17:I[462708,["/_next/static/chunks/3yo3kiro3bmlp.js","/_next/static/chunks/3vr2wvd8f2efb.js","/_next/static/chunks/2vtmb68_vu-9t.js","/_next/static/chunks/2s8mt6_8wrpfo.js","/_next/static/chunks/3vkulz2i3l61y.js","/_next/static/chunks/1cqw2i1silz0i.js","/_next/static/chunks/14dbm3lm_t629.js","/_next/static/chunks/335_v2mb569ld.js","/_next/static/chunks/3ykn5ops9bft5.js","/_next/static/chunks/3cmavum774kjt.js","/_next/static/chunks/3th-0-a2xf9qs.js","/_next/static/chunks/0p0xpwde6kzmv.js","/_next/static/chunks/401-sxxnzbtf_.js","/_next/static/chunks/0wywtv698a1v0.js","/_next/static/chunks/2botzqwpnrzyj.js"],"ArticleReader"] 18:T63eb,## Summary Primary hypertension is sustained elevation of arterial pressure without a single dominant reversible cause. It is usually asymptomatic, but cumulative blood-pressure exposure drives stroke, coronary disease, heart failure, atrial fibrillation, chronic kidney disease, cognitive decline, retinopathy, aortic disease, and peripheral vascular disease. Accurate measurement is part of diagnosis: use a validated upper-arm device, standardized technique, repeated readings, and out-of-office monitoring whenever feasible.[1-3] **Diagnostic thresholds differ by jurisdiction.** The **2025 AHA/ACC multisociety guideline** retains normal <120/<80 mm Hg, elevated 120–129/<80, stage 1 hypertension 130–139 or 80–89, and stage 2 hypertension ≥140 or ≥90. Its overarching treatment goal is **<130/80 mm Hg** for most adults.[1] The **2024 ESC guideline** defines hypertension as office BP ≥140/90 mm Hg, defines 120–139/70–89 mm Hg as elevated BP, and recommends a treated systolic target of **120–129 mm Hg** for most adults when tolerated.[2] **NICE NG136**, updated February 26, 2026, confirms hypertension when clinic BP is ≥140/90 mm Hg and daytime ambulatory or home average is ≥135/85 mm Hg; its usual clinic target is <140/90 below age 80 and <150/90 from age 80, with separate CKD targets and individualization for frailty or postural symptoms.[3] Under the 2025 U.S. framework, start medication plus lifestyle therapy for average BP **≥140/90 mm Hg** and for BP **130–139/80–89 mm Hg** when clinical cardiovascular disease, prior stroke, diabetes, CKD, or **10-year PREVENT total cardiovascular risk ≥7.5%** is present.[1,4] Lower-risk adults with persistent stage 1 hypertension receive structured lifestyle treatment first; medication is recommended if BP remains ≥130/80 after **3–6 months**.[1] First-line drug classes are an ACE inhibitor or ARB, a long-acting dihydropyridine calcium-channel blocker, and a thiazide/thiazide-like diuretic.[1,2] Do not combine an ACE inhibitor with an ARB. Stage 2 hypertension is generally treated initially with **two first-line agents from different classes**, preferably in a single-pill combination when appropriate.[1] Resistant hypertension is a diagnosis of exclusion: confirm standardized and out-of-office BP, adherence, drug doses, diuretic adequacy, and removal of pressor substances; then evaluate secondary causes. Spironolactone **25–50 mg once daily** is the preferred fourth-line drug for many patients when kidney function and potassium permit.[2,7] The 2025 U.S. guideline states that **renal denervation may be reasonable** as an adjunct in carefully selected patients with resistant hypertension, office SBP 140–180 mm Hg and DBP ≥90 mm Hg, and eGFR ≥40 mL/min/1.73 m² despite optimal treatment or when additional medication causes intolerable adverse effects; multidisciplinary review and shared decision-making are required.[1] > **Caution:** BP >180/120 mm Hg is not automatically a hypertensive emergency. Emergency IV treatment is determined by **acute target-organ injury**, not the BP value alone.[1] ## Blood-pressure classification and jurisdiction differences | Framework | Classification | Confirmation | Usual treated target | |---|---|---|---| | 2025 AHA/ACC, United States | Normal <120/<80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90 mm Hg | Average standardized readings; home/ambulatory monitoring integrated into care | <130/80 mm Hg for most adults[1] | | 2024 ESC, Europe | Elevated BP 120–139 or 70–89; hypertension ≥140/90 mm Hg | Out-of-office confirmation recommended when feasible | SBP 120–129 mm Hg for most treated adults if tolerated; DBP generally 70–79 mm Hg[2] | | NICE NG136, United Kingdom | Stage 1 clinic 140/90–159/99 with ABPM/HBPM 135/85–149/94; stage 2 clinic ≥160/100 but <180/120 with ABPM/HBPM ≥150/95 | ABPM preferred; HBPM if ABPM unsuitable | Clinic <140/90 if <80 y; <150/90 if ≥80 y, with condition-specific CKD targets[3] | These cutoffs are management frameworks rather than biologic boundaries. Cardiovascular risk increases continuously with pressure and with duration of exposure. ## Pathophysiology Long-term arterial pressure is determined by renal sodium handling, effective circulating volume, sympathetic tone, the renin-angiotensin-aldosterone system, vascular resistance, endothelial function, and arterial stiffness. Primary hypertension is usually polygenic and multifactorial. Important mechanisms include: - a rightward shift in pressure natriuresis; - enhanced renal sodium retention; - sympathetic activation, especially with obesity and sleep apnea; - renin-angiotensin-aldosterone signaling; - endothelial dysfunction and increased vascular tone; - large-artery stiffening with aging; - obesity-related renal compression, insulin resistance, and neurohormonal activation. The phenotype changes over time: younger adults may have greater sympathetic and diastolic-pressure components, while older adults often develop isolated systolic hypertension from arterial stiffness. ## Risk factors and contributors Common contributors include: - increasing age; - family history and polygenic susceptibility; - overweight and visceral adiposity; - high sodium intake; - low dietary potassium intake; - low physical activity; - excess alcohol; - obstructive sleep apnea; - diabetes and chronic kidney disease; - chronic sleep deprivation; - medications or substances that increase BP. Social conditions—food access, medication cost, shift work, housing instability, transportation, and longitudinal-care access—often determine whether a treatment plan is sustainable. ## Clinical presentation Most chronic hypertension is silent. Headache, dizziness, fatigue, tinnitus, and epistaxis