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blood pressure (hypertension, raised blood pressure)

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Hypertension is high systemic arterial blood pressure. NICE define hypertension as persistent raised blood pressure 140/90 mmHg or higher (1).

Screening of the population for hypertension should be a priority because the condition is common, asymptomatic and has devastating complications.

  • it has a strong association with cardiovascular diseases (CVD) and has become the leading risk factor for premature death in the world. High blood pressure has been attributed to
    • 58% of haemorrhagic stroke
    • 50% of ischaemic stroke
    • 55% of ischaemic heart disease
    • 58% of other cardiovascular diseases - including rheumatic and hypertensive heart disease, cardiomyopathy, rhythm or conduction disorders, aortic aneurysms, peripheral vascular disease and other cardiovascular diseases (2)

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 from stroke
  • 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

Blood pressure targets (1):

 

ABPM = ambulatory blood pressure monitoring

HBPM = home blood pressure monitoring

  • if CKD and hypertension
    • in people with CKD aim to keep the systolic blood pressure below 140 mmHg (target range 120-139 mmHg) and the diastolic blood pressure below 90 mmHg
    • in people with CKD and diabetes, and also in people with an ACR of 70 mg/mmol or more, aim to keep the systolic blood pressure below 130 mmHg (target range 120-129 mmHg) and the diastolic blood pressure below 80 mmHg.

Notes:

  • 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 and stroke.

Reference:

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