Hypertension

Introduction
Hypertension is the major risk factor for heart disease, stroke and kidney failure. Incidence of hypertension varies widely in the world, and the prevalence increases with age. The age-adjusted incidence in the nordic countries is about 40% for both men and women.
Definitions

SBP DBP
Measurement of consultation
Normally <130 mmHg and <85 mmHg
High normal 130-139 mmHg and or 85-89 mmHg
Grade 1 hypertension 140-159 mmHg and or 90-99 mmHg
Grade 2 hypertension 160-179 mmHg and or 100-109 mmHg
Grade 3 hypertension > 180 mmHg and or > 110 mmHg
Isolated systolic hypertension > 140 mmHg and <90 mmHg
Pulse Pressure Difference between systolic and diastolic blood pressure
Orthostatic hypotension 20% drop in systolic blood pressure after 3 minutes in a standing position, or 10% fall in diastolic blood pressure
Ambulatory daily sample
Hypertension > 130 mmHg and or > 80 mmHg
Daghypertensjon (07-23) > 135 mmHg and or > 85 mmHg
Nocturnal hypertension (23-07) > 130 mmHg and or > 70 mmHg
Office Hypertension Elevated blood pressure in the office measurement, normal daily sample
Masked hypertension Normal office blood pressure, elevated daily sample
Home Measurement
Hypertension > 135 mmHg and or > 85 mmHg
Hypertensive ø-help states (indication for IV blood pressure lowering)
Malignant hypertension Severe hypertension, usually diastolic> 130 mmHg and fundus hypertonicus grade III-IV (stasepapiller, bleeding, soft exudates.
Hypertensive crisis Diastolic blood pressure usually> 120 mmHg with cerebral symptoms, heart failure, angina, acute renal failure or aortic dissection

Causes
In most cases one can not identify the cause of hypertension and it is described as essential. Blood pressure should be construed as a function of cardiac output and total vascular resistance. The sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS) is involved in blood pressure regulation and defects in renal salt handling regarded as central in hypertension development. Diagnosed essential hypertension is dependent on that one has excluded the secondary-known causes of hypertension. Genetic factors are thought to contribute about 50% of the causal chain for essential hypertension, while environmental factors such as obesity, salt intake, physical inactivity and stress are modifiable causal factors in the development. Known secondary causes of hypertension are chronic kidney disease (5% of the hypertensive population), primary aldosteronism, pheochromocytoma, hypertension and sleep apnea renovascular. Drugs, alcohol and drug abuse can also lead to secondary hypertension.
Clinical presentation
Hypertension is often asymptomatic and should be detected early through routine checks. Blodtrykksforhøyelse over time can lead to organ damage. Often one will, before symptoms of organ damage occurs, could find left ventricular hypertrophy, microvascular changes in the eye bottom and microalbuminuria as signs of hypertensive target organ damage.

Once the diagnosis is established it should trigger 3 questions by the clinician.

Course and treatment
Hypertension is a major risk factor for cerebrovascular disease, kidney damage, heart disease and heart failure along with including age, gender, smoking, obesity, diabetes mellitus, physical inactivity, lipid profiles and kidney disease. Blood pressure must always be considered in relation to other risk factors, and the overall cardiovascular risk, it is to be emphasized when one considers the treatment indication and treatment goals