Essential hypertension

Question 1

How common is it?

Answer 1

30% of adults have blood pressures that is at least 140/90mmHg

Question 2

Who does it affect?

Answer 2

30% of people 45-54 years of age have blood pressure that is at least 140/90mmHg

70% of people 75 years of age or older have blood pressure that is at least 140/90mmHg

Hypertension is more common in Afro-Caribbean’s than Caucasians.

Question 3

What causes it?

Answer 3

Essential/primary hypertension has no identifiable cause (about 95% of people).

Secondary hypertension has an underlying cause (about 5% of people)

Accelerated/malignant hypertension is defined as BP higher than 180/110mmHg with signs of papilledema and/or retinal haemorrhage (hypertensive retinopathy). In this case same day admission should be arranged.

Question 4

What risk factors are there?

Answer 4

Essential hypertension has a multifactor aetiology: Genetic component, low birthweight, obesity, excess alcohol intake, high salt intake, the metabolic syndrome.

Question 5

How does it present?

Answer 5

Hypertension is generally asymptomatic. Secondary causes of hypertension may be suggested by specific features, such as attacks of sweating and tachycardia in pheochromocytomas

Question 6

Signs on examination?

Answer 6

In most patients the only finding is high blood pressure, but in other signs relating to the cause (e.g. abdominal bruit in renal artery stenosis, delayed femoral pulses in coarctation of the aorta) or the end-organ effects of hypertension may be present, e.g. Loud second heart sound, left ventricular heave, fourth heart sound in hypertensive heart disease, and retinal heart abnormalities.

Question 7

Investigations

Answer 7

24hr BP

U&E’s which may show evidence of renal impairment

Urine Stix test for protein and blood, again for renal disease

Blood glucose

Serum lipids

ECG

Question 8

Treatment?

Answer 8

Lifestyle changes

Step 1: Younger than 55=ACE inhibitor. Older than 55 or black of any age=Calcium channel blocker or thiazide-type diuretic

Step 2: Ace inhibitor+Calcium Channel blocker or Ace inhibitor+ thiazide-type diuretic

Step 3: Ace inhibitor+Calcium channel blocker+thiazide-type diuretic

Step 4: Step 3+ a further diuretic therapy or α-blocker or β blocker. Consider seeking specialist advice

Question 9

Conditions that would present similarly

Answer 9

Other conditions may mimic the effects of a high blood pressure but obviously anything that is an increased blood pressure counts as hypertension.