London Hypertension Clinic. Symptoms and treatments for Hypertension and stress from leading consultant Carl Shakespeare.

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	Abnormal elevation in blood pressure (BP) is referred to as hypertension. It is an important diagnosis to make as prolonged abnormal elevation in BP is associated with risk to the major body organs. Clearly hypertension needs to be distinguished from fluctuations in BP that can occur naturally. The risk associated with major organs is referred to as “Target Organ Damage”. Certainly the presence of target organ damage would result in initiating treatment earlier and more aggressively. Natural elevation in BP can occur in stressful circumstances, and thus should not be measured in such situations.
Not uncommonly, the simple act of measurement can cause the pressure to go up. This is referred to as "white coat hypertension", although very few physicians wear white coats anymore! Often both patient and physician face the dilemma of determining whether an a BP reading reflects true hypertension or the white coat phenomenon. One does not want to treat unnecessarily, but on neither to under treat patients. In other circumstances, there is confusion when on some occasions, measurements are elevated, and at other times, pressure appears normal or low. This referred as "labile hypertension", and needs to be excluded. There is an array of methods of assessment which are discussed in the Diagnostics section. Recent consensus suggests that the commonly measured cuff measurement, so called "office BP", is inaccurate or inconsistent in the assessment and prognostication of hypertension. More recently the validation of non-invasive assessment of central aortic pressure using a tonometer device has emerged as the best prognostic assessment of the true blood pressure and vascular risk (see Investigations). Although most patients have an underlying genetic cause of hypertension, so called "benign or primary hypertension", secondary causes need to be considered in younger patients or patients with more resistant conditions. The mainstay of treatment in the first instance is lifestyle modification. The usual suspects include: smoking, being overweight, and alcohol excess. When choosing medication, different classes of medication suit different patient groups, so it is not a case of "one suit fits all". Essential to the management of blood pressure, is the identification of other risk factors which themselves increase vascular risk. These factors may contribute to blood pressure elevation or need to be "factored in" when considering hypertensive treatment. A vascular risk calculator is provided to perform an assessment.

About Hypertension: