General Medicine
Hypertension
Hypertension for MBBS: primary versus secondary causes, target organ damage, first-line drugs and hypertensive emergencies, mapped to NMC codes IM8.4 to IM8.16.
MedNext Academy | 3 min read
Hypertension
Hypertension for MBBS: primary versus secondary causes, target organ damage, first-line drugs and hypertensive emergencies, mapped to NMC codes IM8.4 to IM8.16.
This chapter covers the definition, evaluation and management of hypertension, distinguishing primary from secondary causes and screening for target organ damage. It sets out first-line drug classes, compelling indications, lifestyle measures and the controlled management of hypertensive emergencies.
High-yield: Hypertension
- Most hypertension is primary, but secondary causes should be sought in the young, the resistant and those with suggestive features.
- The diagnosis rests on repeated accurate office readings supported by home or ambulatory monitoring.
- Common secondary causes include renal parenchymal disease, renal artery stenosis, primary aldosteronism and phaeochromocytoma.
- Target organ damage affects the heart, brain, kidneys, retina and large arteries.
- A hypertensive emergency is a severe pressure rise with acute target organ damage requiring controlled intravenous reduction.
- In hypertensive emergency the blood pressure is lowered gradually to avoid ischaemia, not normalised abruptly.
- First-line drug classes are calcium channel blockers, ACE inhibitors or ARBs and thiazide-like diuretics.
- ACE inhibitors and ARBs are preferred in diabetic and chronic kidney disease patients for renal protection.
- Lifestyle measures such as salt restriction, weight loss and exercise are advised for every patient.
- Baseline investigations screen for target organ damage and secondary causes, including urinalysis, electrolytes, ECG and lipids.
- Phaeochromocytoma classically causes episodic headache, palpitations and sweating with paroxysmal hypertension.
- Primary aldosteronism should be suspected with hypertension and unexplained hypokalaemia.
- Combination therapy is often needed to reach target, and single-pill combinations improve adherence.
- Resistant hypertension is uncontrolled pressure despite three drugs including a diuretic at optimal doses.
- Sustained blood pressure control markedly reduces the risk of stroke, heart failure and kidney disease.
Hypertension essentials
- **Primary versus secondary:** Seek secondary causes in the young, resistant or those with suggestive clinical clues.
- **First-line drugs:** Calcium channel blockers, ACE inhibitors or ARBs, and thiazide-like diuretics.
- **Compelling indications:** ACE inhibitors or ARBs for diabetes and chronic kidney disease for renal protection.
- **Emergency:** Lower pressure gradually with intravenous drugs when there is acute target organ damage.
NMC competencies in this chapter
- **IM8.4:** Definition and classification of hypertension
- **IM8.5:** Primary versus secondary hypertension
- **IM8.6:** Hypertensive urgency and emergency
- **IM8.8:** Target organ damage in hypertension
- **IM8.12:** Diagnostic workup by aetiology
- **IM8.14:** Treatment plan for essential hypertension
- **IM8.15:** Management of hypertensive emergencies
- **IM8.16:** Lifestyle modification counselling
Frequently Asked Questions
When should a secondary cause of hypertension be suspected?
Secondary hypertension should be suspected in young patients, those with resistant or sudden severe hypertension, unexplained hypokalaemia, or clinical clues such as episodic headache and sweating.
What are the first-line drug classes?
Calcium channel blockers, ACE inhibitors or ARBs, and thiazide-like diuretics are first-line, with ACE inhibitors or ARBs preferred in diabetes and chronic kidney disease.
How is a hypertensive emergency managed?
A hypertensive emergency with acute target organ damage is treated with controlled intravenous therapy to lower the pressure gradually, avoiding an abrupt fall that can cause ischaemia.
How does this chapter help for NEET-PG?
Secondary cause clues, compelling drug indications and the controlled management of hypertensive emergencies are common exam themes that map directly to questions.
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