Hypertension

Question 1

Prevalence

Aetiology

Answer 1

Hypertension is persistently raised arterial blood pressure.

Primary hypertension (which occurs in about 90% of people) has no identifiable cause.
Secondary hypertension (about 10% of people) has a known underlying cause, such as renal, endocrine, or vascular disorder, or the use of certain drugs.

Question 2

Risk Factors

Answer 2

FH

Question 3

Symptoms

Answer 3

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).
Measure blood pressure in a relaxed, temperate setting, with the person quiet and seated and their arm outstretched and supported.
Measure blood pressure in both arms using an appropriate cuff size.
If the difference in readings between arms is more than 15 mmHg, repeat the measurements.
If the difference in readings between arms remains more than 15 mmHg on the second measurement, measure subsequent blood pressures in the arm with the higher reading.

If the person’s blood pressure is 180/120 mmHg or higher:
Refer for same-day specialist assessment if there are:
Signs of retinal haemorrhage and/or papilloedema (accelerated hypertension).
Life-threatening symptoms, such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury.
If there are no symptoms or signs indicating same-day referral, carry out investigations for target organ damage as soon as possible.
If target organ damage is identified, consider starting antihypertensive drug treatment immediately, without waiting for the results of ABPM or HBPM.
If no target organ damage is identified, repeat blood pressure measurement within 7 days.

Question 4

Potential impact on lifestyle

Answer 4

increased chance of stroke.mi

Question 5

Investigations

Answer 5

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 6

Classification

Answer 6

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 7

Advice
Medication
Target

Answer 7

ffer lifestyle advice, and continue to offer it periodically.
Diet and exercise — explain that a healthy diet and regular exercise can reduce blood pressure. If the person is overweight or obese, offer weight loss advice. For more information, see the CKS topic on Obesity.
Caffeine — discourage excessive consumption of coffee and other caffeine-rich products.
Dietary sodium — encourage people to keep their dietary sodium intake low, by reducing or substituting sodium salt, as this can reduce blood pressure. Be aware that salt substitutes containing potassium chloride should not be used by older people, people with diabetes, pregnant women, people with kidney disease, and people taking some antihypertensive drugs (such as angiotensin converting enzyme inhibitors and angiotensin-II receptor blockers). Encourage salt reduction in these groups of people.
Smoking — offer advice and help to smokers to stop smoking. For more information, see the CKS topic on Smoking cessation.
Alcohol — if the person drinks excessively, encourage a reduced intake because this can reduce blood pressure and has broader health benefits. For more information, see the CKS topic
Considering the need for antiplatelet or statin treatment.
Offering lifestyle advice, including advice on diet and exercise, stress management, alcohol consumption, and smoking cessation (if applicable).
Target clinic blood pressures are:
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.

Question 8

Monitoring/follow up

Answer 8

egular follow up