Essential (primary) hypertension

Question 1

What is the definition of essential hypertension?

Answer 1

High blood pressure that does not have a known secondary cause
Treat any BP over 160/100mmHg or over 140/90mmHg if high risk

Question 2

What is the epidemiology of essential hypertension?

Answer 2

30-45% of the general population suffer with high blood pressure
95% of all cases of hypertension

Question 3

What is the pathology of essential hypertension?

Answer 3

• Blood pressure is dependent on cardiac output and peripheral resistance
• Cardiac output is determined by stroke volume and heart rate
• Stroke volume is related to myocardial contractility and size of the vascular compartment
• Cardiac output is ↑ early in the disease course
• Then cardiac output ↓ but total peripheral resistance ↑
• Why this happens is not well understood but there are 3 theories:
• 1) over-reactive renin-angiotensin system = vasoconstriction and retention of Na and H20
• 2) Overactive sympathetic nervous system = ↑ stress response

Question 4

What are the risk factors/aetiology of essential hypertension?

Answer 4

• GENETICS
• Low foetal birth weight
• Family history
• Black ethnicity
• Age - > 60
• Diabetes/insulin resistance
• Smoking
• Lack of exercise
• Vit D deficiency
• Obesity
• High salt and alcohol diet

Question 5

What are the signs/symptoms of essential hypertension?

Answer 5

• Usually asymptomatic
• Headaches
• Epistaxis
• Nocturia

Question 6

What other diseases present similarly to essential hypertension?

Answer 6

• Other forms of hypertension e.g. secondary hypertension, malignant etc.

Question 7

What investigations are carried out in suspected essential hypertension?

Answer 7

• BP – in time or 24h
• Urinalysis: protein, albumin:creatinine ratio, haematuria
• Glucose
• Electrolytes
• Creatinine
• eGFR
• Cholesterol
• Fundoscopy
• EGC

Question 8

What are the pharmacological treatments for essential hypertension?

Answer 8

• Under 55 – ACE inhibitor (Ramipril)/low cost ARB (Candesartan)
• Young woman – beta blocker
• Age 55 and above/black African or Caribbean – Ca channel blocker (Amlodipine)
• Diuretics
• Alpha blockers
• Renin blockers

Question 9

What are the non pharmacological treatments for essential hypertension?

Answer 9

• Diet - ↑ fruit and veg, ↓ fat
• Regular exercise
• ↓ alcohol and sodium
• Smoking cessation
• Weight reduction
• Calculate CV risk using QRISK 2-2015