are nonspecific and should not be used to diagnose or grade hypertension. Symptoms matter when they suggest acute organ injury or a secondary cause: - focal neurologic deficit, confusion, seizure, acute visual change; - chest pain or acute dyspnea; - abrupt severe chest/back pain or pulse asymmetry; - oliguria or rapidly worsening kidney function; - episodic palpitations, diaphoresis, and headache suggesting catecholamine excess; - weakness or cramps with hypokalemia suggesting mineralocorticoid excess. ## Accurate BP measurement ### Standardized office technique - Use a validated upper-arm device and cuff matched to arm circumference. - Seat the patient with back supported, feet flat, legs uncrossed, and arm supported at heart level. - Allow quiet rest before measurement. - Avoid conversation during measurement. - When feasible, avoid exercise, nicotine, and caffeine for about 30 minutes beforehand. - Obtain repeated readings and average according to the relevant protocol. - Measure both arms at the initial assessment; if a reproducible difference persists, use the higher-pressure arm for subsequent management.[3] Cuffless consumer devices should not be used for diagnosis or titration unless their accuracy has been validated for that purpose.[1] ### Home BP monitoring A practical NICE protocol is:[3] 1. two seated readings at least 1 minute apart; 2. morning and evening; 3. for at least 4 days, ideally 7; 4. discard day 1 and average the remaining values. Review device validation and technique when home readings are implausible or discordant with clinical findings. ### Ambulatory BP monitoring ABPM is particularly useful for: - white-coat hypertension; - masked hypertension; - nocturnal hypertension; - large office/home discordance; - suspected treatment-related hypotension; - resistant hypertension. NICE confirms hypertension with clinic BP ≥140/90 mm Hg plus daytime ABPM or HBPM average ≥135/85 mm Hg.[3] ## White-coat and masked hypertension **White-coat hypertension:** elevated office BP with normal out-of-office BP. Avoid unnecessary drug escalation, but continue cardiovascular-risk management and periodic reassessment. **Masked hypertension:** normal office BP with elevated home or ambulatory BP. This phenotype carries clinically important cardiovascular risk and should be treated according to the true out-of-office burden and applicable guideline.[1,2] **White-coat effect during treatment** can produce overtreatment if medication is adjusted only to office values. ## Initial diagnostic work-up ### History Assess: - prior BP values and trajectory; - cardiovascular, cerebrovascular, kidney, and peripheral vascular disease; - diabetes, obesity, sleep apnea, gout; - pregnancy potential; - prescribed drugs that raise BP, including NSAIDs, glucocorticoids, stimulants, SNRIs, calcineurin inhibitors, erythropoiesis-stimulating agents, estrogen-containing therapy, and decongestants; - cocaine, amphetamine, excess caffeine, alcohol, and licorice exposure; - sodium intake, activity, sleep, and adherence; - family history of early stroke, severe hypertension, kidney disease, or endocrine tumors. ### Physical assessment Document: - pulse and rhythm; - orthostatic BP when symptoms, older age, diabetes, autonomic disease, or falls are relevant; - body habitus and volume status; - signs of heart failure or vascular disease; - features suggesting endocrine or kidney disease; - retinal status when severe hypertension or visual symptoms are present. ### Baseline laboratory and cardiac testing A practical baseline set includes: - sodium, potassium, creatinine/eGFR; - fasting glucose or HbA1c; - lipid profile; - urinalysis and urine albumin:creatinine ratio; - 12-lead ECG; - CBC and TSH when clinically indicated.[1,2] These tests define cardiovascular risk, target-organ damage, clues to secondary hypertension, and safety baselines for RAAS blockers and diuretics. ## When to suspect secondary hypertension Investigate more aggressively with: - onset before age 40, especially without obesity or family history; - abrupt onset or sudden worsening of previously stable pressure; - resistant hypertension; - spontaneous or diuretic-associated hypokalemia; - unexplained kidney dysfunction or asymmetric kidneys; - recurrent flash pulmonary edema; - adrenal incidentaloma; - episodic adrenergic symptoms; - Cushingoid features or thyroid disease; - coarctation findings; - severe obstructive sleep apnea.[2] The 2024 ESC guideline recommends screening for secondary causes in adults diagnosed before age 40; in younger adults with obesity, sleep-apnea assessment should be prioritized.[2] ### Primary aldosteronism The 2025 Endocrine Society guideline suggests screening **all people with hypertension** using aldosterone and renin where implementation is feasible, reflecting the condition's prevalence and excess cardiovascular risk.[6] At minimum, testing is particularly important in resistant hypertension, hypokalemia, adrenal incidentaloma, or early/severe disease. Interpret aldosterone and renin in the context of assay method, potassium, sodium intake, and interfering medications. Suppressed renin with inappropriately elevated aldosterone requires endocrine evaluation.[6] See [Primary Aldosteronism](../endocrinology/primary-aldosteronism.md). ## Cardiovascular-risk assessment BP treatment should be integrated with smoking cessation, lipid management, diabetes care, kidney protection, weight management, and physical activity. The 2025 U.S. guideline uses the **PREVENT** equations for 10-year total cardiovascular risk. For stage 1 hypertension, **PREVENT risk ≥7.5%** is a medication threshold when another high-risk condition does not already establish treatment eligibility.[1,4] Clinical cardiovascular disease, prior stroke, diabetes, or CKD also lowers the threshold for drug therapy under the U.S. framework.[1] ## Lifestyle treatment Lifestyle therapy is recommended at every BP category.[1,2] ### Sodium The 2025 U.S. guideline recommends limiting sodium to **<2,300 mg/day**, with movement toward approximately **1,500 mg/day** when feasible and appropriate.[1] ### Dietary pattern Use a DASH-style eating pattern emphasizing vegetables, fruits, whole grains, legumes, nuts, seeds, and appropriate low-fat dairy while minimizing highly processed foods and excess sodium.