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Primary or essential hypertension refers to hypertension without demonstrable
cause. It accounts for 95% of all cases of hypertension and is a diagnosis of
Blood pressure is normally distributed in the population and there is no natural
cut-off point above which 'hypertension' definitively exists and below which
it does not
- risk associated with increasing blood pressure is continuous, with each
2 mmHg rise in systolic blood pressure associated with a 7% increased risk
of mortality from ischaemic heart disease and a 10% increased risk of mortality
- diastolic pressure is more commonly elevated in people younger than 50.
With ageing, systolic hypertension becomes a more significant problem, as
a result of progressive stiffening and loss of compliance of larger arteries
- at least one quarter of adults (and more than half of those older than 60)
have high blood pressure.
NICE have classified hypertension as:
This guidance uses ambulatory or home monitoring to confirm stage 1 or stage
Stage 1 hypertension
- clinic blood pressure is 140/90 mmHg or higher AND
- subsequently Ambulatory blood pressure monitoring (ABPM) daytime average
OR Home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg
Stage 2 hypertension
- clinic blood pressure is 160/100 mmHg or higher AND
- subsequently ABPM daytime average or HBPM average blood pressure is
150/95 mmHg higher.
- clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic
blood pressure is 110 mmHg or higher
- the diagnosis of hypertension should not be made on the basis of a single
elevated reading. In many cases, a second blood pressure reading is lower,
and often, a third lower still
- patients found to have malignant or accelerated phase hypertension should
be referred to hospital as an emergency
- the majority of patients will have essential hypertension but it is nevertheless
imperative to fully investigate for secondary causes
- assessment should also consider other risk factors for cardiovascular disease
- NICE (November 2016).
Clinical management of primary hypertension in adults
Last reviewed 01/2018