Essential Hypertension: The Daily PANCE Blueprint
A 38-year-old male with no past medical history presents to the clinic for a routine annual physical. His blood pressure reads 134/82. He keeps a blood pressure log for 2 weeks at home and brings it back to the clinic in a few weeks. Almost all of the readings show a systolic blood pressure between 130-139 and diastolic blood pressure between 80-89. Which of the following classification does this patient meet?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage I hypertension
D. Stage II hypertension
E. Hypertensive crisis
Answer and topic summary
The answer is C. Stage I hypertension
Essential hypertension (aka there’s no identifiable cause) is the main cause of hypertension. The stages of hypertension are as follows:
Normal: SBP < 120, DBP < 80
Elevated: SBP 120-129, DBP < 80
Stage 1 Hypertension: SBP 130-139, DBP 80-89
Stage 2 Hypertension: SBP ≥140 or DBP ≥90
Complications of hypertension include coronary artery disease, CHF, stroke, renal failure, and retinopathy. The diagnosis should NEVER be made off of just one BP reading. Confirm it with the average of 2 or more readings on 2 or more separate occasions, ideally with home or ambulatory BP monitoring, as this patient did. Treatment includes weight loss, exercise, reduction in salt intake, and medications. First-line classes are an ACE inhibitor or ARB, a dihydropyridine CCB (amlodipine), or a thiazide-like diuretic (chlorthalidone); beta-blockers are not first-line for uncomplicated hypertension. Stage 2 starts with two drugs, ideally in one pill. Most patients will need more than 1 drug to reach the goal of <130/80.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒
Also covered as part of the Family Medicine EOR and Internal Medicine EOR topic lists
