Essential hypertension - Complications | BMJ Best Practice

Complications

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Complications table
Complication	Timeframe	Likelihood
coronary artery disease	long term	high
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.[145] 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
cerebrovascular accident	long term	high
The risk of developing cerebrovascular accident (CVA) varies linearly with blood pressure (BP), and BP control reduces the risk of recurrent CVA.[146] Overview of stroke
left ventricular hypertrophy	long term	high
Left ventricular hypertrophy (LVH) on echocardiography is seen in more than 30% of hypertensive patients.[150] Linked to cardiovascular morbidity and mortality.[151] LVH patterns vary based on haemodynamical loading conditions.[152]
congestive heart failure	long term	medium
Patients with hypertension are 3 times more likely to develop congestive heart failure (systolic or diastolic dysfunction) as are normotensive patients.[147] 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.[94] Chronic congestive heart failure
retinopathy	long term	medium
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 term	medium
Treatment of hypertension in patients with peripheral artery disease reduces the risk of myocardial infarction, stroke, or congestive heart failure. Peripheral vascular disease
chronic kidney disease	long term	medium
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.[153] A more malignant course of hypertensive kidney disease is seen in black than in white people.[154] Chronic kidney disease
aortic dissection	long term	low
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.[148][149] Aortic dissection
malignant hypertension	variable	low
Undiagnosed or inadequately treated essential hypertension is the most common cause of hypertensive emergency.[155] Hypertensive emergencies

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