Hypertension: Summary
- Hypertension is persistently raised arterial blood pressure. It increases the risk of a number of conditions, including heart failure, coronary artery disease, stroke, chronic kidney disease, peripheral arterial disease, and vascular dementia.
- 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.
- 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).
- 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.
- Hypertension is classified according to severity:
- 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.
- Accelerated (or malignant) hypertension is a severe increase in blood pressure to 180/120 mmHg or higher (and often over 220/120 mmHg) with signs of retinal haemorrhage and/or papilloedema (swelling of the optic nerve).
- 'White-coat' hypertension is blood pressure that is unusually raised when measured during consultations with clinicians but is normal when measured in other 'non-threatening' situations.
- 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.
- 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 statin treatment, following cardiovascular risk assessment.
- Monitoring response to lifestyle changes and drug treatment.
- Reviewing the person annually to monitor blood pressure, review medication, provide support, and discuss lifestyle, symptoms, and treatment(s).
- 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.
- Postural hypertension — blood pressure target should be based on standing blood pressure.
- Frailty or multimorbidity — clinical judgement should be used.
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