Essential Hypertension

Question 1

How common is it?

Answer 1

• Often goes undiagnosed – prevalence in those over 35 is 31% in men and 28% in women.

Question 2

Cause?

Answer 2

Essential hypertension is of unknown cause.

Question 3

Risk factors?

Answer 3

Prevalence increases with age, men more affected than women.

Question 4

How does it present?

Answer 4

Usually asymptomatic, unless the hypertension has caused something else, in which case there are lots of presentations.

Question 5

How would you investigate the patient?

Answer 5

Take their blood pressure on repeated occasions and different settings before a diagnosis can be made.

Question 6

What treatments would be considered?

Answer 6

Lifestyle interventions - obesity, smoking, salt, exercise.
- Depends on stage of hypertension - could choose from ACE inhibitors, AIIRBs, calcium channel blockers, beta blockers, alpha blockers. Use of thiazide diuretics if evidence of heart failure.

ABCD - 55 yrs/black – Calcium channel blocker (and thiazide diuretic).
→ A+C or A+D → A+C+D → Add either alpha-blocker or spironolactone or other diuretics or beta-blocker and consider specialist referral.