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Chapter 2: Hypertension and vascular diseases 75

Table 2.10 Stratification of risk depending on blood pressure and risk factors
Blood pressure (mmHg)
Normal High Normal Grade 1 Grade 2 Grade 3
SBP 120–129 or SBP 130–139 or SBP 140–159 or SBP 160–179 or SBP >179 or
DBP 80–84 DBP 85–89 DBP 90–99 DBP 100–109 DBP >109
No other risk factors Average risk Average risk low risk Moderate risk High risk
1–2 risk factors Low risk Low risk Moderate risk Moderate risk Very high risk
3+ factors, TOD , Moderate risk High risk High risk High risk Very high risk
∗
ACC or diabetes
†
Target Organ Damage (TOD) including left ventricular hypertrophy, microalbuminuria, hypertensive retinopathy grade III or IV, or radiological evidence
∗
of widespread atherosclerosis.
Associated clinical conditions (ACC) include cerebrovascular disease, cardiac disease, renal disease or peripheral vascular disease.
†
Specialisttestsincludefurthertestsforendorgandam- Presence of retinal changes, presence of renal or car-

age (cerebral, cardiac renal) and tests for the causes diac impairment,
of secondary hypertension (renin, aldosterone, corti- Being male is a greater risk than female,
costeroids, catecholamines, arteriography, renal and Age(young fare worse than old) and
adrenal ultrasound, MRI brain). Coexistence of coronary disease and risk factors.

Management Peripheral arterial disease
Treatment is based on the total level of cardiovascular
Definition
risk and the level of systolic and diastolic blood pressure
Peripheralarterialdiseasedescribesaspectrumofpatho-
(see Tables 2.9 and 2.10)
logical processes affecting either the larger arteries or
Allpatientsshouldbeadvisedtohavelifestylechanges,

small vessels.
includingweightreduction,alcohollimitation,saltre-
striction, reduced total and saturated fat intake and
Incidence
increased fruit and vegetable consumption and in-
Very common.
creased exercise. Stopping smoking as well as the ac-
tions mentioned above will also reduce overall cardio-
Age
vascular risk.
Mainly over 50 years
Patients with high or very high risk should begin treat-

mentimmediately.Patientswithmoderateriskshould
Sex
remain under close follow-up. If after 3 months their
M > F
systolic blood pressure is above 139 or the diastolic
above 89, treatment should be started. The remainder
Geography
of patients and those with low or average risk should
More common in the Western world.
remain under long-term follow-up.
Combination drug treatment is often required. A

Aetiology/pathophysiology
treatment algorithm is shown in Fig. 2.15.
Atheromatous plaques form especially in larger vessels at
areas of haemodynamic stress such as at the bifurcation
Prognosis of vessels and origins of branches. It may affect younger
Patients with untreated malignant hypertension have a patients, particularly diabetics and smokers.
1-year mortality rate of 90%. In general the risks from Arteriosclerosis, ‘hardening of the arteries’, is an age-
hypertension are dependent on: related condition accelerated by hypertension. It often
The level of blood pressure, occurs in conjunction with atheroma.