Complications
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Cardiovasculaire risicobepaling in de eerste lijnPublished by: Domus MedicaLast published: 2020Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2010For every 20/10 mmHg increase in blood pressure (BP), there is a lifetime doubling of mortality related to ischaemic heart disease or cerebrovascular accident.[229] As with all other associated complications and comorbid diseases, aggressive BP control, along with therapy specific for the individual condition, may retard the progression of disease. A longer duration of hypertension has also been associated with increased risks of cardiovascular disease and overall death in a linear fashion.[230]
Patients with hypertension are 3 times more likely to develop congestive heart failure (systolic or diastolic dysfunction) than are normotensive patients.[232]
ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers, aldosterone antagonists, and sodium-glucose co-transporter 2 inhibitors confer a mortality benefit. Diuretics do not, but loop diuretics are frequently used to relieve symptoms of fluid overload.
Hypertension is associated independently with retinopathy.
Hypertension is also a major risk factor for development of other retinal vascular diseases, such as retinal vein or artery occlusion, or ischaemic optic neuropathy.
Treatment of hypertension in patients with peripheral artery disease reduces the risk of myocardial infarction, stroke, or congestive heart failure.
Hypertension is closely associated with the development of renal disease and end-stage renal disease (ESRD). However, while many hypertensive patients will develop a mild degree of nephrosclerosis, few progress to ESRD.[238]
A more malignant course of hypertensive kidney disease is seen in black than in white people.[239]
Approximately 10% of adults with hypertension have orthostatic hypotension and the risk increases with age.[241] Antihypertensive medicine should be optimised in these patients; removing antihypertensives may worsen symptoms. Monitoring for orthostatic hypotension, especially when initiating new treatments in older patients, may be beneficial.[241]
Undiagnosed or inadequately treated essential hypertension is the most common cause of hypertensive emergency.[240]
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