What is Hypertension?
Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses such as heart attack, stroke, heart failure, aneurysm, or renal failure
How would you record the blood pressure?
· Using a device whose accuracy has been validated and one that has been recently calibrated.
· The patient should be seated with the arm at the level of the heart. The blood pressure cuff should be appropriate for the size of the arm and the cuff should be deflated at 2 mm/s and the diastolic blood pressure is measured to the nearest 2 mmHg. Diastolic blood pressure is recorded as disappearance of the sounds (phase V).
· At least two recordings of blood pressure should be made at each of the several visits to determine blood pressure thresholds.
What are the causes of blood pressure discrepancy between the arms or between the arms and legs?
· Coarctation of aorta.
· Patent ductus arteriosus.
· Dissecting aortic aneurysm.
· Arterial occlusion or stenosis of any cause.
· Supravalvular aortic stenosis.
· Thoracic outlet syndrome.
How would you investigate a patient with hypertension in outpatients?
· Full blood count (FBC).
· Urine for sugar, albumin and specific gravity.
· Urea, electrolytes and serum creatinine.
· Fasting lipids, fasting blood sugar, serum uric acid.
· Serum total:HDL cholesterol ratio.
· ECG.
· Chest radiograph.
· 24-hour urine collection to measure vanillylmandelic acid.
What are the indications for ambulatory blood pressure recording?
· When clinic blood pressure shows unusual variability.
· When hypertension is resistant to drug treatment with three or more agents.
· When symptoms suggest that the patient may have hypotension.
· To exclude 'white-coat hypertension'.
What are causes of hypertension?
· Unknown or idiopathic (in 90% of cases).
· Renal: glomemlonephritis, diabetic nephropathy, renal artery stenosis, pyelonephritis.
· Endocrine: Cushing's syndrome, steroid therapy, phaeochromocytoma.
· Others: coarctation of aorta, contraceptives, toxaemia of pregnancy.
What special investigations would you perform to screen for an underlying cause?
· Renal digital subtraction angiography.
· 24-hour urinary catecholamines - at least three samples (phaeochromocytoma).
· Overnight dexamethasone suppression test.
What is the purpose of treatment in hypertension?
The purpose is to reduce the risk of devastating hypertensive complications such as myocardial infarction, stroke and heart failure.
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