Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 189: A 52-Year-Old with Hypertension
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Apr 2, 2026 A clinical case drives a review of how to measure and classify high blood pressure using guideline cutoffs. The conversation highlights when to suspect secondary causes like obstructive sleep apnea, kidney disease, renovascular problems, and primary hyperaldosteronism. Medication and OTC contributors to hypertension are discussed. Practical steps for initial workup and screening are outlined.
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Confirm Hypertension With Multiple Measurements
- Do confirm hypertension with an average of two or more BP measurements from at least two visits before diagnosing hypertension.
- The ACC/AHA defines stage 1 as systolic 130–139 or diastolic 80–89 and stage 2 as ≥140/90, so remeasure and average accordingly.
Order Baseline Tests For New Hypertension
- Do order baseline testing for a patient with new hypertension: EKG, CBC, electrolytes, renal function, lipid profile, A1c, TSH, urinalysis, and consider echo given an S4.
- These tests screen for target-organ effects and clues to secondary causes before labeling primary hypertension.
Obstructive Sleep Apnea Is The Leading Secondary Cause
- Obstructive sleep apnea (OSA) is the single most common secondary cause of hypertension, especially in overweight or obese patients.
- Intermittent hypoxia from OSA raises sympathetic tone, correlates with BP severity, and can increase resistance to antihypertensive therapy.