[1] ### Weight For adults with overweight or obesity, clinically meaningful weight reduction lowers BP. A goal of at least **5% body-weight reduction** is often appropriate when feasible.[1] ### Physical activity Aim for **75–150 minutes/week** of aerobic activity and/or resistance training tailored to functional capacity and comorbidity.[1] ### Alcohol Avoid alcohol when possible. If consumed, the 2025 U.S. guideline advises no more than **2 drinks/day for men and 1 drink/day for women**.[1] ### Potassium Dietary potassium can reduce BP, but indiscriminate supplementation is unsafe in advanced CKD or in patients prone to hyperkalemia, especially with RAAS blockade or MRAs. ## When to start medication ### 2025 U.S. framework Start antihypertensive medication plus lifestyle treatment for:[1,4] - average BP **≥140/90 mm Hg** regardless of calculated risk; - average **130–139/80–89 mm Hg** with clinical cardiovascular disease, prior stroke, diabetes, CKD, or PREVENT 10-year total CVD risk **≥7.5%**; - lower-risk stage 1 hypertension that remains **≥130/80 mm Hg after 3–6 months** of structured lifestyle therapy. For stage 2 hypertension, begin **two first-line drugs from different classes**, preferably as a single-pill combination when appropriate.[1] ### 2024 ESC framework Hypertension ≥140/90 mm Hg generally warrants medication plus lifestyle therapy. Selected high-risk adults with persistent elevated BP below the diagnostic hypertension threshold may also receive medication after lifestyle treatment. The ESC framework places substantial emphasis on total cardiovascular risk.[2] ### NICE framework Drug treatment depends on stage, age, target-organ damage, cardiovascular risk, diabetes/CKD, and patient preference. Confirm diagnosis with ABPM or HBPM unless severe hypertension or urgent circumstances require a different pathway.[3] ## First-line drug treatment | Class | Typical adult starting dose | Strengths | Major cautions and monitoring | |---|---:|---|---| | Dihydropyridine CCB | Amlodipine **5 mg once daily**; 2.5 mg in selected older/frail/hepatic-impaired patients; maximum 10 mg/day | Potent, once daily, no routine electrolyte monitoring | Edema, flushing, headache, gingival overgrowth | | ACE inhibitor | Lisinopril **10 mg once daily**; usual 20–40 mg/day; lower start when volume depleted or already on diuretic | Useful with albuminuric CKD and selected cardiovascular disease | Creatinine, potassium, cough, angioedema; contraindicated in pregnancy | | ARB | Losartan **50 mg once daily**; 25 mg if intravascularly depleted; maximum 100 mg/day | RAAS benefit with less cough than ACE inhibitor | Creatinine, potassium; contraindicated in pregnancy | | Thiazide/thiazide-like diuretic | Agent-specific | Strong outcome evidence; useful in salt-sensitive/volume-mediated disease | Sodium, potassium, creatinine, uric acid; gout, hyponatremia | Do not combine an ACE inhibitor with an ARB because renal and potassium harms outweigh benefit.[1,2] ### Combination strategy Common combinations are: - ACE inhibitor or ARB + dihydropyridine CCB; - ACE inhibitor or ARB + thiazide/thiazide-like diuretic; - RAAS blocker + CCB + thiazide/thiazide-like diuretic when three agents are needed. Single-pill combinations reduce pill burden and are preferred when appropriate.[1,2] Beta-blockers are important when there is another indication—ischemic heart disease, selected arrhythmias, HFrEF, or another compelling condition—but are not universal first-line treatment for uncomplicated primary hypertension.[1,2] ## Monitoring after treatment changes ### ACE inhibitor or ARB Check creatinine/eGFR and potassium before therapy and after initiation or meaningful dose increase, often within **1–2 weeks** in patients at usual risk and sooner when kidney function, volume status, or hyperkalemia risk is unstable. A modest creatinine rise may reflect the expected hemodynamic effect. A large rise should prompt evaluation for volume depletion, NSAID use, renal artery disease, or another cause. ### Diuretic Recheck sodium, potassium, and kidney function after initiation or dose escalation. Earlier testing is appropriate in older adults, CKD, low baseline sodium/potassium, or interacting treatment. ### CCB Monitor BP, edema, orthostatic symptoms, and adherence. Routine laboratory surveillance is not required solely for amlodipine. ### Follow-up interval After initiation or intensification, reassess within weeks rather than months until BP control and tolerability are established. Home readings improve titration accuracy.[1] ## Treatment targets ### United States The 2025 AHA/ACC target is **<130/80 mm Hg** for most adults, with individualization when treatment burden, orthostatic symptoms, pregnancy, institutional care, limited life expectancy, or major frailty alter the balance.[1] ### Europe The 2024 ESC target for most adults receiving medication is systolic **120–129 mm Hg** when tolerated, with diastolic BP generally **70–79 mm Hg**. If the target is not tolerated—particularly with symptomatic orthostasis, age >85 years, moderate/severe frailty, or limited life expectancy—lower BP as far as reasonably achievable without unacceptable harm.[2] ### United Kingdom NICE generally targets clinic BP:[3] - **<140/90 mm Hg** under age 80; - **<150/90 mm Hg** from age 80; - corresponding home/ambulatory targets **<135/85** under age 80 and **<145/85** from age 80. CKD with albumin:creatinine ratio ≥70 mg/mmol has a separate clinic target **<130/80 mm Hg**.[3] ## Resistant hypertension ### Definition and confirmation Suspect resistant hypertension when BP remains above goal despite three complementary agents at maximally tolerated doses, typically including an effective diuretic, or when at least four agents are required for control.[1,2] Before labeling true resistance: 1. repeat standardized measurements; 2. confirm elevated out-of-office BP; 3. assess adherence directly and nonjudgmentally; 4. remove or reduce pressor drugs/substances when feasible; 5. ensure adequate dose and diuretic selection; 6. screen for secondary causes, particularly primary aldosteronism and sleep apnea. ### Fourth-line therapy For many patients with true resistant hypertension and acceptable kidney function/potassium, **spironolactone 25 mg once daily**, titrated to **50 mg once daily** as tolerated, is preferred. PATHWAY-2 showed superior home systolic BP reduction with spironolactone 25–50 mg compared with bisoprolol or doxazosin.