Elevated systemic arterial blood pressure that confers cardiovascular risk


>95% have essential (primary) hypertension.

Secondary hypertension as a result of other disease which are listed below:

Renal: Diabetic nephropathy, Renovascular disease, Glomerulonephritis, Vasculitides, Chronic pyelonephritis, Polycystic kidney Disease

Endocrine: Conn’s syndrome, Cushing’s syndrome, Hyperparathyroidism, Glucocorticoids, Phaeochromocytoma, Acromegaly

Other: Aortic coarctation, Pre-eclampsia, Obesity, Excessive dietary salt, Drugs (NSAIDs, sympathomimetics, amphetamine, MDMA, and cocaine)


Signs of underlying disease, LVH, heart failure, aortic aneurysm, peripheral vascular disease, cerebrovascular disease, retinopathy.


Usually asymptomatic.

Severe hypertension associated with headache, confusion drowsiness, visual symptoms, nausea and vomiting (hypertensive encephalopathy)


Serial Measurements: Ambulatory or home blood pressure monitoring

Bloods: Full lipid profile, fasting glucose, U&E,

ECG: Assess for any underlying cause

MSU: Assess for blood and protein

Other: Investigations for underlying cause as indicated e.g. renal artery MRA

Hypertension Staging:

Stage 1: Clinic BP ≥140/90 mmHg and ambulatory/home daytime

average ≥135/85 mmHg

Stage 2: Clinic BP ≥160/100 mmHg and ambulatory/home daytime average ≥150/95 mmHg

Severe: Clinic SBP ≥180 mmHg or clinic DBP ≥110 mmHg


Treatment should be offered to everyone with stage 2 hypertension or anyone <80 years with stage 1 hypertension and either target organ damage, established CVS disease, renal disease, diabetes or a 10 year CVS risk ≥20%.


Ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, LVH, heart failure, retinopathy, nephropathy, encephalopathy.A reduction in SBP of 20 mmHg or DBP of 10 mmHg is associated with ~50% reduction in risk of death from stroke or ischaemic heart disease

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