What is Hypertension?Statistics on HypertensionRisk Factors for HypertensionProgression of HypertensionSymptoms of HypertensionClinical Examination of HypertensionHow is Hypertension Diagnosed?Prognosis of HypertensionHow is Hypertension Treated?Hypertension ReferencesDrugs/Products Associated with Hypertension What is Hypertension?
Hypertension is defined as elevated blood pressure and is the leading cause globally of death and disability. It is the major risk factor for heart attack and stroke, and is also a significant risk factor for for chronic kidney disease and chronic heart failure. Because individuals with hypertension usually don't have any symptoms, it is a disease that is often under-diagnosed. Diagnosis relies upon routine blood pressure screening to monitor and detect affected individuals.
Statistics on HypertensionIn 2000, it was estimated that nearly one billion individuals worldwide were hypertensive. This figure equates to approximately 26.4% of the total global adult population.
The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) conducted in 1999–2000 reported that 30% of Australians (32% of males and 27% of females) over 25 years of age, or 3.7 million Australians, were hypertensive (blood pressure > 140/90 mmHg).
In general, males are more likely to have hypertension than females, except for between the ages of 45 and 64, when females are at equal risk to males.
The incidence of hypertension is three times higher in Indigenous Australians compared to non-indigenous Australians.
Risk Factors for Hypertension
Virtual Medical Centre Video
Watch a video on High Blood Pressure: Lifestyle
Approximately 95% of hypertension cases are classified as essential or primary hypertension, in which the underlying cause is unknown. The remaining cases are classified as secondary hypertension, in which there is an identifiable cause (e.g. renal artery stenosis).
Major studies have identified the following factors as key predisposing factors for hypertension:
Prehypertensive systolic state (115–139 mmHg);Age-dependent increase in diastolic state;Female gender;Increasing BMI beyond a value of 25;Smoking; andParenteral hypertension.
Factors that have been identified in the Australian 2008 National Heart Foundation Hypertension Guidelines include:
If hypertension remains uncontrolled, it ultimately leads to end organ damage. Hence, uncontrolled hypertension is the major risk factor for coronary artery disease and stroke – two important endpoints in the disease process.
Similarly, chronic renal failure, diabetes, eye disease, erectile dysfunction and chronic heart failure are also significant diseases associated with the progression of uncontrolled or poorly controlled hypertension.
General Cardiovascular Disease 10-Year Risk Calculator
This risk assessment tool is based on data from the Framingham Heart Study to estimate 10-year risk for general cardiovascular disease outcomes (coronary death, myocardial infarction, coronary insufficiency, angina, ischaemic stroke, haemorrhagic stroke, transient ischaemic attack, peripheral artery disease, heart failure). This tool is designed to estimate risk in adults aged 30-74 years of age without CVD at baseline examination. Use the calculator below to estimate 10-year risk.
PredictorsAge years MaleFemaleGender YesNoHave you been diagnosed with Type II diabetes?Are you a smoker?*Are you prescribed medication to lower your blood pressure? If you do not know the following blood pressure and cholesterol parameters ask your General Practitioner on your next visit.Systolic blood pressure** mmHg Total cholesterol*** mmol/L OR mg/dl HDL cholesterol**** mmol/L OR mg/dl ResultsSignificant (> 20%)Elevated (10–20%)
Mild risk (< 10%)
You have a significant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, your sugar levels should be well controlled.Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have an elevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.Significant (> 20%)
Elevated (10–20%)
Mild risk (< 10%)
You have a mild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.*For these purposes "smoker" means any cigarette smoking in the past month.
**Use current blood pressure, regardless of whether the person is on antihypertensive therapy.
***Total cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
****HDL cholesterol values should be the average of at least two measurements obtained from lipoprotein analysis.
References:D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 31433421.Stancoven A, McGuire DK. Preventing macrovascular complications in Type 2 Diabetes Mellitus: glucose control and beyond. American Journal of Cardiology 2007; 99: 5H-11H.
