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Hypertension, or high blood pressure, is very common but generally a silent condition, unless blood pressure is severely high or long-standing and associated with complications such as stroke, kidney disease or heart failure. A diagnosis of hypertension is made if a consistent resting blood pressure is above 140/90mmHg and should lead to further assessment. The severity of hypertension is based on initial clinic or home readings and often supported by 24-hour ambulatory blood pressure monitor findings.

24-hour blood pressure result confirming hypertension

A detailed assessment of cardiovascular risk and any associated organ damage is required. Investigations should include blood tests for renal disease, diabetes and cholesterol, urinary protein levels, 12-lead ECG and Echocardiography. Certain patients will require testing for rarer causes of high blood pressure including metadrenalines for phaeochromocytoma and renin-aldosterone for primary hyperaldosteronism.

Treatment should initially involve strict lifestyle modification including controlled weight loss, stopping smoking, lowering dietary salt, controlling diet and diabetes and taking regular aerobic exercise. Many patients however will require single, or often combination drug therapy, known as anti-hypertensives, to control blood pressure and lower cardiovascular risk.