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Pathology
Elevated systemic arterial blood pressure that confers cardiovascular risk
Aetiology
>95% have essential (primary) hypertension.
Secondary hypertension as a result of other disease which are listed below:
Renal: Diabetic nephropathy, Renovascular disease, Glomerulonephritis,
Vasculitides, Chronic pyelonephritis, Polycystic kidney Disease
Endocrine: Conn’s syndrome, Cushing’s syndrome, Hyperparathyroidism
Glucocorticoids, Phaeochromocytoma, Acromegaly
Other: Aortic coarctation, Pre-eclampsia, Obesity, Excessive dietary salt, Drugs (NSAIDs, sympathomimetics, amphetamine, MDMA, and cocaine)
Signs
Signs of underlying disease,
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Symptoms
Usually asymptomatic.
Severe hypertension associated with headache, confusion drowsiness, visual symptoms, nausea and vomiting (hypertensive encephalopathy)
Investigations
Serial Measurements: Ambulatory or home blood pressure monitoring
Bloods: Full lipid profile, fasting glucose, U&E,
ECG: Assess for any underlying cause
MSU: Assess for blood and protein
Other: Investigations for underlying cause as indicated e.g. renal artery MRA
Staging:
Stage 1: Clinic BP ≥140/90 mmHg and ambulatory/home daytime
average ≥135/85 mmHg
Stage 2: Clinic BP ≥160/100 mmHg and ambulatory/home daytime average ≥150/95 mmHg
Severe: Clinic SBP ≥180 mmHg or clinic DBP ≥110 mmHg
Treatment
Treatment should be offered to everyone with stage 2 hypertension or anyone <80 years with stage 1 hypertension and either target organ damage, established CVS disease, renal disease, diabetes or a 10 year CVS risk ≥20%.
Prognosis
Ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, LVH, heart failure, retinopathy, nephropathy, encephalopathy.
A reduction in SBP of 20 mmHg or DBP of 10 mmHg is associated with ~50% reduction in risk of death from stroke or ischaemic heart disease
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