This tool needs javascript enabled to work.
Male risk estimatePointsAgeHDLTotal CholesterolSBP Not TreatedSBP TreatedSmokerDiabetic-2 60+ PointsCVD riskHeart age (years)-3 or lessBelow 1% 8018 +> 30%> 80
Female risk estimatePointsAgeHDLTotal CholesterolSBP Not TreatedSBP TreatedSmokerDiabeticPointsCVD riskHeart age (years)-2 or less801615.9%>801718.5%>801821.5%>801924.8%>802028.5%>8021+>30%>80
More than 20 pointsSignificant risk of future cardiovascular disease requiring aggressive risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, your sugar levels should be well controlled.Continue to avoid tobacco use or if you are a smoker, consider stopping this is something your General Practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level, you might be advised to commence lifestyle changes or medication.10 to 20 pointsElevated risk of future cardiovascular disease requiring risk factor modification. You should see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.Less than 10 pointsMild risk of future cardiovascular disease, consider risk factor modification. You may like to see a health professional to ensure appropriate management.If diabetic, you should aim for your sugar levels to be well controlled.Continue to avoid tobacco use or if a smoker, consider stopping this is something your general practitioner can help you with.Blood pressure should be monitored closely. If elevated you should consider either lifestyle modification or appropriate medication. Your general Practitioner can advise you on this.Cholesterol levels should be assessed at least annually. Depending on your level you might be advised to commence lifestyle changes or medication.
This information will be collected for educational purposes, however it will remain anonymous.Symptoms of Hypertension
Most people with hypertension are unaware that they have a problem. This is because hypertension has few, if any symptoms. Therefore, primary hypertension is usually detected through routine screening when visiting a GP. Longterm uncontrolled hypertension is associated with an increased risk of heart attack and stroke, amongst other diseases.
Clinical Examination of HypertensionHypertension is assessed via the measurement of blood pressure. A diagnosis of hypertension can be made if, after several readings on separate occasions, an elevated value is consistently recorded.
As a guide, a blood pressure reading greater than 140/90 taken on three different occasions is sufficient to diagnose hypertension. Ambulatory blood pressure monitoring can also be used to assess average blood pressure readings over a 24 hour period.
In addition to blood pressure measurement, a full cardiovascular exam should be performed, noting any signs of an enlarged heart or arterial disease. Additional examinations that should be included if hypertension is suspected include an eye exam, waist circumference and body mass index.
For more information, see blood pressure investigation.
Blood Pressure CalculatorThis risk assessment tool is based on data from the National Heart Foundation´s Guide to management of hypertension 2008. It puts your blood pressure measurement into one of the seven diagnostic categories specified in this guide.Age yearsGender Male / FemaleBlood pressure* / mmHg*Use current blood pressure, regardless of whether the person is on antihypertensive therapy.ResultsNormal
Your blood pressure should be rechecked within 2 years or earlier depending on your risk of developing cardiovascular disease. Your General Practitioner can advise you about this risk and also on lifestyle risk reduction.High-Normal
Your blood pressure is elevated. It should be rechecked within 12 months or earlier depending on your risk of developing cardiovascular disease. Your General Practitioner can advise you about this risk and also on lifestyle risk reduction.Grade 1 (mild) Hypertension
Your blood pressure is elevated. It should be confirmed within 2 months. Your General Practitioner should advise you about lifestyle risk reduction and/or medication to lower your blood pressure.Grade 2 (moderate) Hypertension
Your blood pressure is elevated. It should be confirmed within 1 month and you may also need to see a specialist in this time. Your General Practitioner can advise you about lifestyle risk reduction and/or medication to lower your blood pressure.Grade 3 (severe) Hypertension
Your blood pressure is elevated. It should be confirmed within 1 week and you may also need to see a specialist in this time. Your General Practitioner can advise you about lifestyle risk reduction and/or medication to lower your blood pressure.Isolated systolic hypertension
Your systolic blood pressure is elevated. Depending on the level it needs to be confirmed within a certain time (140-159mmHg - 2 months; 160-179mmHg - 1 month; >180mmHg - 1-7 days).You may also need to see a specialist. Your General Practitioner can advise you about lifestyle risk reduction and/or medication to lower your blood pressure.Isolated systolic hypertension with widened pulse pressure
Your blood pressure is elevated. It should be confirmed within 1 week and you may also need to see a specialist in this time. Your General Practitioner can advise you about lifestyle risk reduction and/or medication to lower your blood pressure.Hypotension
Your blood pressure is lower than normal. Your General Practitioner will ask you about symptoms that you may be experiencing and determine if you require treatment or further investigation.References
National Heart Foundation of Australia. Your blood pressure 2008. http://www.heartfoundation.org.au/document/NHF/A_Hypert_Guidelines2008_
ISC_YourBloodPressure_FINAL.pdf (accessed November 15, 2008).Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma; 34: 216-222
You must have Javascript enabled to use this tool.
