Hypertension

Hypertension (high blood pressure) is an important risk factor

for the future development of cardiovascular disease.
the risk of cardiovascular disease doubles for every 20/10
mmHg rise in blood pressure.
The cardiovascular complications associated with hypertension
are shown in. The most common and important
of these are stroke and myocardial infarction. An increase of
5 mmHg in usual diastolic blood pressure is associated with
a 35–40% increased risk of stroke. There is a similar but less
steep association for coronary heart disease risk. The risk
of heart failure is increased six-fold in hypertensive subjects.
Meta-analysis of clinical trials has indicated that these risks
are reversible with relatively modest reductions in blood
pressure of 10/6 mmHg associated with a 38% reduction in
stroke
and 16% reduction in coronary events
while a 5 mmHg reduction in blood pressure is associated
with a 25% reduction in risk of renal failure.
Complications of hypertension
• Myocardial infarction
• Stroke
– Cerebral/brainstem infarction
– Cerebral haemorrhage
– Lacunar syndromes
– Multi-infarct disease
• Hypertensive encephalopathy/malignant hypertension
• Dissecting aortic aneurysm
• Hypertensive nephrosclerosis
• Peripheral vascular disease

Epidemiology

Causes of hypertension

Primary hypertension (90–95%)

• Essential hypertension

Secondary hypertension (5–10%)

• renal diseases

• Endocrine diseases

– Steroid excess: hyperaldosteronism (Conn's syndrome);

hyperglucocorticoidism (Cushing's syndrome)

– Growth hormone excess: acromegaly

– Catecholamine excess: phaeochromocytoma

– Others: pre-eclampsia

• vascular causes

– Renal artery stenosis: fibromuscular hyperplasia; renal

artery atheroma; coarctation of the aorta

• Drugs

– Sympathomimetic amines

– Oestrogens (e.g. combined oral contraceptive pills)

– Ciclosporin

– Erythropoietin

– NSAIDs

– Steroids

Hypertension is more common in black people of African Caribbean

origin, who are also at particular risk of stroke and renal failure.
Hypertension is exacerbated by other factors, for example, high salt or
alcohol intake or obesity

Regulation of blood pressure

Minute-to-minute changes in blood pressure are regulated by the

baroreceptor reflex, while the renin–angiotensin–aldosterone system

is important for longer term salt, water and blood pressurecontrol.

 Clinical presentation

Malignant (accelerated) hypertension

(usually >220/120mmHg)

The clinical featuresn are confusion, headache, visual loss, seizures and
coma. Malignant hypertension is a medical emergency that requires
hospital admission and rapid control of blood pressure over 12–24 h
towards normal levels.

Management of hypertension

Diagnosis of hypertension

Sphygmomanometer

both arms

should be relaxed

should be measured in both the sitting and the standing positions.

An appropriate sized cuff should be used

Home or ambulatory blood pressure measurements

Ambulatory blood pressure monitoring over 24 h is also useful for

patients who have unusual variability in blood pressure, resistant
hypertension or symptoms suggesting hypotension. Home or
ambulatory blood pressure measurements are usually lower than
clinic recordings, on average by 12/7 mmHg

Assessment of the hypertensive patient

Secondary causes
Contributing factors