Hypertension Management in Clinical Medicine
Hypertension is one of the most common non-communicable diseases encountered in
medical practice and is a major cause of morbidity and mortality worldwide. In Nigeria,
hypertension contributes significantly to cardiovascular disease, stroke, chronic kidney
disease, and heart failure. Medical students at the University of Lagos must understand the
pathophysiology, diagnosis, complications, and management of hypertension because it is
frequently encountered during clinical rotations.
Hypertension is defined as a persistent elevation of blood pressure above the normal range.
According to current guidelines, a systolic blood pressure of 140 mmHg or more and a
diastolic blood pressure of 90 mmHg or more on repeated measurements is considered
hypertension in many clinical settings. Blood pressure should be measured accurately using
a properly calibrated sphygmomanometer, with the patient seated comfortably and rested
for at least five minutes.
Hypertension may be classified into primary and secondary hypertension. Primary
hypertension, also known as essential hypertension, accounts for about 90 to 95 percent of
cases and has no identifiable single cause. Risk factors include obesity, family history,
sedentary lifestyle, excessive salt intake, alcohol consumption, smoking, and stress.
Secondary hypertension occurs due to identifiable causes such as renal disease, endocrine
disorders, pregnancy-related conditions, or certain medications.
The pathophysiology of hypertension involves increased peripheral vascular resistance,
increased cardiac output, activation of the renin-angiotensin-aldosterone system, and
sympathetic nervous system overactivity. Chronic elevation of blood pressure damages
blood vessels and organs over time. Target organs commonly affected include the heart,
brain, kidneys, retina, and blood vessels.
Patients with hypertension may be asymptomatic for many years. Some individuals present
with headaches, dizziness, blurred vision, palpitations, or fatigue. Severe hypertension may
present with complications such as stroke, hypertensive heart disease, acute kidney injury,
or hypertensive emergency. Clinical evaluation should include detailed history taking and
physical examination. Important investigations include urinalysis, fasting blood sugar, lipid
profile, serum electrolytes, urea and creatinine, electrocardiography, and fundoscopy.
Lifestyle modification is an important component of treatment. Patients should reduce salt
intake, maintain healthy body weight, exercise regularly, stop smoking, and limit alcohol
consumption. Dietary approaches such as the DASH diet are beneficial. In many Nigerian
communities, patient education is essential because poor compliance with medication is
common.
Pharmacological management depends on the severity of hypertension and associated
comorbidities. Common antihypertensive drugs include thiazide diuretics, calcium channel
Hypertension is one of the most common non-communicable diseases encountered in
medical practice and is a major cause of morbidity and mortality worldwide. In Nigeria,
hypertension contributes significantly to cardiovascular disease, stroke, chronic kidney
disease, and heart failure. Medical students at the University of Lagos must understand the
pathophysiology, diagnosis, complications, and management of hypertension because it is
frequently encountered during clinical rotations.
Hypertension is defined as a persistent elevation of blood pressure above the normal range.
According to current guidelines, a systolic blood pressure of 140 mmHg or more and a
diastolic blood pressure of 90 mmHg or more on repeated measurements is considered
hypertension in many clinical settings. Blood pressure should be measured accurately using
a properly calibrated sphygmomanometer, with the patient seated comfortably and rested
for at least five minutes.
Hypertension may be classified into primary and secondary hypertension. Primary
hypertension, also known as essential hypertension, accounts for about 90 to 95 percent of
cases and has no identifiable single cause. Risk factors include obesity, family history,
sedentary lifestyle, excessive salt intake, alcohol consumption, smoking, and stress.
Secondary hypertension occurs due to identifiable causes such as renal disease, endocrine
disorders, pregnancy-related conditions, or certain medications.
The pathophysiology of hypertension involves increased peripheral vascular resistance,
increased cardiac output, activation of the renin-angiotensin-aldosterone system, and
sympathetic nervous system overactivity. Chronic elevation of blood pressure damages
blood vessels and organs over time. Target organs commonly affected include the heart,
brain, kidneys, retina, and blood vessels.
Patients with hypertension may be asymptomatic for many years. Some individuals present
with headaches, dizziness, blurred vision, palpitations, or fatigue. Severe hypertension may
present with complications such as stroke, hypertensive heart disease, acute kidney injury,
or hypertensive emergency. Clinical evaluation should include detailed history taking and
physical examination. Important investigations include urinalysis, fasting blood sugar, lipid
profile, serum electrolytes, urea and creatinine, electrocardiography, and fundoscopy.
Lifestyle modification is an important component of treatment. Patients should reduce salt
intake, maintain healthy body weight, exercise regularly, stop smoking, and limit alcohol
consumption. Dietary approaches such as the DASH diet are beneficial. In many Nigerian
communities, patient education is essential because poor compliance with medication is
common.
Pharmacological management depends on the severity of hypertension and associated
comorbidities. Common antihypertensive drugs include thiazide diuretics, calcium channel
