HTN

Question 1

when should hypertension be suspectged?

Answer 1

Hypertension should be suspected if clinic systolic blood pressure is sustained above or equal to 140 mmHg, or diastolic blood pressure is sustained above or equal to 90 mmHg, or both.

The diagnosis is then confirmed with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM).

Question 2

what should be offered to a patient awaiting a diagnosis of HTN?

Answer 2

While waiting for confirmation of a diagnosis of hypertension, the person should be offered:

• Investigations for target organ damage and for secondary causes of hypertension.
• Assessment of cardiovascular risk.

Question 3

how is HTN classified?

Answer 3

Stage 1 hypertension — clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg and subsequent ABPM daytime average or HBPM average blood pressure ranging from 135/85 mmHg to 149/94 mmHg.

Stage 2 hypertension — clinic blood pressure of 160/100 mmHg or higher but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.

Stage 3 or severe hypertension — clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.

Question 4

when should same day referral to a specialist for people with HTN be suggested?

Answer 4

Referral for same-day specialist assessment should be arranged for people with:

• A clinic blood pressure of 180/120 mmHg and higher with signs of retinal haemorrhage or papilloedema (accelerated hypertension) or life-threatening symptoms, such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury.
• Suspected phaeochromocytoma, for example labile or postural hypotension, headache, palpitations, pallor, abdominal pain, or diaphoresis.

Question 5

how is HTN managed?

Answer 5

For all other people with hypertension, management includes:

• Offering lifestyle advice, including advice on diet and exercise, stress management, alcohol consumption, and smoking cessation (if applicable).
• Considering the need for antihypertensive drug treatment, which is initiated in a stepwise approach.
• Considering the need for antiplatelet or statin treatment.
• Monitoring response to lifestyle changes and drug treatment.
• Reviewing the person annually to monitor blood pressure, provide support, and discuss lifestyle, symptoms, and treatment(s).

Question 6

what are the target clinical BP?

Answer 6

Age under 80 years — clinic blood pressure below 140/90 mmHg; ABPM/HBPM below 135/85 mmHg.

Age 80 years and older — clinic blood pressure below 150/90 mmHg; ABPM/HBPM below 145/85 mmHg.

Postural hypertension — blood pressure target should be based on standing blood pressure.

Frailty or multimorbidity — clinical judgement should be used.

Question 7

what are the risk factors for HTN?

Answer 7

age (>60)

sex (male)

ethnicity (more common in black african and Caribbean)

social deprivation

lifestyle

stress

Question 8

what are the symptoms of HTN?

Answer 8

headaches.

shortness of breath.

nosebleeds.

flushing.

dizziness.

chest pain.

visual changes.

blood in the urine.