Hypertension, or high blood pressure, affects more than one billion people worldwide and is the most common cause of various life-threatening conditions such as stroke, heart attack, and kidney failure.
Appropriate management of hypertension has been proven to improve survival and reduce the risk of cardiovascular events.
The vast majority of patients with hypertension are asymptomatic. Hypertension can be classified into two groups. The first group, which is also the most common, is called primary (or 'essential') hypertension. This simply means that there is no known underlying cause of their hypertension and could be genetic or be the result of a poor lifestyle. A small proportion of patients have secondary hypertension. In these patients, high blood pressure is the manifestation of some other underlying medical condition, such as kidney disease.
Management of hypertension involves both identifying any underlying cause and treatment tailored to the individual. Treatment decisions are based upon an estimation of the individual’s overall risk of developing cardiovascular or renal disease and include risk factor modification, lifestyle improvement, and medication. In cases where an underlying cause is identified (secondary hypertension), treatment will involve addressing the underlying cause.
We provide a comprehensive assessment for patients referred to the hypertension clinic. The investigations we offer depends on the individual patient and includes 24-hour blood pressure monitoring, echocardiogram, cardiac MRI (hypertension protocol), urinary catecholamine and cortisol measurement, aldosterone-renin ratio, albumin-creatinine ratio and renal ultrasound and Doppler imaging.
The initial management of hypertension is usually started by your GP. In cases where hypertension is diagnosed as an inpatient, the initial treatment would be started by the medical team in the hospital.
Complex cases of hypertension (hypertension at a young age or difficult-to-treat hypertension) are usually referred to the hypertension clinic at the RD&E. These clinics are run by the following consultants:
Dr Anish George, Consultant cardiologist
Dr Richard D’Souza, Consultant Nephrologist
Where to find us
RD&E Wonford, Barrack Rd, Exeter EX2 5DW
The consultants can be contacted through their secretaries via the hospital switchboard.
Information for healthcare professionals
Consider urgent same-day referral to the hospital if your patients have severe hypertension (clinic BP of 180/120 mm Hg or higher) with:
- Signs of retinal haemorrhage or papilloedma (accelerated hypertension), or
- Signs of life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure or acute kidney injury, or
- Slinical symptoms and signs suggestive of pheochromocytoma
Consider referring your patients to specialist hypertension clinic if they:
- Have confirmed resistant hypertension, or
- Have symptoms of postural hypotension (systolic BP drops by more than 20 mm Hg) which persists despite reviewing of the patient’s medications, or
- Have signs and symptoms suggestive of secondary hypertension, or
- Are under the age of 40 for consideration of evaluation for secondary causes of hypertension