Hypertension

Key words: HBP, high blood pressure, acute myocardial infarction, stroke

Hypertension is an arterial disease characterized by the elevation of the blood pressure. It is an important risk factor for subsequent cardiovascular disease (CVD) such as acute myocardial infarction and stroke.

First Consult's medical topic on Hypertension provides a summary of the disease as follows:

• a systolic blood pressure of at least 140mmHg and/or a diastolic blood pressure of at least 90mmHg in adults.
• Systolic blood pressure of 120-139mmHg or a diastolic blood pressure of 80-89mmHg in adult patients should be considered prehypertensive. These patients require counseling about health-promoting lifestyle changes to prevent or delay the onset of hypertension, and should be followed at least annually
• Approx. 90% of cases of hypertension have no identifiable cause, and uncomplicated essential hypertension is asymptomatic
• Preoperative hypertension is associated with significant increases in perioperative morbidity and mortality, but it is unknown whether the preoperative treatment of hypertension lowers the risk
• Hypertension in children and adolescents is increasingly recognized. Approx. 5% of children and adolescents have essential hypertension.

Guidelines and clinical resources

• The NICE clinical guidelines on management of hypertension in adults in primary care covers: how doctors should find out whether someone has high blood pressure, how doctors should assess someone's risk of developing problems with their heart or blood vessels, such as a heart attack or stroke...
• The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) including a physician reference card and slide shows
• MD Consult differential diagnosis article comparing clinical features for Hypertensive emergencies
• MedlinePlus medical encyclopaedia article on Hypertension
• Emedicine article on Hypertension covering history, treatment and medication of hypertension.
• MD Consult medical topic on Hypertensive disorders in pregnancy. Hypertensive disorders in pregnancy occur in about 12-22% of pregnancies...
• MD Consult article on Hypertension in children. Systemic pediatric hypertension is indicated by blood pressure measurements equal to or greater than the 95th-percentile value for the patient's height, sex, and age...

Images

In this 32-year-old man with hypertension of 8 years’ duration and malignant hypertension on present admission there is progressive accumulation of ^99mTc-MAG₃ on sequential posterior view 3-min images. From Ell & Gambhir: Nuclear Medicine in Clinical Diagnosis and Treatment

Mendelian forms of hypertension that cause mineralocorticoid-induced hypertension. From Goldman: Cecil Medicinee

Some abnormalities in cerebral vessels during chronic hypertension. From Mohr: STROKE: Pathophysiology, Diagnosis, and Management