Hypertension - systemic, primary and secondary
Description
- The largest single contributor to global cardiovascular death and the most treatable
- *A number, not a disease* - manage it as one component of absolute cardiovascular risk
Classification - the thresholds moved, and the documents disagree
| Source | Hypertension defined as | Treatment target |
|---|---|---|
| NHFA/CSANZ (Australia, 2016) | >=140/90 | <140/90; <120 systolic if high absolute risk and tolerated |
| ESC 2024 | >=140/90, plus a new category "elevated BP" 120-139/70-89 | Systolic 120-129 if tolerated |
| AHA/ACC 2025 | >=130/80 | <130/80 |
| *Australian 2026 guideline* | Heart Foundation/Stroke Foundation/Hypertension Australia; due 2026 - check before quoting a target | - |
- Know that the definitional threshold and the target are different questions, and that Australian practice has historically used 140/90 with risk-based intensification
Patterns
- Isolated systolic hypertension - elderly, arterial stiffening; the commonest pattern >60
- White coat hypertension - raised in clinic, normal out of clinic (~15-20%); not benign, but lower risk
- Masked hypertension - normal in clinic, raised out of clinic; higher risk than sustained hypertension because it goes untreated
- Resistant hypertension - BP above target on 3 drugs including a diuretic, at maximally tolerated doses
- Hypertensive urgency vs emergency - the discriminator is acute end-organ damage, not the number
6 more sections, plus exam facts
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