Course on hypertension

Finally, the first day of our hypertension course has come to an end, and I can go to a much needed repose. First I just have to finish my blogpost, and possibly check the twitter. So far it has been a very successful course. As is traditional we started with epidemiology, worked through pathophysiology and diagnosis. Treatment will come tomorrow.

Here is a brief summary of the conclusions from the first day:

Hypertension is developing better traction with the big agencies, WHO etc, as the largest modifiable risk factor for disease and death. Not only in the high-income countries, but globally.

Prehypertension (120-140 in systolic- and 70-90 in diastolic blood pressure) is an important risk factor for later hypertension and later cardiovascular morbidity and death. It should probably indicate a closer follow up and counceling about life-style, although, it is still not well studied enough to be an indication for pharmacological treatment.

Diastolic hypertension is the strongest risk factor for later cardiovascular morbidity and mortality in adolescents. In middle age systolic blood pressure takes over, and in greater ages the pulse pressure is stronger than either.

Hypertension is part of the cluster of risk factors sometimes known as the metabolic syndrome. Increased stress-hormone release may represent a common mechanism behind this syndrome.

High exercise blood pressure (>210 mmHg) in the absence of clinical hypertension may be a sign of masked hypertension.

Hypertension is both caused by, and leads to structural changes in the vasculature, which are important for the associated cardiovascular diseases and end organ damage.

Non-pharmacologic treatment, such as exercise, weight-loss and reduced salt-intake are effective components in the treatment and prevention of hypertension.

The work-up for a patient with hypertension should include ambulatory blood pressure if they are prehypertensive or if the indication for treatment is uncertain. For example, slight hypertension, no other risk factors and no target organ damage. A situation where current guidelines suggest to wait and see. A problem is that ambulatory measures are not included int the current guidelines. So, it is unclear how the results should be interpreted.

Secondary hypertension is a surprisingly common cause of hypertension, in particular hyperaldosteronism which may include 5-13% of all hypertensives.

Albuminuria is an important, independent risk-factor for cardiovascular morbidity all the way from sub-microalbuminuric levels.

In addition to these lectures we had some clinical cases and two panel discussions:

Is hypertension the most important global risk factor for disease and death?

Does living well improve your survival?

Both of these were answered with quite solid affirmative answers. Not really surprising given the audience and setting, but probably not wrong either.