Hopp til hovedinnhold

Hypertensjon

Sist oppdatert: Sist revidert:
Sist revidert av:


Definisjon:
Hypertensjon deles inn i mild, moderat og alvorlig hypertensjon. Årsaken er ukjent i 95% av tilfellene, og i 5% sekundær til annen sykdom.
Forekomst:
Mild hypertensjon finnes hos ca. 20% av den voksne befolkningen.
Symptomer:
Mild eller moderat hypertensjon gir ingen symptomer. Ev. hodepine, svimmelhet eller tung pust ved alvorlig hypertensjon.
Funn:
Kliniske funn er forhøyet blodtrykk, ev. andre tegn til hjerte-kar sykdom.
Diagnostikk:
Diagnosen stilles etter gjentatte blodtrykksmålinger under standardiserte forhold.
Behandling:
Mild hypertensjon behandles medikamentelt bare ved økt totalrisiko for hjerte-kar sykdom. Moderat/alvorlig hypertensjon behandles med livsstilsveiledning og medikamenter. Ingen forskjell på effekt av morgen- eller kveldsdosering. 
  1. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-104. pmid:30165516 PubMed  
  2. Boffa RJ, Constanti M, Floyd CN, et al. Hypertension in adults: summary of updated NICE guidance. BMJ 2019; 367: l5310. pmid:31636059 PubMed  
  3. Gerdts E. Hypertensive kriser - Metodebok i Akutt Indremedisin. Fagprosedyrer/Hjerte-kar-thorax, Helse Bergen HF. Publisert 10.10.2021. kvalitet.helse-bergen.no  
  4. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71:e127-e248. PMID: 29146535 PubMed  
  5. McEvoy JW, Daya N, Rahman F, et al. Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes. JAMA 2020; 323: 329-38. pmid:31990314 PubMed  
  6. Peixoto AJ. Acute Severe Hypertension. N Engl J Med 2019; 381: 1843-52. pmid:31693807 PubMed  
  7. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19,1 million participants. Lancet 2017. PMID: 27863813 PubMed  
  8. Folkehelseinstituttet. Indikatorer for ikke-smittsomme sykdommer. Høyt blodtrykk (indikator 11). Sist oppdatert febr. 2021. Siden lest 16.03.2022 www.fhi.no  
  9. Brouwers S, Sudano I, Kokubo Y, Sulaica EM. Arterial hypertension. Seminar. Lancet 2021. pmid:34019821 PubMed  
  10. Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease change with aging? The Framingham Heart Study. Circulation 2001; 103: 1245-49.
  11. Janke AT, McNaughton CD, Brody AM, et al. Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013. J Am Heart Assoc. 2016 Dec 5;5(12):e004511. PMID: 27919932 PubMed  
  12. Ellervik C, Tarnow L, Pedersen EB. Genetik og hypertension. Ugeskr Læger 2009; 171: 2012. Ugeskrift for Læger  
  13. Luft FC. Twins in cardiovascular genetic research. Hypertension 2001; 37: (part 2) 350-56.
  14. Institute of Medicine Committee on Public Health Priorities to reduce and control hypertension. A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Washington (DC): National Academies Press (US); 2010.
  15. Heimark S, Mariampillai JE, Larstorp ACK, et al. Hvordan tilnærme seg pasienter med antatt terapiresistent hypertensjon og nedsatt medikamentetterlevelse? Indremedisineren 2021; 3: 34-7.
  16. The Blood Pressure Lowering Treatment Trialists Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 2014; 384: 59198. doi:10.1016/S0140-6736(14)61212-5 DOI  
  17. Wiernik E, Pannier B, Czernichow S, et al. Occupational status moderates the association between current perceived stress and high blood pressure. Hypertension. Published online before print January 14, 2013, doi: 10.1161/HYPERTENSIONAHA.111.00302 DOI  
  18. Dudenbostel T, Calhoun DA. Resistant hypertension, obstructive sleep. Journal of Human Hypertension 2012; 26: 281-7. PubMed  
  19. MacIntyre IM, Turtle EJ, Farrah TE, et al . Regular Acetaminophen Use and Blood Pressure in People With Hypertension: The PATH-BP Trial. Circulation 2022. pmid:35130054 PubMed  
  20. Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD009009. DOI: 10.1002/14651858.CD009009.pub3. Accessed 30 November 2022. The Cochrane Library  
  21. US Preventive Services Task Force. Screening for Hypertension in Adults US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2021; 325: 1650-56. pmid:33904861 PubMed  
  22. Staplin N, de la Sierra A, Ruilope LM, et al. Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients. Lancet 2023. pmid:37156250 PubMed  
  23. Mancia G, Bombelli M, Brambilla G, et al. Long-term prognostic value of white coat hypertension: An insight from diagnostic use of both ambulatory and home blood pressure measurements . Hypertension 2013; 62: 168. doi:http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.00690#sthash.1bBRZU2e.dpuf
  24. Verdecchia P, Staessen JA, White WB, Imai Y, O'Brien ET. Properly defining white coat hypertension. Eur Heart J 2002; 23: 106-09.
