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Hypertension
The British Hypertension Society has defined ranges of blood pressure which fall within the normal range & those that indicate hypertension.


Definition of Hypertension
Category Systolic Blood Pressure
(mm Hg)		 Diastolic Blood Pressure
(mm Hg)
Blood Pressure
Optimal
Normal
High Normal
< 120
< 130
130 – 139
< 80
< 85
85 – 89
Hypertension
Grade-1 (Mild)
Grade-2 (Moderate)
Grade-3 (Severe)
140 – 159
160 – 179
> 180
90 – 99
100 – 109
> 110
Isolated Systolic Hypertension
Grade-1
Grade-2

140 – 159
> 160

< 90
< 90


Measurement of Blood Pressure:

The decision to embark upon antihypertensive therapy effectively commits the patient to life long treatment, so it is vital that the blood pressure (B.P.) readings on which this decision is based are as accurate as possible.

Measurements should be made to the nearest 2 mmHg, in the sitting position with the arm supported & repeated after 5 minutes rest of the first recording is high (box).
  • Use a machine that has been validated, well maintained & properly calibrated.
  • Measure sitting B.P. routinely with additional standing B.P. in elderly & diabetic patients & those with possible postural hypotension.
  • Remove tight clothing from the arm.
  • Support the arm at the level of the heart.
  • Use a cuff of appropriate size (the bladder must encompass > two thirds of the arm).
  • Lower the mercury slowly (2 mm per second).
  • Read the B.P. to the nearest 2 mm Hg.
  • Use phase V (disappearance of sounds) to measure diastolic B.P.
  • Take tow measurements at each visit.
Hypertension in old age.

Prevalence :
Affects more than half of all people over the age of 60 (including isolated systolic hypertension).

Risks :
 Hypertension is most important risk factor for MI, heart failure & stroke in older people.

Benefit of Treatment :
Absolute benefit from antihypertensive is greatest in older people (at least upto 80 years).

Target B.P. :
Similar to that for younger patients.

Tolerance of Treatment :
Antihypertensive are tolerated as well as in younger patients.




Management of Hypertension :
British Hypertension Society Guidelines.