Rapid Review·Cardiovascular
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PATHOLOGY
T2High yieldHypertension
FA P302
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Focus on
What counts as hypertension, which patients have a cause worth hunting, and when a high number becomes an emergency.
Key takeaways
What counts as hypertension
Definition
a persistent systolic BP of 130 or above and/or diastolic 80 or above.Risk factors
increasing age, obesity, diabetes, physical inactivity, high-sodium diet, excess alcohol, tobacco, family history. Incidence is greatest in Black > White > Asian populations.Predisposes to
coronary artery disease, concentric LVH (mediated by angiotensin II and endothelin), heart failure, atrial fibrillation, aortic dissection and aneurysm, stroke, hypertensive nephropathy, and retinopathy.Primary or secondary
90% is primary (essential)
related to raised cardiac output or raised total peripheral resistance.10% is secondary
from renal or renovascular disease such as fibromuscular dysplasia ("string of beads" renal artery, usually in adult women), atherosclerotic renal artery stenosis, primary hyperaldosteronism, or obstructive sleep apnea.| Feature | Primary (essential) | Secondary |
|---|---|---|
| Frequency | 90% | 10% |
| Mechanism | Raised cardiac output or raised TPR | An identifiable cause |
| Causes | Multifactorial | Fibromuscular dysplasia ("string of beads", adult women), renal artery stenosis, primary hyperaldosteronism, OSA |
When the number becomes an emergency
Hypertensive urgency
severe hypertension (180/120 or above) without acute end-organ damage.Hypertensive emergency (formerly malignant hypertension)
the same pressure with acute end-organ damage: encephalopathy, stroke, retinal hemorrhages or exudates, papilledema, MI, heart failure, aortic dissection, kidney injury, microangiopathic hemolytic anemia, eclampsia. Arterioles may show fibrinoid necrosis.| Feature | Hypertensive urgency | Hypertensive emergency |
|---|---|---|
| Blood pressure | 180/120 or above | 180/120 or above |
| End-organ damage | Absent | Present: encephalopathy, stroke, retinal hemorrhage or papilledema, MI, heart failure, aortic dissection, kidney injury, MAHA, eclampsia |
| Pathology | None | Arterioles may show fibrinoid necrosis |
Two patients both have a blood pressure of 200/125. One is asymptomatic, the other has papilledema. What is each called?
Same number, different organs: the asymptomatic patient has a hypertensive urgency; papilledema is end-organ damage, so the second is a hypertensive emergency.
How it's tested
Emergency versus urgency turns entirely on end-organ damage, not on the number. The same blood pressure is an urgency in an asymptomatic patient and an emergency in one with encephalopathy, papilledema, acute kidney injury, or chest pain, so the stem is asking you to read the organs rather than the reading. On the aetiology side, primary hypertension accounts for the large majority, and the trigger to hunt for a secondary cause is the pattern rather than the pressure: onset before 30 or after 55, resistance to three drugs, or an abrupt rise in a previously controlled patient.
Go deeper
First Aid 2026 — CV/Pathology (p.302) · B&B — Hypertension · Mehlman — HY Cardio (secondary hypertension, hypertensive emergency)
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Modifiable → (...) inactivity
Modifiable → (...)
Modifiable → (...)
Modifiable → (...)
Modifiable → Excess (...) intake
Modifiable → Excess (...) intake
Nonmodifiable → Increased (...)
Nonmodifiable → (...)
Nonmodifiable → (...)
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