Phys · cardiovascular
Hypertension
Also known as high blood pressure · raised blood pressure · systemic hypertension · essential hypertension · primary hypertension · secondary hypertension · resistant hypertension · hypertensive emergency · accelerated hypertension · malignant hypertension · isolated systolic hypertension
Consultant-physician-depth guide to hypertension — definition and classification across ANZ/UK/US guidelines, pathophysiology, secondary causes workup, target organ damage, lifestyle and pharmacological management, resistant hypertension, and hypertensive emergencies. Structured for FRACP DWE and DCE preparation.
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Target exams
Red flags
- Hypertensive emergency — BP elevation with acute target organ damage (encephalopathy, dissection, pulmonary oedema, eclampsia)
- New or resistant hypertension under age 40 — investigate for secondary cause
- Hypokalaemia in a hypertensive patient not on diuretics — screen for primary aldosteronism
- Episodic hypertension with headache, sweating, palpitations — screen for phaeochromocytoma
- Radio-femoral delay with upper limb hypertension — coarctation of the aorta
- Sudden BP rise above baseline with visual disturbance or confusion — hypertensive encephalopathy
Hypertension
Meet the patient
A 52-year-old man presents for a routine check. His clinic BP is 158/96 on two readings. He smokes, has a BMI of 31, and his father had a stroke at 65. He asks whether he really needs tablets. [1]
The question is not just whether the number is high — it is whether the number is real (confirm with ABPM or home monitoring), what damage it has already done (ECG, urine ACR, renal function, fundoscopy), and what his cardiovascular risk looks like once you factor in smoking and family history. Confirm before you diagnose; assess damage before you treat. [1]
References8ShowHide
- [1]Wright JT Jr, Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control N Engl J Med, 2015.PMID 26551272
- [2]Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients N Engl J Med, 2008.PMID 19052124
- [3]Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial Lancet, 2015.PMID 26414968
- [4]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Hypertension, 2018.PMID 29133354
- [5]Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA) J Hypertens, 2023.PMID 37345492
- [6]Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab, 2016.PMID 26934393
- [7]ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) JAMA, 2002.PMID 12479763
- [8]Cooper CJ, Murphy TP, Cutlip DE, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis N Engl J Med, 2014.PMID 24245566