This information will be collected for educational purposes, however it will remain anonymous.How is Hypertension Diagnosed?
Some investigations that may be ordered to assist with diagnosis include:
Dipstick urinalysis for blood and protein;Urinalysis: Spot urine albumin/creatinine ratioBlood tests: Urea and electrolytes, lipid profile and fasting blood sugar.ECG: To assess for heart enlargement.
More specific investigations may also be required, including:
Hypertension at 50 years of age is associated with a 5 year reduction in life expectancy. If hypertension is properly controlled, the risk of stroke reduces by more than the risk of heart attack.
How is Hypertension Treated?
The decision about how and when to intervene with hypertension is dependent upon the severity of the diagnosis, the absolute cardiovascular risk profile and the evidence of end organ damage.
Immediate medical intervention
Immediate treatment is required with any of the following:3,15,16,19
Severe hypertension;Evidence end organ damage (regardless of blood pressure);Diabetes where BP > 140/90 mmHg;High absolute cardiovascular risk measurement; andIndigeneity.
Lifestyle modification
In all circumstances, the first management step is lifestyle modification, focusing on:
Regular physical activity (minimum 30 minutes a day moderate intensity);Smoking cessation;Dietary modification (salt intake < 4 g/day, plenty of fruit and vegetables, low fat);Weight and waist reduction (aim for BMI < 25, waist < 94 cm (men), 80 cm (women)); andLimit or avoid alcohol (one standard drink per day).
Medications
Four major classes of drug are routinely used:
Diuretics (especially thiazide diuretics);Angiotensin converting enzyme inhibitors and the related angiotension II receptor blockers;Calcium channel blockers; andBeta-blockers.
All of the drug classes appear to have similar short and medium term protective effects, however, issues of tolerability may lead to beta-blockers being considered a second line medication.
Most drugs take 4–8 weeks for maximum effect. Thus, it is recommended that a minimum period of 6 weeks is trialled before changes to medications are made. Generally treatment starts with a single drug. Recent large studies have shown that cheaper, older drugs, are just as effective as newer drugs. If a single drug fails to achieve blood pressure goals, other agents can be added in.
More information
For more information on high blood pressure, including investigations and treatments, as well as some useful animations, videos and tools, see Hypertensions (High Blood Pressure).
