Usually asymptomatic ('silent killer'), found on screening. End-organ clues: retinopathy, LVH, proteinuria. Severe: headache, visual changes.
Gold Standard Diagnosis
≥2 elevated readings on ≥2 separate visits. ACC/AHA 2017: Stage 1 ≥130/80, Stage 2 ≥140/90. Confirm with home/ambulatory BP.
First-line Treatment
Lifestyle + thiazide, ACEi/ARB, or dihydropyridine CCB. ACEi/ARB preferred in DM/CKD; thiazide or CCB preferred as initial therapy in Black adults without HF/CKD. Start 2 agents if ≥20/10 above goal.