  25. Grassi G, Quarti-Trevani F, Seravalle G, et al. Sympathetic Neural Mechanisms Underlying Attended and Unattended Blood Pressure Measurement. Hypertension 2021; 78: 1126-33. pmid:34365811 PubMed  
  26. Messerli FH, Williams B, Ritz E. Essential hypertension. Lancet 2007; 370: 591-603. PubMed  
  27. Gustavsen P, Hansen TW. Prognostisk betydning af »white coat« og maskeret hypertension. Ugeskr Læger 2009; 171: 2019. Ugeskrift for Læger  
  28. Uhlig K, Patel K, Ip S, et al. Self-measured blood pressure monitoring in the management of hypertension: A systematic review and meta-analysis. Ann Intern Med 2013; 159: 185-94. Annals of Internal Medicine  
  29. McManus RJ, Mant J, Bray EP, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010; 376: 163-72. PubMed  
  30. McManus RJ, Mant J, Franssen M, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet 2018; 391: 949-59. pmid:29499873 PubMed  
  31. Nasjonal faglig retningslinje for forebygging av hjerte- og karsykdom. Helsedirektoratet, 2017. Sist oppdatert mai 2018.
  32. Fowkes FGR, Murray GD, Butcher I et al for the Ankle Brachial Index Collaboration . JAMA 2008; 300: 197-208. PubMed  
  33. Gerdts E, Omvik P, Mo R, Kjeldsen SE . Hypertensjon og hjertesykdom. Tidsskr Nor Lægeforen 2004; 124: 802-5. Tidsskrift for Den norske legeforening  
  34. Norsk kvalitetsforbedring av laboratorieundersøkelser (Noklus). Anbefalte analyser ved utvalgte kliniske problemstillinger. Siden besøkt 28.09.2020. www.noklus.no  
  35. Cohen JB, Cohen DL, Herman DS, et al. Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.S. veterans: A retrospective cohort study. Ann Intern Med 2020. pmid:33370170 PubMed  
  36. Saiz LC, Gorricho J, Garjon J, et al. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD010315. doi: 10.1002/14651858.CD010315.pub5 DOI  
  37. Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst Rev 2013; 10: CD008277. doi:10.1002/14651858.CD008277.pub2 DOI  
  38. Tapela N, Collister J, Clifton L, et al. Prevalence and determinants of hypertension control among almost 100 000 treated adults in the UK. Open Heart 2021; 8: e001461. pmid:33707223 PubMed  
  39. Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 2015. doi: 10.1016/S0140-6736(15)00805-3. DOI  
  40. The SPRINT Research Group.A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015. doi: 10.1056/NEJMoa1511939 DOI  
  41. Jaeger BC, Bress AP, Bundy JD, et al. Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2022. pmid:36223105 PubMed  
  42. Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ 2016, 352: i717. doi: 10.1136/bmj.i717 DOI  
  43. Brunstrom M;Carlberg B. Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017 Nov 13. doi: 10.1001/jamainternmed.2017.6015. (Review) PMID: 29131895 PubMed  
  44. Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM. Pharmacotherapy for hypertension in adults aged 18 to 59 years. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD008276. DOI: 10.1002/14651858.CD008276.pub2. Accessed 11 December 2020 The Cochrane Library  
  45. Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, et al; Blood Pressure Lowering Treatment Trialists' Collaboration. Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: An individual participant-level data meta-analysis. Lancet 2021. PMID: 34461040 PubMed  
  46. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003; 289: 2083-93. PubMed  
  47. Filippini T, Malavolti M, Whelton PK, et al. Blood Pressure Effects of Sodium Reduction Dose–Response Meta-Analysis of Experimental Studies. Circulation 2021; 146: 1542-67. pmid:33586450 PubMed  
  48. Johnson C, Raj TS, Trudeau L et al. The science of salt: a systematic review of clinical salt studies 2013 to 2014. J Clin Hypertens (Greenwich). 2015;17(5):401-11. PubMed  
  49. Yin X, Rodgers A, Perkovic A, et al. Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Heart 2022. pmid:35945000 PubMed  
  50. Yokoyama Y, Nishimura K, Barnard ND, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med 2014 Feb 24
  51. Aburto NJ, Hanson S, Gutierrez H, et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. . BMJ 2013 Apr 3;346:f1378 . doi:10.1136/bmj.f1378. DOI  
  52. Binia A, Jaeger J, Hu Y, et al. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2015 Aug;33(8):1509-20. PubMed  
  53. Ma Y, He FJ, Sun Q, et al. 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk. N Engl J Med 2021. pmid:34767706 PubMed  
  54. Yancy WS, Westman EC, McDuffie JR, et al. A randomized trial of a low-carbohydrate diet vs orlistat plus a low-fat diet for weight loss. Arch Intern Med 2010; 170: 136-145. PubMed  
  55. Nordmann AJ, Nordmann A, Briel M, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166: 285-93. PubMed  
  56. Sacks FM, Moore TJ, Appel LJ, et al. A dietary approach to prevent hypertension: A review of the dietary approaches to stop hypertension (DASH) study. Clinical Cardiology 1999; 22 (Suppl S3): s6-s10.
