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

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