Essential Hypertension

Essential (Primary) Hypertension is a chronic systemic elevation of arterial blood pressure in the absence of an identifiable secondary cause. Dubbed the "silent killer," it typically progresses asymptomatically for years while exerting relentless shear stress on arterial vascular walls, accelerating atherosclerosis and causing target organ damage to the heart, brain, kidneys, and eyes.

Often called the "silent killer" because most individuals experience zero overt symptoms even with dangerous elevations. In severe or rapidly worsening stages, individuals may notice:

• Suboccipital morning headache (felt at the back of the head)
• Dizziness, lightheadedness, or vertigo
• Episodes of shortness of breath on exertion
• Epistaxis (nosebleeds)
• Visual blurring or visual disturbances
• Palpitations or pounding sensation in the chest and neck

A multifactorial etiology involving neurohormonal overactivation (sympathetic nervous system), dysregulation of the renin-angiotensin-aldosterone system (RAAS), renal sodium handling defects, vascular endothelial dysfunction, arterial stiffness, and genetic polygenic susceptibility.

Diagnosed based on the average of two or more properly seated, rested blood pressure readings taken on two or more separate clinical encounters:

• Normal: Systolic <120 mmHg and Diastolic <80 mmHg
• Elevated: Systolic 120-129 mmHg and Diastolic <80 mmHg
• Stage 1 Hypertension: Systolic 130-139 mmHg or Diastolic 80-89 mmHg
• Stage 2 Hypertension: Systolic ≥140 mmHg or Diastolic ≥90 mmHg
• Ambulatory Blood Pressure Monitoring (ABPM): 24-hour mean ≥130/80 mmHg confirms diagnosis and rules out "White Coat Hypertension."

Evidence-based management combines lifestyle interventions with first-line antihypertensive pharmacotherapy:

• Lifestyle: DASH diet (fruits, vegetables, whole grains, low-fat dairy, low sodium <1500-2000 mg/day), regular aerobic exercise (150 mins/week), moderation of alcohol, weight reduction.
• First-Line Antihypertensive Classes: ACE Inhibitors (Lisinopril, Enalapril), Angiotensin Receptor Blockers / ARBs (Losartan, Telmisartan), Dihydropyridine Calcium Channel Blockers (Amlodipine), and Thiazide/Thiazide-like Diuretics (Chlorthalidone, Hydrochlorothiazide).
• Combination Therapy: Most patients with Stage 2 hypertension require two first-line agents with complementary mechanisms (e.g., ARB + Calcium Channel Blocker) to achieve target blood pressure (<130/80 mmHg).