DEFINITION
- Hypertension is typically diagnosed when the clinic blood pressure is consistently ≥ 140/90 mmHg.
CLASSIFICATION
AETIOLOGY
- Essential hypertension: the most common form, with no identifiable cause.
- Secondary hypertension: caused by underlying conditions - Renal/Endocrine/Medication.
CLINICAL FEATURES
- Often asymptomatic, but some individuals may experience symptoms such as headaches, dizziness, or visual disturbances.
- Complications of long-standing hypertension may include target organ damage, such as heart disease, stroke, kidney disease, and retinopathy.
INVESTIGATIONS
- Accurate blood pressure measurement using validated devices.
- Confirm diagnosis using ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM) or if not possible through repeated clinic BP measurements.
- ABPM for Hypertension Diagnosis
- Frequency of Measurements: Ensure at least 2 measurements per hour.
- Timing: Take measurements during usual waking hours (e.g., 08:00 to 22:00).
- Confirming Diagnosis: Use the average of at least 14 measurements taken during waking hours.
- HBPM for Hypertension Diagnosis
- Measurement Protocol: Take 2 consecutive measurements for each recording, at least 1 minute apart.
- Frequency of Recordings: Record blood pressure twice daily, ideally in the morning and evening.
- Duration of Monitoring: Continue recording for at least 4 days, ideally for 7 days.
- Data Utilization: Discard measurements from the first day. Use the average value of all remaining measurements to confirm a diagnosis of hypertension.
- Assess for target organ damage - Urinalysis (urine dip for blood + urine ACR), Bloods (U+E, eGFR, HbA1c, Lipid profile), ECG, and fundoscopy.
- Assess cardiovascular risk using the QRISK calculator.
MANAGEMENT
- Lifestyle modifications:
- Encourage weight loss, regular physical activity, healthy diet, sodium reduction, moderation of alcohol consumption, and smoking cessation.
- Medications:
- Consider antihypertensive drug treatment if lifestyle modifications alone are insufficient.
- Choice of medication depends on various factors, including comorbidities.
- Regular monitoring of blood pressure and adjustment of treatment as needed.
- Provide ongoing support, education, and lifestyle advice to promote long-term management and adherence to treatment.
MEDICATIONS
COMPLICATIONS
- Cardiovascular disease:
- Increased risk of heart attacks, strokes, heart failure, and peripheral arterial disease.
- Kidney disease:
- Hypertension can lead to chronic kidney disease and end-stage renal disease.
- Retinopathy:
- Hypertensive retinopathy can cause vision problems and even blindness.
- Other complications:
- Hypertension is associated with an increased risk of aortic aneurysm, cognitive decline, and metabolic disorders.