1. Different types of hypertension
-Pseudohypertension, calcific atherosclerosis- old people its hard to get accurate bp measurements with the cuff.
-Accelerated hypertension -en dor gan damange wthout papilledema
-Malignant hypertension: one or more of the following: papilledema, pulmonary edema (sudden onset heart failure), neurologic findings, angina.
2. Medications/drugs causing hypertension:
-sympathomimetics (decongestants, anoretic agents). NSAIDs, steroids, cyclosporine/tacrolimus, OCPs (takes 3 cycles/3 months to normalize BP after stopping OCPs), TCAs, erythropoeitin. -more than 1-2 drinks, smoking, caffeine, amphetamines/cocaine
-licorice flavored foods
3. Exam findings:
-BP tends to rise on standing in essential hypertension, tends to fall in secondary
-Carotid bruits (think renal artery atherosclerotic narrowing), chest bruits (coarctation), abdominal bruits (renal a stenosis)
4. Baseline labs at diagnosis 
-BMP to look at renal function
-U/A (protein)
-EKG
-TSH to r/o thyroid disease
-Fasting lipids
5. JNC 8 nuances:
-Outcomes (mortality, CAD) correlate with home BP measurements much more strongly than office measurements
-Chlorthalidone protects against electrolyte swings better than hydrochlorothiazide
6. Comorbidities
-HTN and diabetes: ACE or ARB, or CCB/thiazide in black patients
-HTN and CKD: ACE/ARB
-HTN and CAD: B-blocker + ACE/ARB
-HTN and stroke: ACE/ARB
-HTN and heart failure: ACE/ARB + B-blocker
-HTN and LVH: ACE/ARB
7. Diuretics: 
-Absolute indications: heart failure, elderly (good evidence of stroke mortality reduction in this group with diuretics/CCB), systolic htn
-Use with caution: Diabetes
-Relative CI: gout/meds that cause hyperuricemia like cyclosporine, dyslipidemia
8. B-blockers
-Absolute Ind: angina, after MI, tachyrhythmias
-Relative Indication: heart failure (not crazy bad), pregnancy (IUGR), DM (suppresses sx of hypoglycemia)
-Absolute CI: asthma, COPD, heart block
-Relative CI; dyslipidemia, athletes, PAD (can worsen claudication)
9. CCB
-Absolute Ind: Angina, elderly patients, systolic hypertension
-Relative ind: PVD
-Absolute; heart block (amlodipine/nifedipine OK)
-Relative CI: heart failure (neg ino/chronotrope)
10. ACE-I
-Absolute Indication: heart failure, LV dysfunction, after MI, history of angioedema (ARB also CI-- try CCI, has some renal protective effects)
-Absolute CI: pregnancy (fetal renal agenesis), b/l RAS, hyperkalemia (esp if Cr > 2.5, K > 4.5, can increase K)
11. When to initiate medications
-Stage 1: one drug, stage 2: 2-drugs
-Any end organ damage (LVH, AV nicking) - start meds, don't wait for lifestyle modifications to take effect.
-Evidence of renal injury: start ACE even if their BP is normal. Titrate ACE up as high as you can without causing hypotension. Continue even if proteinuria resolves, because it will resume once you stop the meds.