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Hypertension

Essential (Primary) Hypertension

Definition
  • Essential (Primary) Hypertension: High blood pressure with no identifiable cause, accounting for about 90-95% of hypertension cases.
Etiology/Risk Factors
  • Genetic predisposition
  • Lifestyle factors: High salt intake, obesity, physical inactivity, excessive alcohol or caffeine consumption.
  • Age
  • Family history
  • Ethnicity (higher in African-Caribbean populations)
Pathophysiology
  • Complex interplay between genetic and environmental factors leading to increased systemic vascular resistance and/or increased cardiac output.
Clinical Features
  • Often asymptomatic
  • Headache, especially in the morning
  • Blurry vision
  • Shortness of breath
Management
  • Lifestyle modifications: salt reduction, weight loss, exercise, reducing alcohol intake.
  • Medications: ACE inhibitors, calcium channel blockers, beta-blockers, diuretics, angiotensin II receptor blockers (ARBs).
  • Regular monitoring and follow-up.

Secondary Hypertension

Definition
  • Secondary Hypertension: High blood pressure resulting from an identifiable underlying secondary cause. It’s less common, accounting for about 5-10% of hypertension cases.
Etiology/Causes
  • Renal: Chronic kidney disease, renal artery stenosis, glomerulonephritis.
  • Endocrine: Cushing’s syndrome, hyperaldosteronism, pheochromocytoma, hyperthyroidism, acromegaly.
  • Vascular: Coarctation of the aorta.
  • Medications: Oral contraceptives, NSAIDs, steroids, sympathomimetics.
  • Obstructive sleep apnoea.
Clinical Features
  • Resistant to standard antihypertensive treatments.
  • Signs or symptoms related to the underlying cause (e.g., leg pain in coarctation).
  • Severe hypertension in younger patients (<30 years) or sudden onset in older patients.
Investigations
  • Blood tests: Renal function, potassium, thyroid function tests.
  • Renal ultrasound
  • Specialist tests: Plasma aldosterone to renin ratio, urinary catecholamines.
Management
  • Treat the underlying cause.
  • Medications: May differ based on the secondary cause.
  • Regular monitoring and follow-up.

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