Hypertension

“Persistent high blood pressure >140/90mmHg “

Risk Factors

• Older age
• Family History
• Health conditions (CVD / DM)
• Metabolic Syndrome
• Sleep Apnoea
• Alcohol
• Smoking
• Sex (male)

Aetiology

• Primary (essential) hypertension (95%):
  • Idiopathic – may be influenced by certain factors (e.g. obesity, insulin resistance, ageing, stress, high alcohol intake)
• Secondary hypertension (5%):
  • kidney disease (e.g. CKD / PKD), diabetes, pheochromocytoma, pregnancy (pre-eclampsia), hyperthyroidism, hyperparathyroidism, Cushing’s syndrome, hyperaldosteronism, coarctation of the aorta, COCP use

Pathophysiology

• Multifactorial, involving derangement of the body’s blood pressure control mechanisms, including:
  • Endothelial function
  • The autonomic nervous system
  • The renin-angiotensin-aldosterone system

Clinical Presentation

• Often Asymptomatic
• May include:
  • Headaches
  • Shortness of breath
  • Retinopathy and visual disturbances
  • Chest pain

Investigations

• BP measurement: > 2 readings obtained on 2 separate sites
• Other investigations performed may include ECG, urinalysis and blood tests (FBC, TFT, plasma renin/aldosterone) to monitor cardiac function and rule out differential diagnoses

Management

• Conservative:
  • Exercise and improve diet
  • Reduce alcohol intake
  • Stop smoking
• Medical:
  • Antihypertensive therapy, prescribed alone or in combination:
    • ACE inhibitors (e.g. ramipril)
    • Beta-blockers (e.g. atenolol)
    • Aldosterone antagonists (e.g. spironolactone)
    • Calcium channel blockers (e.g. nifedipine)
    • Diuretics (e.g. indapamide)
• Surgical: n/a

• Seconary Hypertension – treat underlying cause and is often reversible

Complications

• Coronary artery disease
• Myocardial Infarction
• Cerebrovascular disease
• Heart failure
• Aneurysms
• Vascular dementia
• Chronic Kidney Disease