Primary hypertension is high blood pressure without a single identifiable cause, linked to genes, age, salt, weight and inactivity. It is defined as 130/80 mmHg or higher on repeated readings and often causes no symptoms while it slowly damages the heart, brain, kidneys and eyes.
Key symptoms
- Usually no symptoms
- Headache when pressure is very high
- Symptoms of complications: chest pain, breathlessness, vision changes
What you find on exam
- Correct technique: seated, rested, right cuff size, arm at heart level, two readings
- Confirm with home or ambulatory monitoring
- BMI, waist, fundoscopy, heart and pulse exam
- Clues to secondary causes: abdominal bruit, unequal pulses, Cushing features
Tests
- Electrolytes, creatinine, glucose or HbA1c, lipid panel, TSH
- Urinalysis and urine albumin-to-creatinine ratio
- 12-lead ECG
- 10-year cardiovascular risk calculation
Treatment basics
- Lifestyle: less salt, DASH diet, weight loss, exercise, less alcohol
- First-line drugs: a thiazide such as chlorthalidone, an ACE inhibitor or ARB, or amlodipine
- Start with two drugs if pressure is 20/10 mmHg or more above goal
- Target under 130/80 mmHg for most adults
Red flags
- Pressure of 180/120 mmHg or more with headache, chest pain or neurologic signs
- Pressure above goal despite three drugs (resistant hypertension)
- New high blood pressure in a young person or with low potassium
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Sources: AHA Scientific Statement, Measurement of Blood Pressure in Humans (Hypertension, 2019); NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.