1. Hypertension
Yasmin Ismail
SpR Cardiology
Gloucestershire Royal Hospital

2. Clinical Significance
• Important determinant in CV morbidity &
mortality
• Major risk factor for MI, PVD,
cerebrovascular disease, renal disease and
heart failure
• Implications for lifelong therapy

3. Definition
• Arbitrary
• NICE guidelines published in June 2006
• Aim to identify pts with HT (persistent raised bp >
160/100 mmHg or >140/90 with a 10yr CVD risk
> 20%)
• Diabetics – higher risk group

4. Aetiology
• Primary HT
• Secondary HT

5. Primary HT
• Accounts for ~ 95% of cases
• Cause unknown
• Factors involved include genetics,
environmental, geographic, foetal, sex, Na+
balance, RA system, endothelial
dysfunction, insulin resistance and
sympathetic activity.

6. Secondary HT
• Accounts for ~ 5%
• Often young patients
• Important to identify as often treatable

7. Causes of Secondary HT
• Renal Disease - parenchymal disease, reno-
vascular disease
• Endocrine Disease - Conn’s Syndrome,
Cushing’s Syndrome, phaeochromocytoma,
hyperparathyroidism, hyperthyroidism,
acromegaly
• Coarctation of the Aorta
• Pregnancy-related
• Drug-induced

8. Clinical Features
• Usually asymptomatic
• Symptoms such as headaches, feeling faint,
tinnitus & epistaxis occur equally in
normotensive and HT populations
• May see endocrine stigmata eg. Cushing-
oid facies
• May see evidence of end-organ damage eg
CVA

9. Clinical Approach I
• First take a full history including salt,
calorie & alcohol intake, additional
cardiovascular risk factors such as smoking,
diabetes mellitus and for possible
complications such as previous CVA, MI.
• Consider secondary causes if pt young and
ask appropriate questions.

10. Clinical Approach II
• Check the blood pressure (ideally twice) on
at least 3 separate clinic visits.
• Pt should be relaxed, quiet and warm.
• Check bp in both arms and take the highest
value.
• Ensure cuff size correct

11. Clinical Approach III
• Perform a full examination ( look for end-
organ damage in eyes, cardiac & peripheral
pulses & for 2 causes such as renal bruits,
radio-femoral delay, polycystic kidneys,
features of endocrine disease)

12. Basic Investigations
• Bloods - U+Es, creatinine, glucose,
HDL/LDL cholesterol.
• 12-lead ECG for LVH
• Urine test for protein (also blood, glucose).

14. Management I
• Lifestyle interventions
• Diet
• Exercise
• Alcohol
• Tea/coffee and xs caffeine-rich products
• Smoking

15. Management II
• Assessment of CV risk
• Use British National Formulary tables (age,
sex, smoking, cholesterol) in non-diabetics
–treat bp if 10 yr CVD risk >20% and bp
>140/90.
• All diabetics - HIGH RISK- aim for bp <
130/80

17. Suggested Websites
• www.bhsoc.org.uk
• www.nice.org.uk