[7] Monitor potassium and creatinine closely. Hyperkalemia risk rises with CKD, diabetes, ACE inhibitor/ARB therapy, and higher baseline potassium. Eplerenone is an alternative when spironolactone causes antiandrogenic adverse effects.[2] ### Renal denervation The 2025 U.S. guideline gives renal denervation a limited adjunctive role. It **may be reasonable** in carefully selected patients with:[1] - systolic and diastolic hypertension; - office SBP **140–180 mm Hg** and DBP **≥90 mm Hg**; - **eGFR ≥40 mL/min/1.73 m²**; - resistant hypertension despite optimal therapy, or intolerable adverse effects from additional medication. Candidates should be reviewed by a multidisciplinary team with expertise in resistant hypertension and the procedure. Discuss the expected modest BP reduction, procedural risks, and the continuing need for lifestyle and usually medication therapy.[1] > **Current practice:** Renal denervation is not a substitute for confirming true resistance, optimizing adherence, correcting secondary causes, or using an adequate diuretic/MRA strategy.[1] ## Severe hypertension and acute target-organ injury ### Severe hypertension without acute organ injury The 2025 U.S. guideline defines severe hypertension in nonpregnant adults as **>180/120 mm Hg** without acute target-organ injury and recommends timely outpatient initiation, reinstitution, or intensification of oral therapy rather than reflexive IV lowering.[1] ### Hypertensive emergency Treat in a monitored hospital setting when severe pressure is accompanied by acute organ injury. BP target and IV drug choice depend on the syndrome. Time-critical contexts include: - acute aortic syndrome; - hypertensive encephalopathy; - acute pulmonary edema; - acute coronary syndrome; - selected acute ischemic stroke or intracerebral hemorrhage scenarios; - acute kidney injury; - severe pregnancy-associated hypertension. See [Hypertensive Emergencies](../emergency-medicine/hypertensive-emergencies.md), [Acute Aortic Syndrome](acute-aortic-syndrome.md), [Acute Ischemic Stroke](../neurology/acute-ischemic-stroke.md), and [Spontaneous Intracerebral Hemorrhage](../neurology/spontaneous-intracerebral-hemorrhage.md). ## Special populations ### Chronic kidney disease Albuminuria favors ACE inhibitor or ARB therapy when tolerated. Kidney function, potassium, and volume status determine safe dosing and monitoring. See [Chronic Kidney Disease](../nephrology/chronic-kidney-disease.md). ### Diabetes Treat BP alongside glycemic, lipid, kidney, and cardiovascular risk. Diabetes is a high-risk condition that lowers the medication threshold in the 2025 U.S. framework.[1] ### Older adults and frailty Older adults frequently benefit from BP lowering but are more susceptible to orthostasis, falls, electrolyte abnormalities, and kidney injury. Measure standing BP when relevant and individualize intensity. ESC allows a less aggressive approach with age >85 years, moderate/severe frailty, symptomatic orthostasis, or limited life expectancy.[2] ### Pregnancy potential ACE inhibitors and ARBs are contraindicated during pregnancy. Review pregnancy plans before prescribing these agents and change to pregnancy-compatible therapy when pregnancy is planned or confirmed. See [Preeclampsia and Eclampsia](../obstetrics-gynecology/preeclampsia-and-eclampsia.md). ## Longitudinal follow-up Once controlled: - continue periodic office and home BP review; - reassess adherence and adverse effects; - monitor orthostatic symptoms; - repeat electrolytes and kidney function according to regimen and comorbidity; - reassess cardiovascular risk, lipids, diabetes, smoking, and kidney disease; - review whether fixed-dose combinations can simplify treatment; - re-evaluate secondary causes when previously stable control is lost. Loss of control after a stable interval should prompt review for medication nonadherence, new pressor drugs/substances, weight gain, sodium/alcohol increase, sleep apnea, kidney disease progression, pain, and secondary hypertension before simply adding another agent. ## Related library topics - [Primary Aldosteronism](../endocrinology/primary-aldosteronism.md) - [Chronic Kidney Disease](../nephrology/chronic-kidney-disease.md) - [Type 2 Diabetes Mellitus](../endocrinology/type-2-diabetes-mellitus.md) - [Obstructive Sleep Apnea in Adults](../sleep-medicine/obstructive-sleep-apnea-in-adults.md) - [Dyslipidemia in Adults](dyslipidemia-in-adults.md) - [Chronic Coronary Disease in Adults](chronic-coronary-disease-in-adults.md) - [Hypertensive Emergencies](../emergency-medicine/hypertensive-emergencies.md) ## References 1. Jones DW, Ferdinand KC, Taler SJ, et al. **2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.** *J Am Coll Cardiol.* 2025;86(18):1567-1678. doi:10.1016/j.jacc.2025.05.007. Hypertension version doi:10.1161/HYP.0000000000000249. https://doi.org/10.1016/j.jacc.2025.05.007 2. McEvoy JW, McCarthy CP, Bruno RM, et al.; ESC Scientific Document Group. **2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension.** *Eur Heart J.* 2024;45(38):3912-4018. doi:10.1093/eurheartj/ehae178. PMID:39210715. https://doi.org/10.1093/eurheartj/ehae178 3. National Institute for Health and Care Excellence. **Hypertension in adults: diagnosis and management (NG136).** Published 2019; updated February 26, 2026. Accessed September 24, 2026. https://www.nice.org.uk/guidance/ng136 4. Khan SS, Lloyd-Jones DM, et al. **Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology.** *J Am Coll Cardiol.* 2025. doi:10.1016/j.jacc.2025.08.001. https://doi.org/10.1016/j.jacc.2025.08.001 5. Gulati M, Moore MM, Cibotti-Sun M. **2025 High Blood Pressure Guideline-at-a-Glance.** *J Am Coll Cardiol.* 2025;86(18):1560-1566. doi:10.1016/j.jacc.2025.07.010. PMID:40817900. https://doi.org/10.1016/j.jacc.2025.07.010 6. Adler GK, Stowasser M, Correa RR, et al. **Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline.** *J Clin Endocrinol Metab.* 2025;110(9):2453-2495. doi:10.1210/clinem/dgaf284. PMID:40658480. https://www.endocrine.org/clinical-practice-guidelines/primary-aldosteronism-2 7. Williams B, MacDonald TM, Morant S, et al. **Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2).** *Lancet.