Hypertension

Question 1

What is hypertension?

Answer 1

Clinic reading persistently above >= 140/90 mmHg,
or:
a 24 hour blood pressure average reading >= 135/85 mmHg

Question 2

What are some causes of primary hypertension?

Answer 2

(Nonmodifiable risk factors) Ethnicity, age
(Modifiable risk factors) Obesity
Diabetes 
Smoking 
Physical inactivity

Question 3

What are some causes of secondary hypertension?

Answer 3

Renal disease

Endocrine disorders

Question 4

What are the clinical features of hypertension?

Answer 4

Usually asymptomatic until end-organ damage or acute spike
(Non-specific symptoms) Headaches, esp. early morning or waking headache
Dizziness, tinnitus, blurred vision
Flushed appearance
Epistaxis
Chest discomfort, palpitations; strong, bounding pulse on palpation
Nervousness
Fatigue, sleep disturbances

Question 5

How is hypertension diagnosed?

Answer 5

24 hour blood pressure (ambulatory blood pressure monitoring (ABPM) / home blood pressure monitoring (HBPM))
(Additional investigation following diagnosis) Urea and electrolytes: check for renal disease, either as a cause or consequence of hypertension
HbA1c: check for co-existing diabetes mellitus, another important risk factor for cardiovascular disease
lipids: check for hyperlipidaemia, again another important risk factor for cardiovascular disease
ECG
urine dipstick

Question 6

What are the stages of hypertension?

Answer 6

(Stage 1 hypertension) Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg
(Stage 2 hypertension) Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg
(Severe hypertension) Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

Question 7

What is the treatment of hypertension?

Answer 7

(Lifestyle change)
(Step 1 treatment) patients < 55-years-old or a background of type 2 diabetes mellitus → ‘A’ : ACE inhibitor or Angiotensin receptor blocker
patients >= 55-years-old or of Afro-Caribbean origin → ‘C’ : Calcium channel blocker
(Step 2 treatment) (A+C) or (A + (D)iuretic ‘thiazine-like’)
(Step 3 treatment) (A + C + D)
(Step 4, resistant hypertension) if potassium < 4.5 mmol/l add low-dose spironolactone
if potassium > 4.5 mmol/l add an alpha- or beta-blocker