This document discusses hypertension (high blood pressure) including its causes, effects on the heart, treatment targets, and drug treatment options. It notes that primary hypertension accounts for 90-95% of cases and outlines trial findings showing benefits of tight blood pressure control, especially in patients with diabetes. Treatment involves lifestyle changes and medications, typically starting with diuretics, with the goal of controlling blood pressure to under 140/85 mmHg.

1. Hypertension

3. This left ventricle is very thickened (slightly over 2 cm in thickness), but the rest of the heart is not greatly enlarged. This is typical for hypertensive heart disease. The hypertension creates a greater pressure load on the heart to induce the hypertrophy.

4. The left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy.

7. Global heart threat from diabetes: A global explosion in the number of cases of diabetes is threatening to reverse the reduction in deaths from heart disease in many western countries, including the United Kingdom. To coincide with World Diabetes Day on 14 November, Diabetes UK is calling for action to be taken to reduce the 20,000 deaths per year from coronary heart disease (CHD) among people with diabetes in the UK.

16. Compelling and possible indications and contrindications for the major classes of antihypertensive drugs INDICATIONS CONTRAINDICATIONS * ACE inhibitors may be beneficial in chronic renal failure but should be used with caution. Close supervision and specialist advice are needed when there is established and significant renal impairment † Caution with ACE inhibitors and angiotensin II receptor antagonists in peripheral vascular disease because of association with renovascular disease. ‡ If ACE inhibitor indicated  -blockers may worsen heart failure, but in specialist hands may be used to treat heart failure British Hypertension Society Guidelines 2000 CLASSS OF DRUG COMPELLING POSSIBLE POSSIBLE COMPELLING  -blockers Prostatism Dyslipidaemia Postural Hypotension Unrinary incontinence Angiotensin converting enzyme (ACE) inhibitors Heart failure Left ventricular dysfunction Chronic renal disease * Type II diabetic nephropathy Renal impairment * Peripheral vascular disease † Pregnancy Renovascular disease Angiotensin II receptor antagonists Cough induced by ACE inhibitor ‡ Heart failure Intolerance of other antihypertensive drugs Peripheral vascular disease Pregnancy Renovascular disease  blockers Myocardial infarction Angina Heart failure Heart failure Dyslipidaemia Peripheral vascular disease Asthma or COPD Heart block Calcium antagonists (dihydropyridine) Isolated systolic hypertension (ISH) in elderly patients Angina Elderly patients _ _ Calcium antagonists (rate limiting) Angina Myocardial infarction Combination with  blockade Heart block Heart failure Thiazides Elderly patients including ISH _ Dyslipidaemia Gout

17. Therapeutic targets Therapeutic targets * Measured in clinic Mean daytime ABPM or home measurement Blood Pressure No diabetes Diabetes No diabetes Diabetes Optimal <140/85 <140/80 <130/80 <130/75 Audit Standard <150/90 <140/85 <140/85 <140/80 The audit standard reflects the minimum recommended levels of BP control. Despite best practice, it may not be achievable in some treated hypertensive patients. NB: Both systolic and diastolic targets should be reached British Hypertension Society Guidelines

18. Logical Combinations * Verapamil + beta-blocker = absolute contra-indication Diuretic  - blocker CCB ACE inhibitor  - blocker Diuretic -  -    - blocker  -  * -  CCB -  * -   ACE inhibitor  -  -   - blocker     -