Hypertension. Stedman's Medical Dictionary [27th edition]. Baltimore: Lippincott Williams and Wilkins; 2000. 855.Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006; 367(9524): 1747-57.National Blood Pressure and Vascular Disease Advisory Committee. Guide to management of hypertension 2008 [online]. National Heart Foundation of Australia. 1 August 2008 [cited 20 March 2009]. Available from URL http://www.heartfoundation.org.au/ SiteCollectionDocuments/ A Hypert Guidelines2008 Guideline.pdf Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005; 365(9455): 217-23.Dunstan D, Zimmet P, Welborn T, Sicree R, Armstrong T, Atkins R, et al. Diabetes & Associated Disorders in Australia 2000: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Melbourne: International Diabetes Institute; 2000.Barr ELM, Magliano J, Zimmet P, Polkinghorne K, Atkins A, Dunstan D, et al. AusDiab 2005: The Australian Diabetes, Obesity and Lifestyle Study. Melbourne: International Diabetes Institute; 2005.Parikh NI, Pencina MJ, Wang TJ, Benjamin EJ, Lanier KJ, Levy D, et al. A risk score for predicting near-term incidence of hypertension: The Framingham Heart Study. Ann Intern Med. 2008; 148(2): 102-10.Chiong J, Aronow W, Khan I, Nair C, Vijayaraghavan K, Dart R, et al. Secondary hypertension: Current diagnosis and treatment. Int J Cardiol. 2008; 124(1): 6-21Kumar P, Clark M. Clinical Medicine [6th edition]. New York: W.B. Saunders; 2005. 787.Kumar V, Abbas A, Fausto N. Robbins and Cotran Pathologic Basis of Disease [7th edition]. Philadelphia: Elsevier Saunders; 2005. 529-30.Grosso A, Veglio F, Porta M, Grignolo FM, Wong TY. Hypertensive retinopathy revisited: Some answers, more questions. Br J Ophthalmol. 2005; 89(12): 1646-54.Manolis A, Doumas M. Sexual dysfunction: The 'prima ballerina' of hypertension-related quality-of-life complications. J Hypertens. 2008; 26(11): 2074-84.Franco OH, Peeters A, Bonneux L, de Laet C. Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: Life course analysis. Hypertension. 2005; 46(2): 280-6.Lawes CM, Bennett DA, Feigin VL, Rodgers A. Blood pressure and stroke: An overview of published reviews. Stroke. 2004; 35(4): 1024.New Zealand Guidelines Group. The assessment and management of cardiovascular risk. Best practice evidence based guideline. Wellington: New Zealand Guidelines Group; 2003.Chobanian A, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA. 2003; 289(19): 2560-71.Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004; 89:1045-50.Staessen JA, Wang JG, Thijs L. Cardiovascular protection and blood pressure reduction: A meta-analysis. Lancet. 2001; 358(9290): 1305-15.Turnbull F, Neal B, Algert C, Chalmers J, Chapman N, Cutler J, et al. Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: Results of prospectively designed overviews of randomized trials. Arch Intern Med. 2005; 165(12): 1410-9.Hill SR, Smith AJ. First line medicines in the treatment of hypertension. Aust Prescr. 2005; 28: 34-7.Therapeutic Guidelines: Cardiovascular. Therapeutic Goods Administration; 2008.Guide to good prescribing. A practical manual [online]. Geneva: World Health Organization; 1994. Available from URL http://www.who.int/ medicines/ library/ par/ ggprescribing/ who-dap-94-11en.pdf Zillich AJ, Garg J, Basu S, Bakris GL, Carter BL. Thiazide diuretics, potassium and the development of diabetes: A quantitative review. Hypertension. 2006; 48(2): 219-24.Bangalore S, Parkar S, Grossman E, Messerli FH. A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus. Am J Cardiol. 2007; 100(8): 1254-62.Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008: 358: 1547-59.Gupta AK, Dahlof B, Dobson J, Sever PS, Wedel H, Poulter NR. Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. Diabetes Care. 2008: 31(5): 982-8.Australian Government: Department of Health and Ageing. Pharmaceutical Benefits Schedule. [online] Department of Health and Ageing: PBS online, available: http://www.pbs.gov.au/html/healthpro/home
The ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288:2981.
