Named the “silent killer”, hypertension is defined as an extended elevation in blood pressure and is one of the most common chronic health disorders (Story, 2025). Due to the vasoconstriction that increases the afterload, the heart has to work harder to pump blood throughout the body resulting in inappropriate activation of the renin-angiotensin-aldosterone system from a decrease in renal blood supply (Story, 2025). This excessive pressure on artery walls results in damage to blood vessels and organs and the longer hypertension is left untreated, the more severe the damage will be (Story, 2025).
In most adults, there is no identifiable cause to hypertension, develops over many years, and is called primary or essential hypertension (Story, 2025). As a result of an underlying condition, secondary hypertension appears abruptly and causes more elevated blood pressure (Story, 2025). Hypertension has a multitude of modifiable and nonmodifiable risk factors including age, race, family history, obesity, physical inactivity, tobacco use, high-sodium diet, excessive alcohol consumption, and high levels of stress (Story, 2025). In addition, secondary hypertension can be causes by renal disease, diabetes mellitus, tumors of the adrenal glands, sleep apnea, disorders of the endocrine system, congenital heart defects, certain medications, as well as illegal drug abuse (Story, 2025).
In the case of the 49-year-old African American smoker with a familial history of hypertension, he is likely suffering from secondary hypertension, class II. The American Heart Association defines stage II hypertension as patients who have untreated blood pressures of systolic blood pressure (SBP) ≥140 mm Hg or untreated diastolic blood pressure (DBP) ≥90 mm Hg (Kaneko et al., 2021).
To confirm this diagnosis the clinician should ensure that the blood pressure measurement was accurate and repeated on two or more separate medical appointments (Story, 2025). If left untreated, he is at higher risk for atherosclerosis, aneurysms, heart failure stroke, hypertensive crisis, renal damage, vision loss, metabolic syndrome, and vascular dementia (Story, 2025).
The treatment for secondary hypertension is to treat any potential causes of hypertension and make lifestyle changes to reduce modifiable risk factors. For example, dietary changes can help to lower blood pressure by limiting daily salt intake, increase fruits, vegetables and whole grain consumption and reducing saturated fat intake (Bloch & Basile, 2024). Teaching the patient that other lifestyle modifications like exercising, quitting smoking, management of stress, limit alcohol consumption, and maintaining a healthy weight can help with the management of secondary hypertension (Bloch & Basile, 2024). If hypertension persists despite lifestyle modifications, there are a plethora of pharmacologic interventions that can help treat it. First-line treatment choice is diuretics while angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers, calcium-channel blockers are additional choices as well as beta blockers and alpha-1 blockers (Story, 2025).
The importance of monitoring blood pressure both at home and in a healthcare setting should be relayed to the patient. Encouraging the patient to keep a journal of blood pressure readings can help to ensure adherence to the regimen and compare to the readings in the clinic. In addition to monitoring, the patient should be encouraged to follow lifestyle modifications for the reduction of risk factors. If the patient is prescribed anti-hypertensive medication, the clinician should provide education regarding dosage and potential side-effects to monitor for. It is also important for the clinician to educate the patient about the importance to report any persistent symptoms or any that could indicate a hypertensive crisis or heart attack and the need for laboratory monitoring and observing for progression of complications.
References
Bloch, M., & Basile, J. (2024, February 12). Patient Education: High Blood Pressure, Diet, and Weight (Beyond the Basics) (W. White & K. Law, Eds.). UpToDate. https://www.uptodate.com/contents/high-blood-pressure-diet-and-weight-beyond-the-basics
Kaneko, H., Yano, Y., Itoh, H., Morita, K., Kiriyama, H., Kamon, T., Fujiu, K., Michihata, N., Jo, T., Takeda, N., Morita, H., Node, K., Carey, R. M., Lima, J. A. C., Oparil, S., Yasunaga, H., & Komuro, I. (2021). Association of Blood Pressure Classification Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Risk of Heart Failure and Atrial Fibrillation. Circulation, 143(23), 2244–2253. https://doi.org/10.1161/circulationaha.120.052624
Story, L. (2025). Pathophysiology : A Practical Approach (5th ed.). Jones & Bartlett Learning.
