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Hypertension

INTRODUCTION

For adults aged ≥18 yrs hypertension is:

  • diastolic pressure (DP) >90 mmHg and/or

  • systolic pressure (SP) >140 mmHg

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Table H10 Definition and classification of blood pressure in adults aged >18 years, measured as sitting blood pressure (mmHg)

Category

Systolic

Diastolic

Follow-up

Optimal

<120

<80

2 years

Normal

120–129

80–84

High normal (prehypertension)

130–139

85–90

1 year or earlier

Grade 1 hypertension (mild)

140–159

90–99

2 months

Grade 2 hypertension (moderate)

160–179

100–109

within 1 month

Grade 3 hypertension (severe)

≥180

≥110

1–7 days

Isolated systolic hypertension

≥140

<90

1 month

Note: When a patient’s systolic and diastolic BPs fall into different categories, the higher category should apply.

RECOMMENDED BP MEASUREMENT

  • All people aged 18+ yrs

  • Every 2 yrs

RECOMMENDED ROUTINE BASIC SCREENING TESTS

  • Ambulatory monitoring

  • Urine tests

    • – urinalysis (for protein, blood and glucose)

    • – microurine (casts, red and white cells)

    • – urine culture (only if urinalysis abnormal)

  • Biochemical tests

    • – potassium and sodium

    • – creatinine and urea/eGFR

    • – ARR (aldosterone/renin ratio), ?hyperaldosteronism

    • – uric acid

    • – glucose

    • – lipids

  • Chest X-ray

  • ESR

  • ECG

Others (e.g. renal ultrasound) only as indicated.

RISK STRATIFICATION AND CALCULATION OF CARDIOVASCULAR RISK

Treatment of hypertension is generally indefinite and it is important to establish the risk status and the prognosis before starting therapy, esp. if hypertension is an isolated factor. The WHO-ISH recommendation is that decisions about management of patients with hypertension should not be based on BP alone, but also on the presence or absence of other risk factors, including important factors such as age, diabetes and smoking. Cardiovascular risk should be stratified according to the BP level and the presence of:

  • absolute cardiovascular risk factors

  • associated clinical conditions

  • target organ damage

A practical approach is to stratify total cardiovascular risk in the terms low, moderate (medium), high and very high added risk which are calibrated to indicate an absolute 10-yr risk of cardiovascular disease of <15%, 15–20%, 20–30% and >30% respectively (based on Framingham criteria). For example, low risk indicates starting treatment and monitoring, high risk indicates treat immediately.

Goals of treatment (adults)

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People with:

Target BP (mmHg)

  • proteinuria >1 g/day (with or without diabetes)

<130/80

  • coronary heart disease

  • diabetes

  • chronic kidney disease

  • stroke or TIA

<140/90

  • general

<140/90

Risk estimates can be determined by referring to various cardiovascular risk tables on the internet. A commonly used tool in Australia is the modified New Zealand Cardiovascular Risk Calculator (www.nzssd.org.nz or www.heartfoundation.org.au) or the Australian Cardiovascular Risk Charts (www.heartfoundation.org.au).

It is important to collaborate with patients in decision making and thus discussing cardiovascular risk assessment, and BP ...

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