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1. Hypertension
Hypertension (high bloodpressure) is an important risk factor
for the future development of cardiovasculardisease.
the risk of cardiovasculardisease doubles for every 20/10
mmHg rise in blood pressure.
The cardiovascularcomplicationsassociated with hypertension
are shown in. The most common and important
of these are stroke and myocardialinfarction. An increase of
5 mmHg in usual diastolic bloodpressure is associated with
a 35–40% increased risk of stroke. There is a similarbut less
steep association for coronary heart disease risk. The risk
of heart failure is increased six-fold in hypertensive subjects.
Meta-analysisof clinicaltrialshas indicatedthat these risks
are reversible with relativelymodest reductionsin blood
pressure of 10/6 mmHg associated with a 38% reductionin
stroke
and 16% reduction in coronary events
while a 5 mmHg reduction in blood pressure is associated
with a 25% reduction in risk of renal failure.

2. Complicationsof hypertension
• Myocardialinfarction
• Stroke
– Cerebral/brainstem infarction
– Cerebral haemorrhage
– Lacunar syndromes
– Multi-infarct disease
• Hypertensive encephalopathy/malignanthypertension
• Dissecting aortic aneurysm
• Hypertensive nephrosclerosis
• Peripheral vasculardisease
Epidemiology
Causes of hypertension
Primary hypertension (90–95%)
• Essential hypertension
Secondary hypertension (5–10%)
• renal diseases
• Endocrine diseases
– Steroid excess: hyperaldosteronism (Conn's syndrome);
hyperglucocorticoidism (Cushing's syndrome)
– Growth hormone excess: acromegaly

3. – Catecholamine excess: phaeochromocytoma
– Others: pre-eclampsia
• vascular causes
– Renal artery stenosis: fibromuscular hyperplasia; renal
artery atheroma; coarctation of the aorta
• Drugs
– Sympathomimetic amines
– Oestrogens (e.g. combined oral contraceptive pills)
– Ciclosporin
– Erythropoietin
– NSAIDs
– Steroids
Hypertension is more common in black people of African Caribbean
origin, who are also at particular risk of stroke and renal failure.
Hypertension is exacerbated by other factors, for example, high salt or
alcohol intake or obesity
Regulation of blood pressure
Minute-to-minute changes in blood pressure are regulated by the
baroreceptor reflex, while the renin–angiotensin–aldosterone system
is important for longer term salt, water and blood pressurecontrol.

4. Clinical presentation
Malignant (accelerated) hypertension
(usually >220/120mmHg)
The clinical featuresn are confusion, headache, visual loss, seizures and
coma. Malignant hypertension is a medical emergency that requires
hospital admission and rapid control of blood pressure over 12–24 h
towards normal levels.
Management of hypertension
Diagnosis of hypertension
Sphygmomanometer
both arms
should be relaxed
should be measured in both the sitting and the standing positions.
An appropriate sized cuff should be used
Home or ambulatory blood pressure measurements
Ambulatory blood pressure monitoring over 24 h is also useful for
patients who have unusual variability in blood pressure, resistant
hypertension or symptoms suggesting hypotension. Home or
ambulatory blood pressure measurements are usually lower than
clinic recordings, on average by 12/7 mmHg
Assessment of the hypertensive patient
Secondary causes

5. Contributing factors