Arterial Hypertension is defined as

systolic blood pressure (SBP) of 140

mmHg or greater, diastolic blood
pressure (DBP) of 90 mmHg or greater,
or taking antihypertensive medication.
ESC, 2019
Recent Guidelines for Hypertension, Volume: 124, Issue: 7, Pages: 984-986, DOI: (10.1161/CIRCRESAHA.119.314789)
Types of hypertension

• Essential hypertension
– 95%
– No underlying cause

• Secondary hypertension
– Underlying cause
Causes of
Secondary Hypertension
 2018 ESC/ESH Guidelines for the
management
of arterial hypertension
Based on office BP, the global
prevalence of hypertension was
estimated to be 1.13 billion in 2015, with
a prevalence of over 150 million in
central and eastern Europe.
The overall prevalence of
hypertension in adults is around 30 -
45%, with a global age-standardized
prevalence of 24 and 20% in men and
Who are at risk ?
Haemodynamic Pattern in
Hypertension

Young : ↑ BP = ↑CO X TPR

Elderly : ↑ BP = ↓ CO X ↑ ↑ TPR
Examination

The physical examination has

three specific objectives:

• documenting an accurate BP

• excluding possible secondary

causes

• quantifying end-organ damage

Target-organ
damage

1. HEART
• Left ventricular hypertrophy
• Angina/prior myocardial infarction
• Prior coronary revascularization
• Heart failure
2. BRAIN
• Stroke or transient ischemic attack
• Dementia
3. CHRONIC KIDNEY DISEASE
• Estimated GFR less than 60 mL/min
• Microalbuminuria
4. PERIPHERAL ARTERIAL DISEASE
5. RETINOPATHY
 ABPM is a better predictor of HMOD than office BP.
Furthermore, 24 h ambulatory BP mean has been consistently shown to have a
closer relationship with morbid or fatal events, and is a more sensitive risk
predictor than office BP of CV outcomes such as coronary morbid or fatal
events and stroke.
 History of possible secondary
hypertension
• Young onset of grade 2 or 3 hypertension (< 40
years), or sudden development of hypertension or
rapidly worsening BP in older patients
• History of renal/urinary tract disease

Risk
• Recreational drug/substance abuse/concurrent
therapies: corticosteroids, nasal vasoconstrictor,
chemotherapy, yohimbine, liquorice
• Repetitive episodes of sweating, headache, anxiety,
or palpitations, suggestive of Phaeochromocytoma
• History of spontaneous or diuretic-provoked

factors hypokalaemia, episodes of muscle weakness, and tetany

(hyperaldosteronism)
•

•
Symptoms suggestive of thyroid disease or
hyperparathyroidism
History of or current pregnancy and oral
contraceptive use

• Family and • History of sleep apnoea

Antihypertensive Drug Treatment

personal • Current/past antihypertensive medication including

effectiveness and intolerance to previous medications
• Adherence to therapy

history of
Body habitus
• Weight and height measured on a calibrated
scale, with calculation of BMI
• Waist circumference
Signs of HMOD
• Neurological examination and cognitive
status
• Fundoscopic examination for hypertensive
retinopathy
• Palpation and auscultation of heart and
carotid arteries
 Task Force now recommends that lifestyle advice should be accompanied by BP-lowering drug
treatment in patients with grade 1 hypertension at low–moderate CV risk.
The evidence supports the recommendation that older patients (>65 years, including patients over 80
years) should be offered BP- lowering treatment if their SBP is ≥160 mmHg.
There is also justification to now recommend BP-lowering treatment for old patients (aged >65 but not
>80 years) at a lower BP (i.e. grade 1 hypertension; SBP = 140–159 mmHg).
BP-lowering drugs should not be withdrawn on the basis of age alone. It is well established that BP-
lowering treatment withdrawal leads to a marked increase in CV risk.
 Hypertensive men who drink alcohol
should be advised to limit their consumption to
14 units per week and women to 8 units per
week (1 unit is equal to 125 mL of
wine or 250 mL of beer).
Alcohol-free days during the week and
avoidance of binge drinking are also advised.
 Resistant hypertension
• Hypertension is defined as resistant to treatment when the recommended
treatment strategy fails to lower office SBP and DBP values to <140 mmHg
and/or < 90 mmHg, respectively, and the inadequate control of BP is
confirmed by ABPM or HBPM in patients whose adherence to therapy has
been confirmed.
• The recommended treatment strategy should include appropriate lifestyle
measures and treatment with optimal or best-tolerated doses of three or more
drugs, which should include a diuretic, typically an ACE inhibitor or an ARB,
and a CCB.
• Pseudo-resistant hypertension and secondary causes of hypertension should also
have been excluded.
• Prevalence studies of resistant hypertension have been limited by variation in
the definition used, and reported prevalence rates range from 5–30% in patients
with treated hypertension. After applying a strict definition (see above) and
having excluded causes of pseudo- resistant hypertension, the true prevalence
of resistant hypertension is likely to be <10% of treated patients.
• Patients with resistant hypertension are at higher risk of HMOD, CKD, and
premature CV events.