Cardiovascular System >
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)
- Antihypertensive therapy, prescribed alone or in combination:
- 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