Complications

Complications table
ComplicationTimeframeLikelihood

coronary artery disease

long termhigh

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] 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.

cerebrovascular accident

long termhigh

The risk of developing cerebrovascular accident (CVA) varies linearly with blood pressure (BP), and BP control reduces the risk of recurrent CVA.[163]

left ventricular hypertrophy

long termhigh

Left ventricular hypertrophy (LVH) on echocardiography is seen in more than 30% of hypertensive patients.[167]

Linked to cardiovascular morbidity and mortality.[168] LVH patterns vary based on haemodynamical loading conditions.[169]

congestive heart failure

long termmedium

Patients with hypertension are 3 times more likely to develop congestive heart failure (systolic or diastolic dysfunction) as are normotensive patients.[164]

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]

retinopathy

long termmedium

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.

peripheral artery disease

long termmedium

Treatment of hypertension in patients with peripheral artery disease reduces the risk of myocardial infarction, stroke, or congestive heart failure.

chronic kidney disease

long termmedium

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]

A more malignant course of hypertensive kidney disease is seen in black than in white people.[171]

aortic dissection

long termlow

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][166]

malignant hypertension

variablelow

Undiagnosed or inadequately treated essential hypertension is the most common cause of hypertensive emergency.[172]

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