HYPERTENSION

What is blood pressure and hypertension?

  • Blood Pressure: The pressure exerted on artery walls as blood moves through them. It’s measured by taking the following 2 readings:

    • Systolic Pressure: Pressure when the heart beats.

    • Diastolic Pressure: Pressure when the heart is at rest.

Who is at risk of hypertension?

  • Age: Higher prevalence with increasing age. As systolic Pressure rises throughout life.

  • Ethnic Group: Higher in Black individuals.

  • Gender: Men have early onset, but women have a higher increase after age 65.

Hypertension

  • Definition: Persistently raised systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg in non-diabetics.

    It dossn’t have to be both of them high.

  • Hypertension could lead to stroke, heart disease.

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    Clinical blood pressure check

    1. Take blood pressure in both arms

    • reading below 90/60 mmHg —> low BP

      - advice on healthy behaviour + BP check within 1yr if no symptoms

      -

    • Both readings between 90/60 mmHg & 139/89mmHg + not significantly different—> BP is normal

      - recommend BP check within 5yrs.

Diagnosis

  1. Clinic BP: ≥140/90 mmHg.

  2. ABPM (Ambulatory BP Monitoring): Daytime average ≥135/85 mmHg.

  3. HBPM (Home BP Monitoring): Twice daily for at least 4 days (optimal 7).

Ways in which drugs work

  • Targets: Receptors, Enzymes, Ion channels, Carriers (transporters).

Choosing Antihypertensive Drug Treatment

Step One of treatment

  • Over 55/Black individuals: Calcium-channel blocker (CCB) is recommended.

  • If CCB is unsuitable: Use thiazide-like diuretics.

Drugs that work on ion channels (inhibit transport mechanisms)

  • Ca2+ Blockers: Prevent smooth muscle contraction.

Step 2 Treatment

  • If hypertension remains uncontrolled: Add an ACE inhibitor, ARB, or thiazide-like diuretic.

  • For Black individuals: Prefer ARB over ACE inhibitors with CCB.

Step 3 & 4 Treatment

Step 3:

  • Combine ACE inhibitor or ARB with CCB and thiazide-like diuretic if hypertension persists at ≥140/90 mmHg.

Step 4 (Resistant Hypertension):

  • Add low-dose spironolactone or alpha/beta-blockers if required.

Blood Pressure Targets

  • Under 80 years: <140/90 mmHg (Clinic), <135/85 mmHg (ABPM/HBPM).

  • Over 80 years: <150/90 mmHg (Clinic), <145/85 mmHg (ABPM/HBPM).

Other Considerations

  • Diabetes: Use ACE inhibitors or ARBs, especially for diabetic nephropathy.

  • Pregnancy: Labetalol is first-line, followed by nifedipine or methyldopa if necessary.

Lifestyle Advice

  • Salt: Reduce to <2.4g/day.

  • Alcohol: ≤14 units/week.

  • Exercise: 150 minutes of moderate activity per week.

  • Diet: Increase fruits, vegetables; reduce saturated fats.

Example: Amlodipine Prescription Advice

  • Dose: 1 tablet daily.

  • Side Effects: Swollen ankles, headache, facial flushing.

Healthy Lifestyle Recommendations

  • Weight reduction, smoking cessation, alcohol moderation.

  • Dietary adjustments: Reduced salt and fat intake, increase in fruits/vegetables.