HYPERTENSION IN

GENERAL PRACTICE

D R . H A S E E B A M U K H TA R
LEARNING OBJECTIVES;

1. Identify the red flags in a hypertensive patient and appropriately refer to

specialty care when required
2. Describe the strategies for the prevention of hypertension and its
complications.
3. Explain the management strategies of a hypertensive patient in general
practice including the psychosocial impact of disease on patient and their
families.
HYPERTENSION  
• The following definitions and staging system were suggested in 2017 by the
American College of Cardiology/American Heart Association (ACC/AHA)
• Normal blood pressure – Systolic <120 mmHg and diastolic <80 mmHg
• Elevated blood pressure – Systolic 120 to 129 mmHg and diastolic <80 mmHg
• Hypertension:
• •Stage 1 – Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
• •Stage 2 – Systolic at least 140 mmHg or diastolic at least 90 mmHg
RED FLAGS FOR REFERAL

1.Severe or resistant hypertension: If a patient's blood pressure remains

consistently high despite appropriate lifestyle modifications and medication
management, it may be necessary to refer them to a specialist for further
evaluation and management.
2.Hypertensive emergencies: Rapidly progressive or severe elevation of blood
pressure accompanied by symptoms such as severe headache, blurred vision,
chest pain, shortness of breath, neurological deficits, or signs of organ damage
(e.g., acute kidney injury) may indicate a hypertensive emergency. These
patients require immediate medical attention and should be referred to an
emergency department or a specialized hypertension unit.
3. Secondary hypertension: Certain conditions can cause secondary
hypertension, meaning high blood pressure is a result of an underlying medical
condition. Red flags for secondary hypertension include the onset of
hypertension at a younger age (<30 years) or older age (>55 years), sudden or
severe elevation in blood pressure, resistance to standard antihypertensive
medications, presence of symptoms suggestive of an underlying cause (e.g.,
excessive sweating, palpitations, weight loss), or a family history of early-onset
hypertension or specific genetic disorders.
4. Target organ damage: Red flags indicating potential organ damage include
symptoms such as chest pain, shortness of breath, signs of heart failure, edema in
the legs, blood in the urine, a significant decline in kidney function, neurological
symptoms (e.g., severe headache, confusion, seizures), or vision changes.
Referral to the appropriate specialist, such as a cardiologist, nephrologist,
neurologist, or ophthalmologist, may be necessary for further evaluation and
management.
5. Coexisting medical conditions: If a hypertensive patient has complex medical
conditions or comorbidities that require specialized care, such as diabetes,
chronic kidney disease, cardiovascular disease, or pregnancy-induced
hypertension, referral to the respective specialists involved in their overall
management is important for optimal treatment and risk reduction.
PREVENTION OF HYPERTENSION;
PHARMACOLOGICAL MANAGEMENT;
SCENARIO:

• Mrs. Johnson is a 55-year-old woman who comes to your general practice for a routine check-
up. During the examination, you measure her blood pressure and find it to be consistently
elevated at 160/100 mmHg. As her primary care physician, you need to identify any red flags
and decide if a referral to specialty care is necessary. Additionally, you should provide
information on prevention strategies, and management strategies, and consider the
psychosocial impact on the patient and her family.
IDENTIFYING RED FLAGS AND REFERRAL TO SPECIALTY
CARE:

1. Severe Hypertension: Mrs. Johnson's blood pressure of 160/100 mmHg is considered stage 2
hypertension. While not an immediate red flag, it indicates the need for further evaluation and
management.
2. Hypertensive Crisis: Mrs. Johnson does not exhibit signs of a hypertensive crisis, which
typically presents with severely elevated blood pressure (>180/110 mmHg) along with
symptoms like severe headache, chest pain, shortness of breath, blurred vision, or confusion. In
the absence of these symptoms, immediate referral to specialty care is not required
PREVENTION STRATEGIES FOR
HYPERTENSION AND ITS COMPLICATIONS
1. Lifestyle Modifications: Encourage Mrs. Johnson to adopt a healthy lifestyle, including regular
exercise, a balanced diet (low in sodium and high in fruits, vegetables, and whole grains),
weight management, and limiting alcohol consumption.
2. Stress Management: Teach stress-reduction techniques such as deep breathing exercises,
meditation, or yoga to help Mrs. Johnson cope with daily stressors.
3. Smoking Cessation: If Mrs. Johnson is a smoker, emphasize the importance of quitting
smoking to reduce the risk of hypertension and its complications
MANAGEMENT STRATEGIES FOR HYPERTENSIVE
PATIENTS IN GENERAL PRACTICE:

