Hypertension

Exam Cram

• Assess hypertension by severity (hypertensive emergency vs urgency) and by cause 

• Hypertension emergency: evidence of end organ damage (heart, brain, kidneys)

• Hypertension urgency: SBP > 140 without evidence of end organ damage

• Hypertension caused by essential hypertension (primary) or secondary causes

Assessment of Hypertension

Categorise severity:

• Normotensive: BP 120/80 (BP < 140/90)

• Hypertensive urgency: BP > 140/90 without end organ damage

• Hypertensive emergency:  BP > 140/90 with end organ damage

Categorise by cause:

• Essential Hypertension (primary)

• Secondary Causes of Hypertension

See Hypertension (disease) for discussing essential and secondary causes of hypertension. 

Schema:

• Symptom -> sign -> diagnosis -> classification

• E.g. Lethargy -> hypotension -> hypertensive urgency -> essential hypertension

Outline

Evidence of End Organ Damage

• Symptoms

  1. 1. Cerebral: headaches, confusion, drowsiness, focal neurology

     2. Chest: chest pain, palpitations

     3. Oliguria

• Investigations

  1. 1. CT-Head ?hypertensive encephalopathy

     2. ECG & troponin: hypertensive cardiomyopathy- LVH

     3. Urine analysis: hypertensive nephropathy- haemtoproteinuria

Hypertensive Emergency

• Diagnosis: 

  1. 1. SBP > 140

     2. With evidence of end organ damage

• Management

  1. Antihypertensive IV infusions: 

     1. GTN

     2. Labetolol

     3. Nitroprusside

  2. Disposition: HDU

Hypertensive Urgency

• Diagnosis: 

  1. BP > 140./ 90 

  2. Without evidence of end organ damage

• Management (as per underlying cause, if undiagnosed assume Essential Hypertension)

  1. ACE inhibitors if diabetic or under 55; calcium channel blockers if over 55 or African American

  2. ACE inhibitor + CCB

  3. Thiazide or thiazide like diuretic

  4. Spironolactone if K+ > 4.5, alpha/ beta blocker if K+ < 4.5

  5. Refer to specialist

• Disposition: discharge

There is little urgency for HTN urgency and BP medications take hours to days to reach steady states. These can be difficult to manage within the acute stressful setting of the hospital. 

Causes of Hypertension

• Essential Hypertension (primary)

• Secondary Hypertension

  • Hyperaldosteronism- Conn's Syndrome, Bilateral Adrenal Hyperplasia

  • Hypercortisolaemia (Cushing's syndrome)

  • Renal (CKD) Causes

  • Vascular causes- e.g. coarctation

Resources & References

1. https://www.mims.co.uk/hypertension-adults-nice-guideline/cv-blood-pressure/article/892706

Written in 2025