Hypertension

Chronically elevated blood pressure (BP) is known clinically as hypertension. Hypertension is typically diagnosed as BP that is greater than or equal to 130/80 mm Hg in adults; it is important to note that this is a lower threshold than previously noted by Hypertension Canada (Goupil et al., 2025).

Hypertension is typically a silent disorder, so hypertensive clients may not recognize the seriousness of their condition and not adhere to their treatment plan. The result is often a heart attack or stroke. Hypertension may also lead to an aneurysm (ballooning of a blood vessel caused by a weakening of the wall), peripheral arterial disease (obstruction of vessels in peripheral regions of the body), chronic kidney disease, or heart failure (OER#2).

Common errors in measurement and natural fluctuations in blood pressure can result in readings that erroneously suggest hypertension. Some of the errors are due to the operator (i.e., the healthcare provider) and others are due to client anxiety and situational determinants. As a healthcare provider, it is important to review your technique to assess possible measurement errors and assess the client for factors that could elevate blood pressure. If the client’s blood pressure is elevated, repeat the measurement for accuracy, and then, take the blood pressure in the opposite arm.

Because hypertension is a silent disorder, healthcare providers measure blood pressure at regular intervals. The intervals depend on the client’s health status and risk factors. Before a diagnosis of hypertension is made, blood pressure is monitored over days, weeks, or months either in the office using an automatic blood pressure machine, or at home using an ambulatory blood pressure machine.

Guidelines to Determine Hypertension in Adults

In this section, guidelines to determine hypertension in primary care are discussed since this is the setting where hypertension is most often diagnosed. Guidelines to determine hypertension are updated regularly so it is important to check them regularly. In Canada, you can check out the Hypertension Canada website. It is best to assess and evaluate BP with a “validated automated device and using a standardized method” as described below (Goupil et al., 2025, pg. E2). However, validated devices are not always available, and in this case, manual BP is taken.

Hypertension Canada (Goupil et al., 2025) recommends that the client should not participate in exercise and consume caffeine and tobacco in at least 30 minutes prior to having their blood pressure taken. Since the client should be relaxed, they should empty their bladder and bowel (if needed). Additionally, it is preferable that they are not in any acute anxiety, stress, and pain.

As per Hypertension Canada, the following techniques should be adhered to when assessing BP in a primary care setting:

• The client should be placed in a quiet room with no noises/disturbances and they should be asked to sit quietly – not moving or talking throughout the procedure.
• They should be seated in a chair with legs uncrossed, feet flat on floor, relaxed with their back against the back of the chair.
• Arm should be bare and rested on a table with their hand facing upwards.
• It is best that they are at rest for 5 minutes prior to the measurements.
• And then, BP should be measured with an automatic cuff three times “at 1-minute intervals” – all values should be recorded and the values should be averaged.
  (Goupil et al., 2025).

When hypertension is diagnosed in a primary setting, it is recommended (when feasible to do so) to conduct out-of-office (home BP monitoring) to confirm the diagnosis and rule-out white-coat hypertension (a situation when BP is elevated in clinical settings) (Goupil et al., 2025). However when out-of-office monitoring is not feasible, then repeated office measurements are recommended (Goupil et al., 2025).

Treatment approaches (lifestyle or pharmacotherapy) are tailored so that systolic BP is lowered to less than 130 mm Hg; although this target can vary for each client based on adverse effects (Goupil et al., 2025). Hypertension Canada (Goupil et al., 2025) recommends the following treatment approaches.

BP greater than or equal to 130/80, but less than 140/90:

• Lifestyle modification recommended.
• Reassessment of BP in 3 to 6 months; if the BP remains in this range at the next assessment, then continue to reassess every 6 to 12 months.
• Series of tests are recommended to assess cardiovascular disease risk such as blood tests (e.g., fasting lipid panel, Hemoglobin A1c, fasting blood glucose, creatinine) and 12-lead electrocardiography.

BP greater than or equal to 140/90 (or 130-139 and at high cardiovascular disease risk such as coronary artery disease, heart failure, kidney disease, diabetes, greater than or equal to 75 years of age):

• Lifestyle modification recommended.
• Pharmacotherapy (medications) initiation.
• Reassess every 1 to 3 months “until BP at target” and then every 6 to 12 months.

However, it is important to recognize cues related to a hypertensive crisis, which is when a client’s BP is greater than 180/120 mm Hg (Sibley et al., 2020). A hypertensive crisis is a priority of care as it can result in cardiovascular events such as a myocardial infarction (heart attack) or a cerebrovascular accident (stroke). Associated cues may include angina (chest pain), shortness of breath, dizziness, confusion, and loss of consciousness. When a hypertensive crisis is suspected, the client should be referred to the hospital emergency for immediate assessment and treatment.

Modifiable and Non-Modifiable Risk Factors

As part of the assessment, you should assess a client’s cardiovascular risk factors for atherosclerosis and hypertension. These risk factors are categorized as modifiable and non-modifiable. See Table 5 for an overview of risk factors adapted based on Hypertension Canada guidelines (Leung, et al., for Hypertension Canada, 2017)

Table 5: Modifiable and Non-Modifiable Risk Factors

Test Your Knowledge

Please answer the three questions in the following question set.

References

Goupil, R., Tsuyuki, R., Santesso, N., Terenzi, K., Habert, J., Cheng, G., Gysel, S., Bruneau, J., Leung, A., Campbell, N., Schiffrin, E., & Hundemer, G. (2025). Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care. CMAJ, 197, E1-E16. https://doi.org/10.1503/cmaj.241770

Sibley, A., Atkinson, P., & Shayne, P. (2020). Just the facts: Hypertension in the emergency department. Canadian Association of Emergency Physicians, 22(4), 456-458.

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Part of this content was adapted from OER #2 (as noted in brackets above):
© Apr 10, 2017 OpenStax Anatomy and Physiology. Textbook content produced by OpenStax Anatomy and Physiology is licensed under a Creative Commons Attribution License 4.0 license. Download for free at http://cnx.org/contents/7c42370b-c3ad-48ac-9620-d15367b882c6@12

Rabi et al., (2020). Guidelines: Hypertension Canada’s 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Canadian Journal of Cardiology, 36, 596-624.