Changes

** Renal: bilateral [[RAS]], [[PKD]], [[CKD]], '''glomerular disease (nephrotic and nephritic syndromes)'''

** Renal: bilateral [[RAS]], [[PKD]], [[CKD]], '''glomerular disease (nephrotic and nephritic syndromes)'''

** Other: [[Cocaine]], [[OSA]], [[OCPs]], [[Coarctation]]

** Other: [[Cocaine]], [[OSA]], [[OCPs]], [[Coarctation]]

* Tx: For SBP 121-130, start with 8-12 weeks lifestyle modifications and reassess. If SBP 131-139 or DBP 81-89, '''risk stratify based on 10-yr ASCVD risk, if > 10%, start medication, if < 10%, can do trial of lifestyle modifications'''. For stage 2 hypertension (>140/90), '''start treatment with 2 medications.''' When starting medication, start with 1 or 2 agents depending on severity, reassess efficacy every month and up the dose or add another agent as needed. ACEI/ARB (good for kidney protection, don't do both), Dihydropyridine CCB (better for HTN) > non-dihydropyridine CCB (better for rate control), Beta Blockers (cardiac selective (MAN BABES) > non-selective), Thiazide-Like Diuretics > Thiazide-Type Diuretics. For most patients, the combination of ACEI/ARB + CCB is the best, so start with one of these two classes so that the second can be added later for synergy. Special population considerations: [[CHF]] (avoid CCBs, use beta blockers, ACEI/ARBs, spironolactone), [[CKD]] (use ACEI/ARB), Pregnancy (hydralazine, labetalol, nicardipine, methyldopa), post-MI (use beta blockers + ACEI/ARB), Blacks (CCB + thiazide-like diuretic), Cocaine (don't give beta blockers due to unopposed alpha).

* Tx: For SBP 121-130, start with 8-12 weeks lifestyle modifications and reassess. If SBP 131-139 or DBP 81-89, '''risk stratify based on 10-yr ASCVD risk, if > 10%, start medication, if < 10%, can do trial of lifestyle modifications'''. For stage 2 hypertension (>140/90), '''start treatment with 2 medications.'''  

** When starting medication, start with 1 or 2 agents depending on severity, reassess efficacy every month and up the dose or add another agent as needed.  

** ACEI/ARB (good for kidney protection, don't do both), Dihydropyridine CCB (better for HTN) > non-dihydropyridine CCB (better for rate control), Beta Blockers (cardiac selective (MAN BABES) > non-selective), Thiazide-Like Diuretics > Thiazide-Type Diuretics.  

** For most patients, the combination of ACEI/ARB + CCB is the best, so start with one of these two classes so that the second can be added later for synergy.  

** Special population considerations: [[CHF]] (avoid CCBs, use beta blockers, ACEI/ARBs, diuretics, spironolactone); [[CKD]] (use ACEI/ARB); Pregnancy (hydralazine, labetalol, nicardipine, methyldopa); post-MI (use beta blockers + ACEI/ARB, spironolactone); Blacks (CCB + thiazide-like diuretic); Cocaine (lorazepam, don't give beta blockers due to unopposed alpha); BPH (diuretics, alpha 1 antagonists)

* Hypertensive Urgency BP > 180 + mild symptoms

* Hypertensive Urgency BP > 180 + mild symptoms

* Hypertensive Emergency BP > 180 + ominous symptoms

* Hypertensive Emergency BP > 180 + ominous symptoms