* 2015;386(10008):2059-2068. doi:10.1016/S0140-6736(15)00257-3. PMID:26414968. https://pubmed.ncbi.nlm.nih.gov/26414968/19:T6471,## Summary Primary hypertension is sustained elevation of arterial pressure without a single dominant reversible cause. It is usually asymptomatic, but cumulative blood-pressure exposure drives stroke, coronary disease, heart failure, [atrial fibrillation](/library/atrial-fibrillation), chronic kidney disease, cognitive decline, retinopathy, aortic disease, and peripheral vascular disease. Accurate measurement is part of diagnosis: use a validated upper-arm device, standardized technique, repeated readings, and out-of-office monitoring whenever feasible.[1-3] **Diagnostic thresholds differ by jurisdiction.** The **2025 AHA/ACC multisociety guideline** retains normal <120/<80 mm Hg, elevated 120–129/<80, stage 1 hypertension 130–139 or 80–89, and stage 2 hypertension ≥140 or ≥90. Its overarching treatment goal is **<130/80 mm Hg** for most adults.[1] The **2024 ESC guideline** defines hypertension as office BP ≥140/90 mm Hg, defines 120–139/70–89 mm Hg as elevated BP, and recommends a treated systolic target of **120–129 mm Hg** for most adults when tolerated.[2] **NICE NG136**, updated February 26, 2026, confirms hypertension when clinic BP is ≥140/90 mm Hg and daytime ambulatory or home average is ≥135/85 mm Hg; its usual clinic target is <140/90 below age 80 and <150/90 from age 80, with separate CKD targets and individualization for frailty or postural symptoms.[3] Under the 2025 U.S. framework, start medication plus lifestyle therapy for average BP **≥140/90 mm Hg** and for BP **130–139/80–89 mm Hg** when clinical cardiovascular disease, prior stroke, diabetes, CKD, or **10-year PREVENT total cardiovascular risk ≥7.5%** is present.[1,4] Lower-risk adults with persistent stage 1 hypertension receive structured lifestyle treatment first; medication is recommended if BP remains ≥130/80 after **3–6 months**.[1] First-line drug classes are an ACE inhibitor or ARB, a long-acting dihydropyridine calcium-channel blocker, and a thiazide/thiazide-like diuretic.[1,2] Do not combine an ACE inhibitor with an ARB. Stage 2 hypertension is generally treated initially with **two first-line agents from different classes**, preferably in a single-pill combination when appropriate.[1] Resistant hypertension is a diagnosis of exclusion: confirm standardized and out-of-office BP, adherence, drug doses, diuretic adequacy, and removal of pressor substances; then evaluate secondary causes. Spironolactone **25–50 mg once daily** is the preferred fourth-line drug for many patients when kidney function and potassium permit.[2,7] The 2025 U.S. guideline states that **renal denervation may be reasonable** as an adjunct in carefully selected patients with resistant hypertension, office SBP 140–180 mm Hg and DBP ≥90 mm Hg, and eGFR ≥40 mL/min/1.73 m² despite optimal treatment or when additional medication causes intolerable adverse effects; multidisciplinary review and shared decision-making are required.[1] > **Caution:** BP >180/120 mm Hg is not automatically a hypertensive emergency. Emergency IV treatment is determined by **acute target-organ injury**, not the BP value alone.[1] ## Blood-pressure classification and jurisdiction differences | Framework | Classification | Confirmation | Usual treated target | |---|---|---|---| | 2025 AHA/ACC, United States | Normal <120/<80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90 mm Hg | Average standardized readings; home/ambulatory monitoring integrated into care | <130/80 mm Hg for most adults[1] | | 2024 ESC, Europe | Elevated BP 120–139 or 70–89; hypertension ≥140/90 mm Hg | Out-of-office confirmation recommended when feasible | SBP 120–129 mm Hg for most treated adults if tolerated; DBP generally 70–79 mm Hg[2] | | NICE NG136, United Kingdom | Stage 1 clinic 140/90–159/99 with ABPM/HBPM 135/85–149/94; stage 2 clinic ≥160/100 but <180/120 with ABPM/HBPM ≥150/95 | ABPM preferred; HBPM if ABPM unsuitable | Clinic <140/90 if <80 y; <150/90 if ≥80 y, with condition-specific CKD targets[3] | These cutoffs are management frameworks rather than biologic boundaries. Cardiovascular risk increases continuously with pressure and with duration of exposure. ## Pathophysiology Long-term arterial pressure is determined by renal sodium handling, effective circulating volume, sympathetic tone, the renin-angiotensin-aldosterone system, vascular resistance, endothelial function, and arterial stiffness. Primary hypertension is usually polygenic and multifactorial. Important mechanisms include: - a rightward shift in pressure natriuresis; - enhanced renal sodium retention; - sympathetic activation, especially with obesity and sleep apnea; - renin-angiotensin-aldosterone signaling; - endothelial dysfunction and increased vascular tone; - large-artery stiffening with aging; - obesity-related renal compression, insulin resistance, and neurohormonal activation. The phenotype changes over time: younger adults may have greater sympathetic and diastolic-pressure components, while older adults often develop isolated systolic hypertension from arterial stiffness. ## Risk factors and contributors Common contributors include: - increasing age; - family history and polygenic susceptibility; - overweight and visceral adiposity; - high sodium intake; - low dietary potassium intake; - low physical activity; - excess alcohol; - obstructive sleep apnea; - diabetes and chronic kidney disease; - chronic sleep deprivation; - medications or substances that increase BP. Social conditions—food access, medication cost, shift work, housing instability, transportation, and longitudinal-care access—often determine whether a treatment plan is sustainable. ## Clinical presentation Most chronic hypertension is silent. Headache, dizziness, fatigue, tinnitus, and epistaxis are nonspecific and should not be used to diagnose or grade hypertension. Symptoms matter when they suggest acute organ injury or a secondary cause: - focal neurologic deficit, confusion, seizure, acute visual change; - chest pain or acute dyspnea; - abrupt severe chest/back pain or pulse asymmetry; - oliguria or rapidly worsening kidney function; - episodic palpitations, diaphoresis, and headache suggesting catecholamine excess; - weakness or cramps with hypokalemia suggesting mineralocorticoid excess. ## Accurate BP measurement ### Standardized office technique - Use a validated upper-arm device and cuff matched to arm circumference. - Seat the patient with back supported, feet flat, legs uncrossed, and arm supported at heart level. - Allow quiet rest before measurement. - Avoid conversation during measurement. - When feasible, avoid exercise, nicotine, and caffeine for about 30 minutes beforehand. - Obtain repeated readings and average according to the relevant protocol. - Measure both arms at the initial assessment; if a reproducible difference persists, use the higher-pressure arm for subsequent management.