Hypertension: Difference between revisions

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[[image:highbloodpressure.jpeg|right|thumb|350px|The blood pressure here is incredibly high]]
===What is Hypertension===
===Definition===
'''Hypertension is high [[blood pressure]]'''. It's the opposite of [[hypotension]].
High blood pressure. According to NICE, it has to be persistenly over 140/90mmHg.
===Epidemiology===
Ridiculously high prevalence - 11.3%.  95% is primary (i.e. no known cause).
===Pathophysiology===
There are two types :
*'''essential''' (aka ''primary'' or ''systemic'') - it just happens and nobody knows the cause.
*'''secondary''' - caused by another disease.


===Risks===
===What types are there?===
====Risk Factors====
There are two types of hypertension:
Nobody knows the exact cause of hypertension but there are some risk factors:
*Diet - high salt, calcium and coffee intake
*[[Genetics]]
*[[Oral contraceptive]]
*[[HRT]]


====Associated Risks====
*[[Essential hypertension]] - which is caused by, well, nobody's sure.
Hypertension is massively associated with [[cardiovascular]] disease which is why it is so important. It increase the risk of:
*[[Secondary hypertension]] - which is caused by something else.
*[[stroke]]
*[[ischaemic heart disease]]
*[[left ventricular hypertrophy]] and [[cardiac failure]]


===Clinical Features===
Excluding the second of these is important because it's often incredibly serious (like [[renal failure]] or something).
The main clinical feature of high blood pressure is high blood pressure. Go figure. Well, I'm sure you did. This is about excluding [[secondary hypertension]].
 
====Classification====
 
 
{| border="1"
|-
!Category
!Systolic blood pressure (SBP)
!Diastolic blood pressure (DBP)
|-
|''Normal''
|
|
|-
|Optimal
|<120
|<80
|-
|Normal
|<130
|<85
|-
|High normal
|130-139
|85-89
|-
|''Hypertension''
|
|
|-
|Mild (grade 1)
|140-159
|90-99
|-
|Moderate (grade 2)
|160-179
|100-109
|-
|Severe (grade 3)
|>/=180
|>/=110
|}
 
Obviously, in most patients, looking to get the BP to normal is what you aim for. However, there are certain populations where you need to aim lower. Check this shit!
 
{| border="1"
|-
|
!SBP
!DBP
|-
!Diabetes - ''no nephropathy''
|
|
|-
|Intervention threshold
|140
|90
|-
|Target levels
|130
|80
|-
!Diabetes - ''with nephropathy''
|
|
|-
|Target levels
|130
|80
|-
|Proteinuria (<1g/24h protein in urine)
|125
|75
|-
!Renal disease
|
|
|-
|Intervention threshold
|140
|90
|-
|Target
|130
|80
|-
|Chronic renal disease/proteinuria (see above)
|125
|75
|}
 
===Investigations===
These are more appropriate if [[secondary hypertension]] is suspected. I'd look at the [[secondary hypertension]] page if I were you.
 
===Management===
[[NICE]] and the [http://www.bhsoc.org/ British Hypertension Society] (BHS) each came up with a set of guidelines regarding the management of hypertension. They came up with the algorithm on the right.
[[image:niceguidelines.gif|right|thumb|400px|<font color=red>A=ACE Inhibitors</font>; <font color=steelblue>C=Calcium-Channel Blocker</font>; and <font color=green>D=Thiazide Diuretic</font>]]
 
Hopefully, when to use <font color=red>ACE inhibitors</font> (ramipril, lisonipril, enalapril), <font color=steelblue>calcium-channel blockers</font> (amlodipine, felodipine, nifedipine) and <font color=green>thiazide diuretics</font> (usu. bendroflumethiazide) is obvious from the incredibly professionally drawn flow chart. Under the "clever other shit" moniker we have things like:
*Beta blockers - atenolol, propanolol, bisoprolol
*Angiotensin II receptor inhibitors/angiotensin receptor blocker (ARB)- losartan, irbesartan, valsartan
*alpha blockers - doxasozin
Basically, you try different drugs until you get their blood pressure to the target levels (or you give up and refer them to a specialist).<br>
<br>
In '''diabetes''' (both types) '''with nephropathy''' an <font color=red>ACE inhibitor</font> is recommeneded (with ARBs as an alternative). The same treatment should be used in '''chronic kidney disease'''. The benefit is beyond that of simply lowering blood pressure.

Latest revision as of 06:11, 5 April 2013

What is Hypertension

Hypertension is high blood pressure. It's the opposite of hypotension.

What types are there?

There are two types of hypertension:

Excluding the second of these is important because it's often incredibly serious (like renal failure or something).

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