Hypertension (HTN)

🔍 When to Suspect

Clinic blood pressure reading ≥140/90 mmHg, usually found on opportunistic screening as most patients are asymptomatic

From the full topic in The Ocean Library: Hypertension (HTN)

🧭 When to suspect

Hypertension is usually asymptomatic – the “silent killer”. It is most often found through opportunistic screening or as an incidental clinic reading, rather than because the patient feels unwell.

Suspect it when:

• A clinic blood pressure (BP) is ≥ 140/90 mmHg, or

• There is evidence of hypertension-mediated organ damage (left ventricular hypertrophy, chronic kidney disease, retinopathy or raised urine albumin:creatinine ratio).

A single high clinic reading is not a diagnosis.

• A discrepancy of more than 20/10 mmHg between clinic and out-of-office readings (the white-coat effect) is common.

• Confirm the diagnosis with ambulatory BP monitoring (ABPM) – or home BP monitoring (HBPM) if ABPM is unsuitable or not tolerated – unless the clinic BP is in the severe range.

• A clinic BP in the severe range (≥ 180/120 mmHg) warrants more urgent action.

• Adults with a normal BP should be screened at least every 5 years.

Category	Clinic BP	ABPM/HBPM average
Normal or not diagnosed	< 140/90 mmHg	–
Stage 1	140/90 – 159/99 mmHg	135/85 – 149/94 mmHg
Stage 2	≥ 160/100 (and < 180/120) mmHg	≥ 150/95 mmHg
Stage 3 (severe)	Systolic ≥ 180 or diastolic ≥ 120 mmHg	Confirm urgently or same-day review if indicated

Raise suspicion of a secondary cause in anyone aged under 40, in resistant hypertension, or where the history points to it:

• Paroxysmal headache, palpitations, pallor and sweating (phaeochromocytoma).

• Muscle weakness or hypokalaemia (primary hyperaldosteronism or Conn’s).

• Snoring and daytime somnolence (obstructive sleep apnoea).

• Renal disease.

Always review BP-raising agents – NSAIDs, corticosteroids, combined oral contraceptives, venlafaxine, decongestants and liquorice.

Source: NICE NG136

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