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The greatest danger to a man is that someone will discover hypertension and some fool will try to reduce it.


Hypertension is a serious community disorder and the most common condition requiring long-term drug therapy in Australia. It is a silent killer because most people with hypertension are asymptomatic and unaware of their problem. Epidemiological studies have demonstrated the association between hypertension and stroke, coronary heart disease, kidney disease, heart failure and atrial fibrillation. Treatment may be lifelong, hence the need for careful work-up.

  • Target organs that can be damaged by hypertension include the heart (failure, LVH, ischaemic disease), kidney (kidney insufficiency), retina (retinopathy), blood vessels (peripheral vascular disease, aortic dissection) and brain (cerebrovascular disease).

  • Almost 6% of the Australian disease burden is due to hypertension.1

  • Factors increasing the chances of dying in hypertensive patients are: male, onset at a young age, family history, increased diastolic pressure.2


  • The various categories of BP are arbitrarily defined (and change over time in different guidelines) according to BP values for both diastolic and systolic readings (see TABLE 77.1).3,4

  • Isolated systolic hypertension is that of ≥140 mmHg in the presence of a diastolic pressure <90 mmHg.

  • Hypertension is either essential or secondary (see TABLE 77.2).

  • Essential hypertension is the presence of sustained hypertension in the absence of underlying, potentially correctable kidney, adrenal or other factors.

  • Malignant hypertension is that with a diastolic pressure >120 mmHg and exudative vasculopathy in the retinal and kidney circulations.

  • Refractory hypertension is a BP >140/90 mmHg despite maximum dosage of 2 drugs for 3–4 months.

Table 77.1Definition and classification of blood pressure in adults aged 18 years and older measured as sitting blood pressure (mmHg)4,5
Table 77.2Causes of hypertension

For adults aged 18 years and older, hypertension is repeated measurements of:

  • diastolic ...

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