Hypertension

A blood pressure of 136/84 mm Hg does not answer the treatment question by itself. First confirm that the pressure is real and persistent; then ask whether the patient has cardiovascular risk that makes medication worthwhile now, whether a reversible or secondary cause is present, and whether the reading is accompanied by acute target-organ injury. The current Canadian primary-care framework defines adult hypertension as blood pressure of 130/80 mm Hg or higher when obtained with a validated device under standardized conditions. Medication is recommended for blood pressure of 140/90 mm Hg or higher, and for systolic blood pressure of 130-139 mm Hg when cardiovascular risk is high. When pharmacotherapy is needed, treatment usually starts with low-dose combination therapy rather than a prolonged trial of one drug at a high dose. The therapeutic destination is a systolic pressure below 130 mm Hg if it is tolerated. Frailty, orthostatic hypotension, fall risk, and goals of care can make the safest target less intensive. A markedly elevated number becomes an emergency only when it is causing acute organ injury; the same number without...