Section 10: Specific Circumstances10.1 Resistant HypertensionBackgroundResistant hypertension is defined as seated office BP >140/90mm Hg in a patient treated with three or more antihyperten-sive medications at optimal (or maximally tolerated) doses in-cluding a diuretic and after excluding pseudoresistance (poorBP measurement technique, white coat effect, nonadherenceand suboptimal choices in antihypertensive therapy)104,105 aswell as the substance/drug-induced hypertension and sec-ondary hypertension

Section 9: Common and Other Comorbiditiesand Complications of HypertensionBackground• Hypertensive patients have several common and othercomorbidities that can affect cardiovascular risk andtreatment strategies.• The number of comorbidities increases with age, withthe prevalence of hypertension and other diseases

Section 8: Treatment of Hypertension8.1 Lifestyle ModificationsHealthy lifestyle choices can prevent or delay the onset ofhigh BP and can reduce cardiovascular risk.46 Lifestyle mod-ification is also the first line of antihypertensive treatment.Modifications in lifestyle can also enhance the effects ofantihypertensive treatment. Lifestyle modifications should in-clude the following (Table 8)

Section 7: Exacerbators and Inducers ofHypertensionBackgroundSeveral medications and substances may increase BP or an-tagonize the BP-lowering effects of antihypertensive therapyin individuals (Table 7). It is important to note that the indi-vidual effect of these substances on BP can be highly vari-able with greater increases noted in the elderly, those withhigher baseline BP, using antihypertensive therapy or withkidney disease

Section 6: Hypertension-Mediated OrganDamage (HMOD)Definition and Role of HMOD in HypertensionManagementHypertension-mediated organ damage (HMOD) is defined asthe structural or functional alteration of the arterial vascula-ture and/or the organs it supplies that is caused by elevated BP.End organs include the brain, the heart, the kidneys, centraland peripheral arteries, and the eyes

Section 5: Cardiovascular Risk FactorsDiagnostic Approach• More than 50% of hypertensive patients have additionalcardiovascular risk factors

Section 4: Diagnostic / Clinical TestsMedical HistoryPatients with hypertension are often asymptomatic, how-ever specific symptoms can suggest secondary hyperten-sion or hypertensive complications that require furtherinvestigation. A complete medical and family history isrecommended and should include

Section 3: Blood Pressure Measurement andDiagnosis of HypertensionHypertension Diagnosis – Office BP Measurement• The measurement of BP in the office or clinic ismost commonly the basis for hypertension diagno-sis and follow-up. Office BP should be measured ac-cording to recommendations shown in Table 3 andFigure 1

Section 2: Definition of Hypertension• In accordance with most major guidelines it is rec-ommended that hypertension be diagnosed when aperson’s systolic blood pressure (SBP) in the officeor clinic is ≥140 mm Hg and/or their diastolic blood

Section 1: IntroductionContext and Purpose of This GuidelineStatement of RemitTo align with its mission to reduce the global burden of raisedblood pressure (BP), the International Society of Hypertension(ISH) has developed worldwide practice guidelines for themanagement of hypertension in adults, aged 18 years andolder

Section 3: Blood Pressure Measurement andDiagnosis of HypertensionHypertension Diagnosis – Office BP Measurement• The measurement of BP in the office or clinic ismost commonly the basis for hypertension diagno-sis and follow-up. Office BP should be measured ac-cording to recommendations shown in Table 3 andFigure 1