The Clinical Notebook

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Short Notes on Hypertension

Hypertension (high blood pressure) is a condition in which the blood pressure in the arteries is persistently elevated.
Normal BP: 120 mmHg

Types
1. Primary (Essential) Hypertension (~90–95%): No identifiable cause; multifactorial (genetics, environment, lifestyle).
2. Secondary Hypertension (~5–10%): Caused by an underlying condition
- Renal disease (glomerulonephritis, renal artery stenosis)
- Endocrine: Primary aldosteronism, Cushing’s, pheochromocytoma, hyperthyroidism
- Coarctation of aorta
- Obstructive sleep apnea
- Drugs (OCPs, NSAIDs, steroids, sympathomimetics)

Risk Factors
- Age (>55 men, >65 women)
- Family history
- Obesity, high salt intake, low potassium
- Physical inactivity
- Excess alcohol, smoking
- Stress
- Black ethnicity (earlier onset, more severe)

Clinical Features
- Usually asymptomatic (“silent killer”)
- Occasional: Occipital headache (morning), dizziness, epistaxis
- Long-term: Target organ damage
- Heart: LVH, heart failure, CAD
- Brain: Stroke, hypertensive encephalopathy
- Kidneys: Chronic kidney disease, proteinuria
- Eyes: Hypertensive retinopathy (AV nipping, hemorrhages, papilledema)
- Vessels: Aortic dissection, aneurysm

Diagnosis
- Multiple BP readings on separate occasions
- Ambulatory BP monitoring (ABPM) or home BP monitoring to confirm
- Rule out white-coat and masked hypertension
- Basic investigations:
- Urine analysis (proteinuria)
- Blood urea, creatinine, electrolytes
- Fasting glucose, lipid profile
- ECG (for LVH)
- Fundoscopy
- Echocardiogram if needed

Management
Lifestyle modifications (first-line for all)
- Weight loss (5–20 mmHg reduction per 10 kg)
- DASH diet, reduce salt

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