Cardiovascular

Hypertension

Hypertension is persistently raised arterial blood pressure, usually without symptoms, diagnosed by correctly measured clinic pressure plus ambulatory or home confirmation unless severe pressure and acute target-organ injury require immediate specialist assessment.

Definition

Hypertension is persistently raised arterial blood pressure, confirmed in routine adult practice by clinic BP at least 140/90 mmHg plus waking ABPM or structured HBPM average at least 135/85 mmHg. Stage and the presence of acute target-organ injury determine urgency and treatment.

First principles

Blood pressure reflects flow and vascular resistance

Arterial pressure is determined principally by cardiac output and systemic vascular resistance. Primary hypertension emerges from interacting renal sodium handling, vascular stiffness, sympathetic tone, renin-angiotensin-aldosterone activity, age, genetics and environment rather than one lesion. A secondary cause becomes more likely with young onset, an abrupt change, suggestive symptoms or true resistance to treatment.

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