Treatments Used in This Disease:Angiotensin II Receptor Blockers (ARB)Angiotensin-converting Enzyme Inhibitors (ACE inhibitors, ACEi)Drugs/Products Used in the Treatment of This Disease:Adalat 10, Adalat 20 (Nifedipine)Amprace (Enalapril maleate)Anselol (Atenolol)Atacand (Candesartan cilexetil)Avapro (Irbesartan)Barbloc (Pindolol)Captopril (Captopril)Corbeton (Oxprenolol hydrochloride)Coversyl (Perindopril erbumine)Cozaar (Losartan potassium)Deralin (Propranolol hydrochloride)Dilatrend (Carvedilol)Felodur ER (Felodipine)Frusemide-BC (Frusemide)GenRx Diltiazem (Diltiazem hydrochloride)Karvea (Irbesartan)Karvezide (Hydrochlorothiazide, Irbesartan)Metoprolol (Terry White Chemists) (Metoprolol tartrate)Micardis (Telmisartan)Micardis Plus (Telmisartan, Hydrochlorothiazide)Monopril (Fosinopril sodium)Norvasc (Amlodipine besylate)Olmetec (Olmesartan)Ramace (Ramipril)Spiractin (Spironolactone)Teveten (Eprosartan mesylate)Connect
Sign up for free newsletters 
Subscribe to RSS feeds 
Discuss on Forum 
Article Dates:
Modified: 30/8/2010 Reviewed: 30/3/2009 Created: 21/2/2006 List Diseases by Medical Area All Diseases Men's Health Diseases Women's Health Diseases Children's Health Diseases Allergy Diseases Blood Diseases Bone Diseases Brain Diseases Cancer Diseases Dental Diseases Eye Diseases Fitness Diseases Gastro Diseases Heart Diseases Hormone Diseases Infection Diseases Joints Diseases Kidney Diseases Lungs Diseases Mental Health Diseases Pain Diseases Pregnancy Diseases Skin Diseases Weight Loss Diseases New on VMC
Orange and Avocado Salad more... 
As the weather warms up – preparing kids for toilet training more... 
Dr Joe: Ear health more... 
Recovering from disaster and trauma more... 
VMC NewslettersVMC newsletters are FREE on subscription. See VMC's previous newsletters here.
Free Membership & NewslettersNot yet a member?Stay up to date with the latest health news
Resend Activation Email -Forgot your Password?Today's medical surveyTrauma
Have you ever suffered second-hand trauma, for example after watching a disaster on TV/internet/or a loved one going through it?
Yes, I sought help from a counsellor/other professional
Yes, I talked through it with loved ones
Yes, but I was too embarrassed to talk about it
No
Other (please comment)
Comment:What is 2 + 2 =
View Results » Current Sponsors About Virtualmedicalcentre.com
Australia�s leading source for trustworthy medical information written by health professionals.
Please be aware that we do not give advice on your individual medical condition,
if you want advice please see your treating physician.
Virtual Medical Centre © 2002 - 2013 | Privacy Policy Last updated 1 Nov 2013
Parenting information is available at Parenthub.com.au
About Us Careers Advertise with us Advertising policy Contact Us Copyright Information Corrections Editorial Advisory Board Investor Information Partners Sitemap Terms of Use User-generated Content
^ Back to Top Partners and Accreditations 
This site complies with the HONcode standard for trustworthy health information: verify here.
For banner advertising
Website and videos by 
Titan Web Clients
Web Design Perth
E F G H
I J K L
M N O P
Q R S T
U V W X
Y Z Medical Information Health Topics Anatomy Devices Diseases Doctor Videos Drugs Health & Lifestyle Investigations Medical Dictionary My Experiences Symptoms Supplements Supportive Care Tools Treatments Useful Links News News & Events Latest News Events Newsletter Newsletters Lifestyles Health and Lifestyles Exercise Family General Mental Health Nutrition Occupational Health and Safety Pregnancy Preventative Health Recipes Sexuality Sleep Smoking and Alcohol Win Competitions Current Competitions Competition Winners Health Professionals Health Professionals Editorial Advisory Board Conferences Events Case Studies Research & Trials Publications Consult Magazine Pro Newsletters Pro Membership
Read more detailed and referenced information written by Australian health professionals, make sure you select health professional in the signup form!
Sign up Login About VMC | Contact Us | Sitemap Follow us on:
No comments:
Post a Comment