Intended for healthcare professionals

Clinical Review State of the Art Review

Management of mild hypertension in adults

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5719 (Published 21 November 2016) Cite this as: BMJ 2016;355:i5719

Re: Management of mild hypertension in adults

Viera and Hawes make an important, though non-controversial point, in saying that lifestyle interventions are the first line of treatment in mild hypertension. Not everyone agrees on which lifestyle interventions. There are at least two (and probably more) subsets of “essential” hypertension.

The first phenotype, associated with persistent hyperglycaemia in men with waists >37” and women with waists > 34”, increases blood viscosity and blood pressure. Reducing the duration and extent of the hyperglycaemia by (i) reducing carbohydrate intake, (ii) whole-body exercise e.g., swimming, reduces blood pressure to levels that, often, do not require pharmacological treatment.

The second phenotype results from narrowing of renal arterioles associated with persistent straining during defaecation that occurs in the uterus, and, is also supplied from sympathetic segments T10-12 (1-3). This refractory form of hypertension may require catheter-based, endovascular ablation of injured renal nerves for its treatment (4). Clearly, advice regarding diet and bowel habits may also be helpful?

Home-based, sphygmomanometry and glucose meters optimize daily feedback for individual patients who can titrate their own diets and metabolism against their blood pressure. Medicine has been very slow to engage in self-management of hypertension with cheap, widely-available and reliable, clinical measurement devices.

(1) Wu XQ, Cai YY, Xia WT, Yang SM, Quinn MJ. The aetiology of preeclampsia, 1945-1953. BJOG 2016 (in press).

(2) Quinn MJ. The aetiology of narrowed uterine arterioles in obstetric and gynaecological syndromes. Placenta 2016: 44:414-5.

(3) Wu XQ, Cai YY, Xia WT, Quinn M. All-Cause and Cause-Specific Mortality After Hypertensive Disease of Pregnancy. Obstet Gynecol. 2016 Dec; 128(6):1445-1446.

(4) Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009, 27;361(9):932-4.

Competing interests: No competing interests

30 November 2016
MJ Quinn
OBGYN
First Affiliated Hospital, Medical University of Wenzhou,
1 Nanbaixiang Road, Ouhai, Wenzhou