HYPERTENSION

Types:

• BP >140/90 (graded from 1 through to 3 in terms of severity)

• Essential Hypertension = Unknown aetiology = 95%
• Malignant Hypertension = BP > 200/130

Aetiology/Pathophysiology:

• Essential = Unknown
• Isolated Systolic Hypertension = arteriosclerosis (stiffening of large arteries)
• Secondary Hypertension (CHAPS – Conn’s, Hyperaldosteronism, Aortic
coarctation, Phaechromocytoma, Stenosis of renal arteries)
o Renal = (75% intrinsic, 25% renovascular)
o Endocrine = (Cushing’s, Conn’s, phaeochromocytoma, acromegaly,
hyperparathyroidism)
o Others = (Coarctation, pregnancy, steroids, MAOI, OCP)
• Vessel changes – structural changes in arteries i.e. thickening, reduction in
lumen diameter. Thickening of meida of large arteries, increase in collagen,
secondary deposition of Ca+, loss of arterial compliance. Left ventricular
hypertrophy

Symptoms/Signs:

• Usually asymptomatic (except malignant = headaches +/- papilloedema)

• Hypertensive retinopathy:
o I – tortuous arteries with thick shiny walls (sliver/copper wiring)
o II- A-V nipping (narrowing where arteries cross veins)
o III- Flame haemorrhages and cotton wool spots
o IV- Papilloedema

Investigations:

• ECG, BSL, Lipid profile (other vascular risk factors), UEC, urine dipstick for
protein/blood, 24 hour ambulatory BP monitoring (non-dippers i.e. no
lowering of hypertension during sleep have worse outcomes)

Management:
 • Treatment is dependent on definitive establishment of hypertension,
secondary causes ruled out, more aggressive when other vascular risk factors
present. In simple terms:
o Between 140-159, pharm treatment only when CHD/Stroke Risk Fx are
present. Lifestyle changes always recommended.

• NON-PHARM: ABCDE (Alcohol/Apnoea, Body weight i.e. reduce obesity,

Cigarette smoking cessation, Diet i.e. sodium restriction, Exercise)
• PHARM: Think ABCD (ACEI/ATRB, Beta Blockers, Calcium Channel Blockers,
Diuretics)
o Thiazide/thiazide like diuretics well established to reduce

Complications:

• RENAL: Proteinuria/Nephrosclerosis – CKD

• CARDIAC: LVH – CAD, Angina, Systolic/diastolic dysfunction, Afib, Ventricular
Arrhythymias  MI, CCF, VT/VF
• NEURO: Retinopathy, TIAs  Stroke
• Peripheral Vascular Disease