Complications tableComplication | Timeframe | Likelihood |
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| long term | high |
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For every 20/10 mmHg increase in blood pressure (BP), there is a lifetime doubling of mortality related to ischaemic heart disease or cerebrovascular accident.[162]Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903-13.
http://www.ncbi.nlm.nih.gov/pubmed/12493255?tool=bestpractice.com
As with all other associated complications and comorbid diseases, aggressive BP control, along with therapy specific for the individual condition, may retard the progression of disease. Overview of acute coronary syndrome |
| long term | high |
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The risk of developing cerebrovascular accident (CVA) varies linearly with blood pressure (BP), and BP control reduces the risk of recurrent CVA.[163]PROGRESS Collaborative Group. Randomized trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001 Sep 29;358(9287):1033-41.
http://www.ncbi.nlm.nih.gov/pubmed/11589932?tool=bestpractice.com
Overview of stroke |
| long term | high |
---|
Left ventricular hypertrophy (LVH) on echocardiography is seen in more than 30% of hypertensive patients.[167]Schmieder RE, Messerli FH. Hypertension and the heart. J Hum Hypertens. 2000 Oct-Nov;14(10-11):597-604.
http://www.ncbi.nlm.nih.gov/pubmed/11095153?tool=bestpractice.com
Linked to cardiovascular morbidity and mortality.[168]Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001 Mar;141(3):334-41.
http://www.ncbi.nlm.nih.gov/pubmed/11231428?tool=bestpractice.com
LVH patterns vary based on haemodynamical loading conditions.[169]Devereux RB, Roman MJ, Ganau A, et al. Cardiac and arterial hypertrophy and atherosclerosis in hypertension. Hypertension. 1994 Jun;23(6 Pt 1):802-9.
http://www.ncbi.nlm.nih.gov/pubmed/8206580?tool=bestpractice.com
|
| long term | medium |
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Patients with hypertension are 3 times more likely to develop congestive heart failure (systolic or diastolic dysfunction) as are normotensive patients.[164]Levy D, Larson MG, Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA. 1996 May 22-29;275(20):1557-62.
http://www.ncbi.nlm.nih.gov/pubmed/8622246?tool=bestpractice.com
ACE inhibitors, angiotensin-II receptor antagonists, and beta-blockers confer a mortality benefit. Diuretics do not, but loop diuretics are frequently used to relieve symptoms of fluid overload. Blockade of aldosterone has been associated with decreased end-organ fibrosis.[100]Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure: Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999 Sep 2;341(10):709-17.
https://www.nejm.org/doi/full/10.1056/NEJM199909023411001
http://www.ncbi.nlm.nih.gov/pubmed/10471456?tool=bestpractice.com
Chronic congestive heart failure |
| long term | medium |
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Hypertension is associated independently with retinopathy. Hypertension is also a major risk factor for development of other retinal vascular diseases, such as retinal vein or artery occlusion, or ischaemic optic neuropathy. |
| long term | medium |
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Treatment of hypertension in patients with peripheral artery disease reduces the risk of myocardial infarction, stroke, or congestive heart failure. Peripheral vascular disease |
| long term | medium |
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Hypertension is closely associated with the development of renal disease and end-stage renal disease (ESRD). However, while many hypertensive patients will develop a mild degree of nephrosclerosis, few progress to ESRD.[170]Bidani AK, Griffin KA. Pathophysiology of hypertensive renal damage: implications for therapy. Hypertension. 2004 Nov;44(5):595-601.
https://www.ahajournals.org/doi/full/10.1161/01.hyp.0000145180.38707.84
http://www.ncbi.nlm.nih.gov/pubmed/15452024?tool=bestpractice.com
A more malignant course of hypertensive kidney disease is seen in black than in white people.[171]Marcantoni C, Ma LJ, Federspiel C, et al. Hypertensive nephrosclerosis in African Americans versus Caucasians. Kidney Int. 2002 Jul;62(1):172-80.
https://www.kidney-international.org/article/S0085-2538(15)48534-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/12081576?tool=bestpractice.com
Chronic kidney disease |
| long term | low |
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More than 70% of patients with aortic dissection have a history of hypertension. Despite improved methods of diagnosis and increased awareness, aortic dissection remains associated with high mortality rates, particularly proximal (type A) dissections.[165]Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 Feb 16;283(7):897-903.
https://jamanetwork.com/journals/jama/fullarticle/192401
http://www.ncbi.nlm.nih.gov/pubmed/10685714?tool=bestpractice.com
[166]Prisant LM, Nalamolu VR. Aortic dissection. J Clin Hypertens (Greenwich). 2005 Jun;7(6):367-71.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1524-6175.2005.04116.x
http://www.ncbi.nlm.nih.gov/pubmed/16088302?tool=bestpractice.com
Aortic dissection |
| variable | low |
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Undiagnosed or inadequately treated essential hypertension is the most common cause of hypertensive emergency.[172]Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001 Aug 16;345(7):479-86.
https://www.nejm.org/doi/full/10.1056/NEJMoa010273
http://www.ncbi.nlm.nih.gov/pubmed/11519501?tool=bestpractice.com
Hypertensive emergencies |