Hypertension is a major contributor to the development of cardiovascular disease and affects more than 25% of the UK population.
The prevalence increases with age such that more than half of all people older than 65 years have a BP of has led to BP control becoming a major focus of primary and secondary cardiovascular disease prevention.
LVH or high resting heart rate are markers of worse outcome in patients with hypertension.
An abnormal ECG should prompt a referral for consideration of echocardiography.
Hypertension risk factors Smoking, obesity and metabolic syndrome are causally associated with high BP and the combination of several or all of these risk factors in the UK population is increasingly common.
Other risk factors for the development of hypertension include alcohol, family history and ethnic origin.For example, the prevalence of hypertension is greater in patients of African or Caribbean origin in whom it often appears earlier and is more difficult to treat.- Chronic renal failure, acute and chronic glomerulonephritis polycystic disease, pyelonephritis, tumours (Wilm’s tumour), diabetes - Atherosclerosis, fibromuscular dysplasia, embolism, polyarteritis nodosa Most patients have no symptoms or clinical findings on examination and their hypertension is identified incidentally, or as a result of the complications of essential hypertension, such as angina pectoris, MI, stroke and arrhythmias, such as AF.so overdiagnosing hypertension seems generally harmless, yet underdiagnosing it might not be. Furthermore, although ABPM and HBPM readings are better at predicting cardiovascular events than clinic readings, all of the studies demonstrating improved outcome from antihypertensive therapy have been based on a diagnosis made in a clinic setting. Antihypertensive medication The treatment target in most patients is 140/90mm Hg, although this is lower (135/85mm Hg) in patients with diabetes mellitus and higher in those ≥80years (150/90mm Hg). Many patients will require more than one agent, and it is important to discuss this when starting treatment. It is incongruous that they should be fourth line for hypertension in patients with quiescent coronary artery disease, but then receive an upgrade to first line once coronary artery disease becomes overt, despite the fact that BP lowering is the most powerful way to control both primary and secondary risk. There are suggestions that they might be less protective against stroke and might increase the rate of diabetes. Hypertension is now one of the most common conditions treated in primary care in the UK.Although young adults with high BP are frequently referred for investigation to exclude high-profile but rare secondary causes (see box, below), most adult patients (95%) with high BP have primary hypertension.