Key references:

Key take-home points:

• After smoking and diet, hypertension is the biggest risk factor in the UK for premature death and disability.
• Around 90% of cases are primary – or essential – hypertension, where no obvious cause is found.
• The remainder of cases (secondary hypertension) are usually linked to endocrine problems, renal disease or pregnancy.
• Non-modifiable risks include getting older, gender, a family history of hypertension and ethnicity.
• Modifiable risks include obesity, smoking, alcohol, a sedentary lifestyle and too much salt in the diet.
• Stage 1 hypertension is classified as a blood pressure greater than 140/90 mmHg, stage 2 is greater than 160/100 mmHg and stage 3 is greater than 180/120 mmHg
• The diagnosis is confirmed if blood pressure taken in surgery is repeatedly greater than 140/90 mmHg and the average ambulatory blood pressure readings are 135/85 mmHg or higher.
• Consider treating individuals under the age of 60 with stage 1 hypertension and an estimated cardiovascular disease risk greater than 10%.
• Offer treatment to adults of any age with stage 2 hypertension.
• If type 2 diabetes is present, or if a person is under the age of 55 and is not of black African or African-Caribbean family origin, start treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), adding in a calcium channel blocker or thiazide-like diuretic if required.
• For hypertension without type 2 diabetes, where the individual is aged 55 or over or is of black African or African-Caribbean family origin, start treatment with a calcium channel blocker, adding in an ACE inhibitor, an ARB or a thiazide-like diuretic.
• The NICE guidelines provide further advice on treatment scenarios.
• Seek expert advice if blood pressure remains uncontrolled on optimal tolerated doses of four drugs.