Endocrine Causes:
    1. Primary hyperaldosteronism.
    2. Pheochromocytoma.
    3. Hyperthyroidism.
    4. Cushing's Syndrome.
  1. Vascular Causes:
    1. Coarctation of the aorta.
    2. Renal artery stenosis.
  1. Chemical/medication induced:
    1. Oral contraceptives.
    2. Nonsteroidal anti-inflammatory drugs (NSAIDs).
    3. Decongestants.
    4. Antidepressants.
    5. Sympathomimetics.
    6. Corticosteroids.
    7. Lithium.
    8. Ergotamine alkaloids.
    9. Cyclosporine.
    10. Monoamine oxidase inhibitors (MAOIs), in combination with certain drugs or foods.
    11. Appetite suppressants, in combination with certain drugs or foods.
    12. Cocaine.
    13. Amphetamines.
  1. Obstructive Sleep Apnea (OSA).

Predisposing Factors

Common findings

Majority of HTN is asymptomatic.

Other signs and symptoms

Potential Complications


  1. Family history of HTN/cardiac/renal disease.
  2. PMH HTN/cardiac/renal diseases.
  3. Home/Clinic BP readings.
  4. Risk factors:
    1. Smoking.
    2. Alcohol intake.
    3. High fat intake.
    4. Obesity
    5. Diabetes
  5. Social factors:
    1. Lifestyle.
    2. Exercise regimen.
    3. Work environment. (Note: I wonder how does it relate?)
    4. Stress level.
  6. Does the patient have sx related to causes you don't want to miss?
    1. Palpitations, headache, diaphoresis (pheochromocytoma).
    2. Anxiety, weight gains, or loss (thyroid abnormality).
    3. Muscle weakness, polyuria (primary hyperaldosteronism).
  7. Rx hx: including OTC and herbal products.
  8. Are you nervous? (i.e. "white coat HTN").
  9. Recreational/illicit drug use.

Physical Examination

Will post later.

Note however:Diagnosis is made after the average of ≥ 2 readings in ≥ 2 visits at (From my understanding, though it is not in the book) at least 2 weeks apart.

Also note:(for later) Systolic blood pressure readings in the left and right arms should be roughly equivalent. A discrepancy of more than 15 mmHg may indicate subclavian stenosis and, hence, peripheral arterial disease.

Diagnostic Tests

Things you will probably order at initial visit:

  1. Hemoglobin/Hematocrit.
  2. Chemistry profile.
    1. Monitor K⁺ if using ACE/ARBs or spironolactone.
  3. Liver function tests (LFTs; lactate dehydrogenase [LDH], uric acid).
  4. Lipid profile (total and HDL cholesterol and TGLs)
  5. Urinalysis for proteinuria
  6. eGFR
  7. ECG
  1. If Hx/PE/Laboratory tests indicate the need, patient may get:
    1. Intravenous pyelography (IVP).
    2. Renal arteriogram.
    3. Plasma renin.
    4. Catecholamines.
    5. Chest radiography.
    6. Aortogram.
    7. Ultrasonography.
    8. Sleep study.

Differential Diagnoses

  1. Primary/Secondary HTN.
  2. Drug-induced HTN.
  3. "White coat" syndrome.



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