What is essential hypertension?

From the Guidelines

Essential hypertension is defined as high blood pressure with no identifiable cause, accounting for approximately 95% of all hypertension cases, where blood pressure readings consistently exceed 130/80 mmHg. This condition develops gradually over years due to a combination of genetic factors, lifestyle choices, and environmental influences, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The management of essential hypertension typically involves lifestyle modifications, such as reduced salt intake, regular exercise, weight management, and limited alcohol consumption.

Key Factors and Management

• Risk factors for essential hypertension include family history, aging, obesity, high sodium intake, physical inactivity, excessive alcohol consumption, and chronic stress.
• Lifestyle modifications are crucial in managing essential hypertension, and may be supplemented with medications if necessary, such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers.
• The treatment of essential hypertension is critical, as uncontrolled hypertension can lead to serious complications, including heart disease, stroke, kidney damage, and vision problems, highlighting the importance of evidence-based guidelines like those from the American College of Cardiology/American Heart Association task force on clinical practice guidelines 1.

Clinical Considerations

The 2018 systematic review for the ACC/AHA guideline emphasizes the significance of high blood pressure as the single most common risk factor for cardiovascular disease burden and the importance of clinical practice guidelines in managing and controlling high blood pressure 1. This underscores the need for rigorous systematic evidence reviews to inform clinical recommendations and promote optimal patient care and cardiovascular health.

Evidence-Based Practice

Given the evidence from the 2018 systematic review 1, the management of essential hypertension should prioritize lifestyle modifications and, when necessary, medication, to reduce morbidity and mortality associated with high blood pressure. This approach aligns with the goals of promoting optimal patient care and cardiovascular health, as outlined in the ACC/AHA writing committee's objectives 1.

From the FDA Drug Label

Losartan has been evaluated for safety in more than 3300 adult patients treated for essential hypertension and 4058 patients/subjects overall.

Essential hypertension is not explicitly defined in the provided drug labels. The labels mention that losartan is indicated for the treatment of hypertension in adults and pediatric patients, and that it has been evaluated for safety in patients with essential hypertension, but they do not provide a definition of the term. 2 2

From the Research

Definition of Essential Hypertension

• Essential hypertension is defined as a rise in blood pressure of unknown cause that increases risk for cerebral, cardiac, and renal events 3.
• It is also known as primary or idiopathic hypertension, and accounts for at least 95% of all cases of hypertension 4.
• Hypertension is arbitrarily defined as diastolic blood pressure (DBP) of 90 mm Hg or higher, systolic blood pressure (SBP) of 140 mm Hg or higher, or both, on 3 separate occasions 4.

Prevalence and Risk Factors

• The risk of becoming hypertensive during a lifetime exceeds 90% in industrialised countries 3.
• Essential hypertension usually clusters with other cardiovascular risk factors such as ageing, being overweight, insulin resistance, diabetes, and hyperlipidaemia 3.
• Approximately 60% of the 50 million Americans with hypertension are at increased risk for cardiovascular disease resulting from uncontrolled hypertension 4.

Pathophysiology

• Essential hypertension develops when the kidneys become unable to excrete the amount of sodium ingested, unless blood pressure is increased 5.
• A shift of the pressure natriuresis relationship toward abnormally high pressure levels is a pathophysiological characteristic of essential hypertension 5.
• Evidence indicates that this anomaly in the pressure natriuresis relationship arises from a sympathetic nervous system dysfunction 5.

Management and Treatment

• All antihypertensive drugs lower blood pressure, and this decline is the best determinant of cardiovascular risk reduction 3.
• Most hypertensive patients need two or more drugs for blood-pressure control and concomitant statin treatment for risk factor reduction 3.
• The European hypertension guidelines recommend that angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) are combined with calcium channel blockers (CCBs) and/or thiazide diuretics 6.
• Triple therapy with an ARB, CCB, and thiazide diuretic is required in 15%-20% of treated uncontrolled hypertensive patients 6.