3.4. Hypertension

📄Definition

Hypertension is defined as persistently elevated arterial blood pressure. Diagnosis is confirmed by out-of-office measurement.

  • Stage 1: Clinic BP ≥140/90 mmHg AND ABPM/HBPM ≥135/85 mmHg

  • Stage 2: Clinic BP ≥160/100 mmHg AND ABPM/HBPM ≥150/95 mmHg

  • Severe: Clinic systolic ≥180 mmHg OR diastolic ≥120 mmHg

🔍 PASSMAP Insight
The GMC combines “arterial thrombosis” and “hypertension” in the core condition list to emphasise how long-term vascular damage from high blood pressure leads to life-threatening thrombotic events such as MI, stroke, and limb ischaemia.

🛡️ Risk Factors 

  • Age >55 (men), >65 (women)

  • Black African or Caribbean ethnicity

  • Obesity

  • Smoking

  • Diabetes

  • Excess alcohol intake

  • Family history of hypertension or cardiovascular disease

📋 Clinical Features

Most cases are asymptomatic. 

❗Symptoms suggest complications:

  • Headache (esp. in severe/malignant HTN)

  • Visual disturbances (retinopathy)

  • Chest pain / dyspnoea (LVH, HF)

  • Neurological symptoms (stroke, TIA)

🔬Investigations 

🧠 Mnemonic: HYPERTENSION

  • HbA1c (diabetes)

  • Yield: ABPM/HBPM for diagnosis

  • Proteinuria/ACR & U&Es (renal function)

  • ECG (LVH, arrhythmia)

  • Retinopathy (fundoscopy)

  • Total cholesterol/lipids

  • EGFR & creatinine

  • Natrium (Sodium), potassium

  • Secondary causes (young, resistant HTN)

  • Invest for end-organ damage

  • Observe lifestyle factors

  • Non-invasive CV risk score (QRISK3)

💊 Management

🧠 Mnemonic: A-C-D Rule (age, ethnicity, and diabetes-based)

➡️ Step 1:

  • Age <55 and no diabetes: ACEi or ARB

  • Age ≥55 or Black African/Caribbean ethnicity (any age, no diabetes): CCB

  • Diabetes (any age or ethnicity): ACEi or ARB

➡️ Step 2: Combine A + C (ACEi/ARB + CCB)

➡️ Step 3: Add D (thiazide-like diuretic e.g. indapamide)

➡️ Step 4: Consider low-dose spironolactone if K+ ≤4.5 or higher-dose thiazide-like diuretic if K+ >4.5. Seek specialist advice for resistant HTN.

💡 All patients:

  • Lifestyle advice (weight loss, salt restriction, DASH diet, physical activity)

  • Statin if 10-year CV risk ≥10% (QRISK3)

❗Complications

  • MI, stroke, TIA

  • Heart failure

  • CKD

  • Retinopathy

  • Aortic dissection

🩺 Monitoring

  • Monitor BP every 4–6 weeks until controlled, then 6–12 monthly

  • Monitor U&Es if on ACEi, diuretic, or spironolactone

  • Annual QRISK3 update

Last updated in line with NICE NG136 (March 2022)
Last reviewed: July 2025
PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

Scroll to Top