Hypertension

Hypertension is an independent risk factor for cardiovascular disease. The prevalence of hypertension in England is about 30%. The World Health Organization estimates that hypertension is responsible for ‘4.5% of current global disease burden’. Hypertension is asymptomatic in the majority of patients, making diagnosis and management more challenging. However, the associated mortality and morbidity from stroke and myocardial infarction is significant. Once blood pressure (BP) is over 115/70 mmHg, the risk of myocardial infarction or stroke doubles with each 20/10 mmHg increase in BP. The majority of hypertensive patients (90%) will have primary hypertension with no known cause. The term ‘essential hypertension’ has been used to describe primary hypertension, based on the assumption that an elevated BP was required to maintain adequate organ perfusion. A minority of hypertensive patients will have ‘secondary hypertension’ with an underlying pathological cause, such as chronic kidney disease or Conn’s syndrome.