| Primary (essential) hypertension | Secondary hypertension |
| > Accounts for 85–95% of >>>> cases of hypertension in >>>> adults > No specific cause; >>>> multifactorial aetiology >>>> including epigenetic/ >>>> genetic and >>>> environmental factors > Non-modifiable risk factors >>>o Positive family history >>>o Ethnicity >>>o Advanced age > Modifiable risk factors >>>o Obesity >>>o Diabetes >>>o Smoking, >>>excessive alcohol or >>>caffeine intake > Diet high in sodium, low in >>>potassium > Physical inactivity > Psychological stress | > Accounts for 5–15% of cases of >>>> hypertension in adults > Caused by a specific organ condition >>>o Endocrine hypertension >>>o Primary >>>> hyperaldosteronism (Conn >>>> syndrome) >>>o Primary >>>> hyperparathyroidism >>>o Pheochromocytoma >>>o Hypercortisolism (Cushing >>>> syndrome) >>>o Hyperthyroidism >>>o Acromegaly >>>o Congenital adrenal >>>> hyperplasia >>>o Renal hypertension >>>o Medications Drugs causing HYPERTENSION: > Anabolic steroids: Nandrolone, >>>> oxymetholone, oxandrolone > Antidepressants: Venlafaxine, tricyclics, >>>> MAO inhibitors > Immunosuppressants: Cyclosporin, >>>> tacrolimus > Mineralocorticoids: Fludrocortisone, 9a->>>> >>>>fluoroprednisolone > NSAIDs/coxibs: All, but COX-2 worse >>>> than COX-1, indomethacin > Oral contraceptives: Oestrogen containing > Serotonergic: Dihydroergotamine, >>>> sumatriptan |
| Hypertensive crisis | >>>>Hypertensive urgency and hypertensive >>>>emergency. These two >>>>conditions occur when blood pressure >>>>becomes very high, possibly >>>>causing organ damage |
| Hypertensive urgency | >>>>Marked elevation in blood pressure >>>>(180 mm Hg or more systolic, or >>>>110 mm Hg) without evidence of target >>>>organ damage >>>>Where there is no organ damage gradual >>>>bp reduction over several >>>>days is sufficient and safer |
| Hypertensive emergency | >>>>Elevated blood pressure (180 mm Hg or more >>>>systolic, or 110 mm Hg) with irreversible >>>>hypertension-mediated organ damage >>>>(HMOD) >>>>IV antihypertensives are preferred >>>>Avoid precipitous BP reduction> 25% >>>>over 2 hours >>>>Aim towards 160/100 rather than normal >>>>BP level, then wait 24 hour >>>>for lower further |
| Pregnancy induced hypertension | >>>>Development of new hypertension in a >>>> pregnant woman after 20 >>>>weeks’ gestation |
| Resistant Hypertension | >>>>Hypertension is considered resistant when >>>>patient is taking three >>>>different blood pressure medications at >>>>their maximally tolerated >>>>doses and blood pressure does not >>>>respond well to aggressive >>>>medical treatment |
