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Hypertension

Revision as of 14:43, 19 October 2023 by Nikolas (talk | contribs) (Created page with "'''Hypertension''', elevated blood pressure in the arterial system, is not a disease but a risk factor for development of many diseases, most notably cardiovascular disease. It’s mostly asymptomatic. Hypertension is a major cause of morbidity and mortality worldwide, and it’s also becoming more and more common. However, even small decreases in blood pressure in the case of hypertension cause large improvements in the risk for complications. Hypertension is Primar...")
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Hypertension, elevated blood pressure in the arterial system, is not a disease but a risk factor for development of many diseases, most notably cardiovascular disease. It’s mostly asymptomatic.

Hypertension is a major cause of morbidity and mortality worldwide, and it’s also becoming more and more common. However, even small decreases in blood pressure in the case of hypertension cause large improvements in the risk for complications.

Hypertension is primary (idiopathic) in 90% of cases. The remaining are secondary to an underlying disorder.

Classification of severity

According to the European Society of Cardiology (ESC):

Severity Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg)
Normal <140 <90
Grade 1 HTN 140 – 160 90 – 100
Grade 2 HTN 160 – 180 100 – 110
Grade 3 HTN >180 >110
Isolated systolic HTN >140 <90
Isolated diastolic HTN <140 >90

Special types

  • White-coat hypertension – hypertension in a clinical scenario (hospital, clinic) but not on ambulatory measurements
  • Masked hypertension – hypertension on ambulatory measurements but not in a clinical scenario
  • Treatment-resistant hypertension – uncontrolled blood pressure despite the use of 3 antihypertensive agents of different classes, where one is a diuretic.
  • Hypertensive crisis – an acute increase in blood pressure corresponding to grade 3 hypertension. It’s an umbrella term for two conditions, hypertensive urgency and hypertensive emergency.
    • A hypertensive urgency is a hypertensive crisis which is asymptomatic or only causes nonspecific symptoms like headache or dizziness.
    • A hypertensive emergency is a hypertensive crisis which causes end-organ damage to the heart, CNS, kidney, eye, etc.

Clinical features

Hypertension by itself is asymptomatic, but there may be findings of cardiovascular disease or renal disease. Severe hypertension may cause non-specific symptoms like headache.

Diagnosis and evaluation

The diagnosis of hypertension is not made after one measurement of elevated blood pressure. Proper diagnosis requires multiple measurements under standardised conditions at multiple consultations.

Ambulatory (24 hour) blood pressure monitoring (ABPM) involves wearing a blood pressure during a whole 24-hour period while the patient goes along with their life. It measures the blood pressure at fixed intervals of 15 – 60 minutes. ABPM can be used to confirm blood pressure readings and diagnose white coat and masked hypertension.

Home blood pressure monitoring (HBPM) requires patient training and proper equipment to be accurate.

Complications