[3] Cuffless consumer devices should not be used for diagnosis or titration unless their accuracy has been validated for that purpose.[1] ### Home BP monitoring A practical NICE protocol is:[3] 1. two seated readings at least 1 minute apart; 2. morning and evening; 3. for at least 4 days, ideally 7; 4. discard day 1 and average the remaining values. Review device validation and technique when home readings are implausible or discordant with clinical findings. ### Ambulatory BP monitoring ABPM is particularly useful for: - white-coat hypertension; - masked hypertension; - nocturnal hypertension; - large office/home discordance; - suspected treatment-related hypotension; - resistant hypertension. NICE confirms hypertension with clinic BP ≥140/90 mm Hg plus daytime ABPM or HBPM average ≥135/85 mm Hg.[3] ## White-coat and masked hypertension **White-coat hypertension:** elevated office BP with normal out-of-office BP. Avoid unnecessary drug escalation, but continue cardiovascular-risk management and periodic reassessment. **Masked hypertension:** normal office BP with elevated home or ambulatory BP. This phenotype carries clinically important cardiovascular risk and should be treated according to the true out-of-office burden and applicable guideline.[1,2] **White-coat effect during treatment** can produce overtreatment if medication is adjusted only to office values. ## Initial diagnostic work-up ### History Assess: - prior BP values and trajectory; - cardiovascular, cerebrovascular, kidney, and peripheral vascular disease; - diabetes, obesity, sleep apnea, gout; - pregnancy potential; - prescribed drugs that raise BP, including NSAIDs, glucocorticoids, stimulants, SNRIs, calcineurin inhibitors, erythropoiesis-stimulating agents, estrogen-containing therapy, and decongestants; - cocaine, amphetamine, excess caffeine, alcohol, and licorice exposure; - sodium intake, activity, sleep, and adherence; - family history of early stroke, severe hypertension, kidney disease, or endocrine tumors. ### Physical assessment Document: - pulse and rhythm; - orthostatic BP when symptoms, older age, diabetes, autonomic disease, or falls are relevant; - body habitus and volume status; - signs of heart failure or vascular disease; - features suggesting endocrine or kidney disease; - retinal status when severe hypertension or visual symptoms are present. ### Baseline laboratory and cardiac testing A practical baseline set includes: - sodium, potassium, creatinine/eGFR; - fasting glucose or HbA1c; - lipid profile; - urinalysis and urine albumin:creatinine ratio; - 12-lead ECG; - CBC and TSH when clinically indicated.[1,2] These tests define cardiovascular risk, target-organ damage, clues to secondary hypertension, and safety baselines for RAAS blockers and diuretics. ## When to suspect secondary hypertension Investigate more aggressively with: - onset before age 40, especially without obesity or family history; - abrupt onset or sudden worsening of previously stable pressure; - resistant hypertension; - spontaneous or diuretic-associated hypokalemia; - unexplained kidney dysfunction or asymmetric kidneys; - recurrent flash pulmonary edema; - adrenal incidentaloma; - episodic adrenergic symptoms; - Cushingoid features or thyroid disease; - coarctation findings; - severe obstructive sleep apnea.[2] The 2024 ESC guideline recommends screening for secondary causes in adults diagnosed before age 40; in younger adults with obesity, sleep-apnea assessment should be prioritized.[2] ### Primary aldosteronism The 2025 Endocrine Society guideline suggests screening **all people with hypertension** using aldosterone and renin where implementation is feasible, reflecting the condition's prevalence and excess cardiovascular risk.[6] At minimum, testing is particularly important in resistant hypertension, hypokalemia, adrenal incidentaloma, or early/severe disease. Interpret aldosterone and renin in the context of assay method, potassium, sodium intake, and interfering medications. Suppressed renin with inappropriately elevated aldosterone requires endocrine evaluation.[6] See [Primary Aldosteronism](../endocrinology/primary-aldosteronism.md). ## Cardiovascular-risk assessment BP treatment should be integrated with smoking cessation, lipid management, diabetes care, kidney protection, weight management, and physical activity. The 2025 U.S. guideline uses the **PREVENT** equations for 10-year total cardiovascular risk. For stage 1 hypertension, **PREVENT risk ≥7.5%** is a medication threshold when another high-risk condition does not already establish treatment eligibility.[1,4] Clinical cardiovascular disease, prior stroke, diabetes, or CKD also lowers the threshold for drug therapy under the U.S. framework.[1] ## Lifestyle treatment Lifestyle therapy is recommended at every BP category.[1,2] ### Sodium The 2025 U.S. guideline recommends limiting sodium to **<2,300 mg/day**, with movement toward approximately **1,500 mg/day** when feasible and appropriate.[1] ### Dietary pattern Use a DASH-style eating pattern emphasizing vegetables, fruits, whole grains, legumes, nuts, seeds, and appropriate low-fat dairy while minimizing highly processed foods and excess sodium.[1] ### Weight For adults with overweight or obesity, clinically meaningful weight reduction lowers BP. A goal of at least **5% body-weight reduction** is often appropriate when feasible.[1] ### Physical activity Aim for **75–150 minutes/week** of aerobic activity and/or resistance training tailored to functional capacity and comorbidity.[1] ### Alcohol Avoid alcohol when possible. If consumed, the 2025 U.S. guideline advises no more than **2 drinks/day for men and 1 drink/day for women**.