Short Note: Hypertension

Definition: Persistent elevation of systolic blood pressure of 140mmHg or greater and/or diastolic blood pressure of 90mmHg or more.

Classifications:

1)     Aetiological

a.     Primary Hypertension

b.     Secondary Hypertension

                                                    i.     Hyperaldosteronism (Conn’s syndrome)

                                                   ii.     Pheochromocytoma

                                                  iii.     Cushing’s syndrome

                                                 iv.     Hyperparathyroidism

                                                   v.     Hyper/hypothyroidism

                                                 vi.     Renal artery stenosis

                                                vii.     Chronic renal failure

                                               viii.     Drugs

                                                 ix.     Obstructive sleep apnoea

                                                   x.     Neurofibromatosis

2)     Blood pressure reading

a.     Optimal: systolic less than 120mmHg, diastolic less than 80mmHg

b.     Prehypertension: systolic 120-139mmHg and/or diastolic 80-89mmHg

c.      Stage 1 Hypertension: systolic 140-159mmHg and/or diastolic 90-99mmHg

d.     Stage 2 Hypertension: systolic 160-179mmHg and/or diastolic 100-109mmHg

e.     Stage 3 Hypertension: systolic ≥180mmHg, diastolic ≥110mmHg

Symptom of Hypertension: None

Sign of Hypertension: Elevated blood pressure

Cardiovascular risk factors:

a)     Hypertension
b)     Cigarette smoking
c)     Central obesity
      i)     Men: waist circumference >90 cm
      ii)   Women: waist circumference >80 cm
d)     Physical inactivity
e)     Dyslipidaemia
f)       Diabetes mellitus
g)     Microalbuminuria
h)     GFR <60 mL/min
i)       Age: men >55 years old, women >65 years old
j)       Family history of cardiovascular disease

History should include:

a)     Duration and level of elevated blood pressure
b)     Symptoms of secondary causes of hypertension
c)     Symptoms of target organ damage
d)   Symptoms of concomitant disease that affect prognosis of hypertension i.e. diabetes mellitus, gout, renal disease
e)     Family history of hypertension, heart diseases, stroke, diabetes, renal disease, dyslipidaemia
f)       Dietary history: salt, fat, caffeine and alcohol intake
g)     Drug history
h)     Lifestyle and environmental factors: smoking, physical inactivity, work stress, weight gain

Physical examination:
a)     Height, weight, waist circumference
b)     Two or more blood pressure measurements: each supine, seated, after standing for at least one minute
c)     Blood pressure of both arms
d)     Fundoscopy
e)     Carotid bruit, abdominal bruit, presence of peripheral pulses, radio-femoral delay
f)       Cardiac examination
g)     Examination for evidence of cardiac failure
h)     Abdominal examination: renal masses, aortic aneurysm, abdominal obesity
i)       Neurological examination to look for evidence of stroke
j)       Signs of endocrine diseases

Target organ damage or complication
a)     Cardiac: left ventricular hypertrophy (displaced apex beat), coronary heart disease, heart failure
b)     Cerebrovascular: transient ischaemic attack, stroke
c)     Peripheral vasculature: absence peripheral pulse, intermittent claudication
d)   Renal: chronic kidney disease (GFR <60ml/min, proteinuria, microalbuminuria 2 out of 3 positive tests
     over 4-6 months)
e)     Retinopathy: haemorrhages, exudates, papilloedema