Hypertension

Hypertension is a common disorder and a leading cause of morbidity and mortality worldwide. The majority (90%) of patients have ‘primary’ or ‘essential’ hypertension where no identifiable underlying cause is found. The remaining minority (up to 10%) have ‘secondary’ hypertension where a cause is identified. Complete assessment of the hypertensive patient must include an assessment of overall cardiovascular risk and the identification of potential secondary causes of hypertension. Any decision to treat hypertension should be based on repeated blood pressure readings or the 24 h ambulatory BP measurements monitor. Treatment of hypertension is based on large international trials and extensive meta-analyses, which have now been condensed into established published guidelines. NICE/BHS proposes the ACD rule that recommends drug classes that can be used to control blood pressure depending on the age and race of the patient. Most patients will require two or more drugs and will need to be followed up for side effects and non-adherence. It is important to be vigilant for secondary causes of resistant hypertension.