Hypertension

Published on 01/03/2015 by admin

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Last modified 01/03/2015

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68

Hypertension

Hypertension is a common clinical problem. It is defined as chronically increased systemic arterial blood pressure. The definition of hypertension has changed over the years, as more effective treatments have become available. The WHO classification of hypertension is shown in Table 68.1. It is important not to base clinical decisions on a single blood pressure reading. Some patients have ‘white coat’ hypertension, where readings taken by doctors or other health professionals are misleadingly high. Ambulatory blood pressure measurement over a whole day provides the most detailed information (Fig 68.1).

Table 68.1

WHO classification of hypertension

Category BP (mmHg)
Optimal blood pressure <120/80
Normal blood pressure <130/85
Mild hypertension 140/90–159/99
Moderate hypertension 160/100–179/109
Severe hypertension ≥180/110

If hypertension is left untreated, patients are at risk of several complications. These include:

Occasionally patients present with severe hypertension associated with a severe form of retinopathy known as papilloedema, and progressive renal failure. This is known as malignant hypertension and requires urgent treatment.

Causes of hypertension

Hypertension is related to genetic and environmental factors. Often it runs in families, more than would be expected simply on the basis of a shared environment; other associations include obesity, diabetes, and excess alcohol consumption. In many patients, the cause is not known, and in these patients it is referred to as ‘primary’ or ‘essential’ hypertension. So-called secondary hypertension is due to clearly identifiable causes (see below), some of which may be diagnosed or monitored biochemically. However, other modalities of investigation are at least as important in the investigation of hypertension. For example, imaging of renal arteries, or isotope renograms, may provide vital diagnostic information.