Hypertension: Difference between revisions

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(Replacing page with 'There are two types of hypertension: *Essential hypertension - which is caused by, well, nobody's sure. *Secondary hypertension - which is caused by something else. G...')
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[[Essential hypertension]]
There are two types of hypertension:


===Definition===
*[[Essential hypertension]] - which is caused by, well, nobody's sure.
[[image:highbloodpressure.jpeg|right|thumb|200px|The blood pressure here is incredibly high]]
*[[Secondary hypertension]] - which is caused by something else.
High [[blood pressure]]. According to NICE, it has to be persistenly over 140/90mmHg.


===Epidemiology===
Generally, excluding the second of these (if you'll excuse the pun), is important because it's often incredibly serious (like [[renal failure]] or something).
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===
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:
Hypertension is also massively associated with [[cardiovascular]] disease which is why it is so important. It increase the risk of:
*[[stroke]]
*[[ischaemic heart disease]]
*[[left ventricular hypertrophy]] and [[cardiac failure]]
 
===Clinical Features===
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]] BP
![[Diastolic]] BP
|-
|''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
|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.

Revision as of 13:59, 26 March 2009

There are two types of hypertension:

Generally, excluding the second of these (if you'll excuse the pun), is important because it's often incredibly serious (like renal failure or something).

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