1. Regular Blood Pressure Monitoring: Advise Mrs. Johnson to monitor her blood pressure at
home and keep a record of the readings to track her progress.
2. Medication Therapy: Consider initiating antihypertensive medication for Mrs. Johnson to help
control her blood pressure. Start with a single medication and adjust the dosage or add
additional medications if needed.
3. Lifestyle Counseling: Provide ongoing education and support for Mrs. Johnson regarding
lifestyle modifications, medication adherence, and the importance of regular follow-up
appointments.
PSYCHOSOCIAL IMPACT ON THE
PATIENT AND THEIR FAMILIES:
1. Patient Education: Explain to Mrs. Johnson and her family the significance of hypertension, its
potential complications, and the importance of adherence to treatment plans. Address any
concerns or misconceptions they may have.
2. Emotional Support: Recognize that a diagnosis of hypertension can cause anxiety and stress for
the patient and their family. Offer emotional support and encourage them to seek counseling or
support groups if needed.
3. Family Involvement: Encourage family members to participate in lifestyle modifications, such
as adopting healthy eating habits or engaging in physical activity together. This can foster a
supportive environment and enhance the patient's motivation to manage their hypertension
effectively.
SCENARIO 2;

• Patient's Medical History: Name: John Smith Age: 45 Gender: Male

• John Smith is a 45-year-old male with a past medical history of obesity and a
sedentary lifestyle. He presents to his primary care physician complaining of
frequent headaches and occasional dizziness over the past few weeks. John
mentions that his father had a stroke at a relatively young age, but he is unsure
about any other family history of cardiovascular diseases. He denies any chest
pain, shortness of breath, or changes in vision.
 LAB INVESTIGATIONS;

1.Blood Pressure Measurement: A primary care physician measures John's blood pressure
using a sphygmomanometer. His initial reading shows a blood pressure of 160/100
mmHg, indicating hypertension.
2.Lipid Profile: John's lipid profile reveals elevated levels of total cholesterol (220 mg/dL)
and low-density lipoprotein (LDL) cholesterol (160 mg/dL), indicating dyslipidemia.
3.Fasting Blood Glucose: John's fasting blood glucose level is within the normal range,
ruling out diabetes as a cause of hypertension.
4.Renal Function Tests: The renal function tests show no abnormalities, indicating normal
kidney function at this stage.
5.Electrocardiogram (ECG): John's ECG shows no significant abnormalities, suggesting
normal cardiac function.
QUESTIONS??

1.What are the red flags in John's medical history?

2.What signs and symptoms does John present with?
3.Which laboratory investigations are relevant for assessing John's condition?
4.What are the findings of John's laboratory investigations?
ANSWERS;
1.The red flags in John's medical history include a family history of stroke and his
complaint of frequent headaches and dizziness.
2.John presents with frequent headaches, occasional dizziness, obesity, and a
sedentary lifestyle.
3.The relevant laboratory investigations for assessing John's condition include
blood pressure measurement, lipid profile, fasting blood glucose, renal function
tests, and an electrocardiogram (ECG).
4.The findings of John's laboratory investigations are as follows: his blood
pressure is elevated (160/100 mmHg), his lipid profile indicates dyslipidemia
with elevated total cholesterol (220 mg/dL) and LDL cholesterol (160 mg/dL),
his fasting blood glucose is within the normal range, his renal function tests
show no abnormalities, and his ECG is normal.