[1] ### Potassium Dietary potassium can reduce BP, but indiscriminate supplementation is unsafe in advanced CKD or in patients prone to hyperkalemia, especially with RAAS blockade or MRAs. ## When to start medication ### 2025 U.S. framework Start antihypertensive medication plus lifestyle treatment for:[1,4] - average BP **≥140/90 mm Hg** regardless of calculated risk; - average **130–139/80–89 mm Hg** with clinical cardiovascular disease, prior stroke, diabetes, CKD, or PREVENT 10-year total CVD risk **≥7.5%**; - lower-risk stage 1 hypertension that remains **≥130/80 mm Hg after 3–6 months** of structured lifestyle therapy. For stage 2 hypertension, begin **two first-line drugs from different classes**, preferably as a single-pill combination when appropriate.[1] ### 2024 ESC framework Hypertension ≥140/90 mm Hg generally warrants medication plus lifestyle therapy. Selected high-risk adults with persistent elevated BP below the diagnostic hypertension threshold may also receive medication after lifestyle treatment. The ESC framework places substantial emphasis on total cardiovascular risk.[2] ### NICE framework Drug treatment depends on stage, age, target-organ damage, cardiovascular risk, diabetes/CKD, and patient preference. Confirm diagnosis with ABPM or HBPM unless severe hypertension or urgent circumstances require a different pathway.[3] ## First-line drug treatment | Class | Typical adult starting dose | Strengths | Major cautions and monitoring | |---|---:|---|---| | Dihydropyridine CCB | Amlodipine **5 mg once daily**; 2.5 mg in selected older/frail/hepatic-impaired patients; maximum 10 mg/day | Potent, once daily, no routine electrolyte monitoring | Edema, flushing, headache, gingival overgrowth | | ACE inhibitor | Lisinopril **10 mg once daily**; usual 20–40 mg/day; lower start when volume depleted or already on diuretic | Useful with albuminuric CKD and selected cardiovascular disease | Creatinine, potassium, cough, angioedema; contraindicated in pregnancy | | ARB | Losartan **50 mg once daily**; 25 mg if intravascularly depleted; maximum 100 mg/day | RAAS benefit with less cough than ACE inhibitor | Creatinine, potassium; contraindicated in pregnancy | | Thiazide/thiazide-like diuretic | Agent-specific | Strong outcome evidence; useful in salt-sensitive/volume-mediated disease | Sodium, potassium, creatinine, uric acid; gout, hyponatremia | Do not combine an ACE inhibitor with an ARB because renal and potassium harms outweigh benefit.[1,2] ### Combination strategy Common combinations are: - ACE inhibitor or ARB + dihydropyridine CCB; - ACE inhibitor or ARB + thiazide/thiazide-like diuretic; - RAAS blocker + CCB + thiazide/thiazide-like diuretic when three agents are needed. Single-pill combinations reduce pill burden and are preferred when appropriate.[1,2] Beta-blockers are important when there is another indication—ischemic heart disease, selected arrhythmias, HFrEF, or another compelling condition—but are not universal first-line treatment for uncomplicated primary hypertension.[1,2] ## Monitoring after treatment changes ### ACE inhibitor or ARB Check creatinine/eGFR and potassium before therapy and after initiation or meaningful dose increase, often within **1–2 weeks** in patients at usual risk and sooner when kidney function, volume status, or hyperkalemia risk is unstable. A modest creatinine rise may reflect the expected hemodynamic effect. A large rise should prompt evaluation for volume depletion, NSAID use, renal artery disease, or another cause. ### Diuretic Recheck sodium, potassium, and kidney function after initiation or dose escalation. Earlier testing is appropriate in older adults, CKD, low baseline sodium/potassium, or interacting treatment. ### CCB Monitor BP, edema, orthostatic symptoms, and adherence. Routine laboratory surveillance is not required solely for amlodipine. ### Follow-up interval After initiation or intensification, reassess within weeks rather than months until BP control and tolerability are established. Home readings improve titration accuracy.[1] ## Treatment targets ### United States The 2025 AHA/ACC target is **<130/80 mm Hg** for most adults, with individualization when treatment burden, orthostatic symptoms, pregnancy, institutional care, limited life expectancy, or major frailty alter the balance.[1] ### Europe The 2024 ESC target for most adults receiving medication is systolic **120–129 mm Hg** when tolerated, with diastolic BP generally **70–79 mm Hg**. If the target is not tolerated—particularly with symptomatic orthostasis, age >85 years, moderate/severe frailty, or limited life expectancy—lower BP as far as reasonably achievable without unacceptable harm.[2] ### United Kingdom NICE generally targets clinic BP:[3] - **<140/90 mm Hg** under age 80; - **<150/90 mm Hg** from age 80; - corresponding home/ambulatory targets **<135/85** under age 80 and **<145/85** from age 80. CKD with albumin:creatinine ratio ≥70 mg/mmol has a separate clinic target **<130/80 mm Hg**.[3] ## Resistant hypertension ### Definition and confirmation Suspect resistant hypertension when BP remains above goal despite three complementary agents at maximally tolerated doses, typically including an effective diuretic, or when at least four agents are required for control.[1,2] Before labeling true resistance: 1. repeat standardized measurements; 2. confirm elevated out-of-office BP; 3. assess adherence directly and nonjudgmentally; 4. remove or reduce pressor drugs/substances when feasible; 5. ensure adequate dose and diuretic selection; 6. screen for secondary causes, particularly primary aldosteronism and sleep apnea. ### Fourth-line therapy For many patients with true resistant hypertension and acceptable kidney function/potassium, **spironolactone 25 mg once daily**, titrated to **50 mg once daily** as tolerated, is preferred. PATHWAY-2 showed superior home systolic BP reduction with spironolactone 25–50 mg compared with bisoprolol or doxazosin.[7] Monitor potassium and creatinine closely. Hyperkalemia risk rises with CKD, diabetes, ACE inhibitor/ARB therapy, and higher baseline potassium. Eplerenone is an alternative when spironolactone causes antiandrogenic adverse effects.[2] ### Renal denervation The 2025 U.S. guideline gives renal denervation a limited adjunctive role. It **may be reasonable** in carefully selected patients with:[1] - systolic and diastolic hypertension; - office SBP **140–180 mm Hg** and DBP **≥90 mm Hg**; - **eGFR ≥40 mL/min/1.73 m²**; - resistant hypertension despite optimal therapy, or intolerable adverse effects from additional medication. Candidates should be reviewed by a multidisciplinary team with expertise in resistant hypertension and the procedure. Discuss the expected modest BP reduction, procedural risks, and the continuing need for lifestyle and usually medication therapy.[1] > **Current practice:** Renal denervation is not a substitute for confirming true resistance, optimizing adherence, correcting secondary causes, or using an adequate diuretic/MRA strategy.[1] ## Severe hypertension and acute target-organ injury ### Severe hypertension without acute organ injury The 2025 U.S. guideline defines severe hypertension in nonpregnant adults as **>180/120 mm Hg** without acute target-organ injury and recommends timely outpatient initiation, reinstitution, or intensification of oral therapy rather than reflexive IV lowering.[1] ### Hypertensive emergency Treat in a monitored hospital setting when severe pressure is accompanied by acute organ injury. BP target and IV drug choice depend on the syndrome. Time-critical contexts include: - acute aortic syndrome; - hypertensive encephalopathy; - acute pulmonary edema; - [acute coronary syndrome](/library/acute-coronary-syndrome); - selected [acute ischemic stroke](/library/acute-ischemic-stroke) or intracerebral hemorrhage scenarios; - [acute kidney injury](/library/acute-kidney-injury); - severe pregnancy-associated hypertension. See [Hypertensive Emergencies](../emergency-medicine/hypertensive-emergencies.md), [Acute Aortic Syndrome](acute-aortic-syndrome.md), [Acute Ischemic Stroke](../neurology/acute-ischemic-stroke.md), and [Spontaneous Intracerebral Hemorrhage](../neurology/spontaneous-intracerebral-hemorrhage.md). ## Special populations ### Chronic kidney disease Albuminuria favors ACE inhibitor or ARB therapy when tolerated. Kidney function, potassium, and volume status determine safe dosing and monitoring. See [Chronic Kidney Disease](../nephrology/chronic-kidney-disease.md). ### Diabetes Treat BP alongside glycemic, lipid, kidney, and cardiovascular risk. Diabetes is a high-risk condition that lowers the medication threshold in the 2025 U.S. framework.[1] ### Older adults and frailty Older adults frequently benefit from BP lowering but are more susceptible to orthostasis, falls, electrolyte abnormalities, and kidney injury. Measure standing BP when relevant and individualize intensity. ESC allows a less aggressive approach with age >85 years, moderate/severe frailty, symptomatic orthostasis, or limited life expectancy.[2] ### Pregnancy potential ACE inhibitors and ARBs are contraindicated during pregnancy. Review pregnancy plans before prescribing these agents and change to pregnancy-compatible therapy when pregnancy is planned or confirmed. See [Preeclampsia and Eclampsia](../obstetrics-gynecology/preeclampsia-and-eclampsia.md). ## Longitudinal follow-up Once controlled: - continue periodic office and home BP review; - reassess adherence and adverse effects; - monitor orthostatic symptoms; - repeat electrolytes and kidney function according to regimen and comorbidity; - reassess cardiovascular risk, lipids, diabetes, smoking, and kidney disease; - review whether fixed-dose combinations can simplify treatment; - re-evaluate secondary causes when previously stable control is lost. Loss of control after a stable interval should prompt review for medication nonadherence, new pressor drugs/substances, weight gain, sodium/alcohol increase, sleep apnea, kidney disease progression, pain, and secondary hypertension before simply adding another agent. ## Related library topics - [Primary Aldosteronism](../endocrinology/primary-aldosteronism.md) - [Chronic Kidney Disease](../nephrology/chronic-kidney-disease.md) - [Type 2 Diabetes Mellitus](../endocrinology/type-2-diabetes-mellitus.md) - [Obstructive Sleep Apnea in Adults](../sleep-medicine/obstructive-sleep-apnea-in-adults.md) - [Dyslipidemia in Adults](dyslipidemia-in-adults.md) - [Chronic Coronary Disease in Adults](chronic-coronary-disease-in-adults.md) - [Hypertensive Emergencies](../emergency-medicine/hypertensive-emergencies.md) ## References 1. Jones DW, Ferdinand KC, Taler SJ, et al. **2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.** *J Am Coll Cardiol.* 2025;86(18):1567-1678. doi:10.1016/j.jacc.2025.05.007. Hypertension version doi:10.1161/HYP.0000000000000249. https://doi.org/10.1016/j.jacc.2025.05.007 2. McEvoy JW, McCarthy CP, Bruno RM, et al.; ESC Scientific Document Group. **2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension.** *Eur Heart J.* 2024;45(38):3912-4018. doi:10.1093/eurheartj/ehae178. PMID:39210715. https://doi.org/10.1093/eurheartj/ehae178 3. National Institute for Health and Care Excellence. **Hypertension in adults: diagnosis and management (NG136).** Published 2019; updated February 26, 2026. Accessed September 24, 2026. https://www.nice.org.uk/guidance/ng136 4. Khan SS, Lloyd-Jones DM, et al. **Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology.** *J Am Coll Cardiol.* 2025. doi:10.1016/j.jacc.2025.08.001. https://doi.org/10.1016/j.jacc.2025.08.001 5. Gulati M, Moore MM, Cibotti-Sun M. **2025 High Blood Pressure Guideline-at-a-Glance.** *J Am Coll Cardiol.* 2025;86(18):1560-1566. doi:10.1016/j.jacc.2025.07.010. PMID:40817900. https://doi.org/10.1016/j.jacc.2025.07.010 6. Adler GK, Stowasser M, Correa RR, et al. **Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline.** *J Clin Endocrinol Metab.* 2025;110(9):2453-2495. doi:10.1210/clinem/dgaf284. PMID:40658480. https://www.endocrine.org/clinical-practice-guidelines/primary-aldosteronism-2 7. Williams B, MacDonald TM, Morant S, et al. **Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2).** *Lancet.* 2015;386(10008):2059-2068. doi:10.1016/S0140-6736(15)00257-3. PMID:26414968. https://pubmed.ncbi.nlm.nih.gov/26414968/7:["$","$L17",null,{"article":{"id":"medical-primary-hypertension-in-adults","title":"Primary Hypertension in Adults","slug":"primary-hypertension-in-adults","description":"Primary hypertension is sustained elevation of arterial pressure without a single dominant reversible cause. 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