  57. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2021; 42: 3227-3337. doi:10.1093/eurheartj/ehab484 DOI  
  58. Park S, Han K, Lee S, et al. Cardiovascular or mortality risk of controlled hypertension and importance of physical activity. Heart 2021. pmid:33402363 PubMed  
  59. Carlson DJ, Dieberg G, Hess NC, et al . Isometric exercise training for blood pressure management: a systematic review and meta-analysis. Mayo Clin Proc 2014; 89: 327-34. pmid:24582191 PubMed  
  60. Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022; 400: 1417-1425. pmid:36240838 PubMed  
  61. Garjon J, Saiz LC, Azparren A, et al. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database Syst Rev. 2020 Feb 6;2:CD010316. doi: 10.1002/14651858.CD010316.pub3 DOI  
  62. Xue H, Lu Z, Tang WL, et al. First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension. Cochrane Database Syst Rev. 2015 Jan 11;1:CD008170. . The Cochrane Library  
  63. Wright JM, Musini VM. First-line drugs for hypertension. Cochrane Database Syst Rev 2009; 3: CD001841. Cochrane (DOI)  
  64. Chen N, Zhou M, Yang M, Guo J, Zhu C, Yang J, Wang Y, Yang X, He L. Calcium channel blockers versus other classes of drugs for hypertension. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD003654. DOI: 10.1002/14651858.CD003654.pub4. DOI  
  65. Tocci G, Battistoni A, Passerini J, et al.. Calcium channel blockers and hypertension. J Cardiovasc Pharmacol Ther 2015; Mar;20(2): 121-30. pmid:25398848 PubMed  
  66. Chen RC, Suchard MA, Krumholz HM, et al. Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study. Hypertension 2021. pmid:34304580 PubMed  
  67. Suchard MA, Schuemie MJ, Krumholz HM, et al. Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis. Lancet 2019. doi:10.1016/S0140-6736(19)32317-7 DOI  
  68. Wong GW, Laugerotte A, Wright JM. Blood pressure lowering efficacy of dual alpha and beta blockers for primary hypertension. Cochrane Database Syst Rev. 2015 Aug 26;8:CD007449. PMID:26306578 PubMed  
  69. Fretheim A, Odgaard-Jensen J, Brørs O, Madsen S, et al. Comparative effectiveness of antihypertensive medication for primary prevention of cardiovascular disease: systematic review and multiple treatments meta-analysis. BMC Medicine 2012; 10: 33. PubMed  
  70. Wiysonge CS, Bradley HA, Volmink J, et al. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2017; 1: CD002003. PMID: 28107561. PubMed  
  71. Chow CK, Atkins ER, Hillis GS, et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet. 2021. PMID: 34469767 PubMed  
  72. O'Hagan ET, McIntyre D, Nguyen T, Chow CK. Hypertension therapy using fixed-dose polypills that contain at least three medications. Heart 2023. pmid:36810213 PubMed  
  73. Edvardsen F, Øien CMM, Helland A, et al. Serumkonsentrasjonsmåling av blodtrykksmedisiner ved behandlingsresistent hypertensjon. Tidsskr Nor Legeforen 2016; 136: 1514-15. doi:10.4045/tidsskr.16.0713 DOI  
  74. Choi HK, Soriano LC, Zhang Y, Rodriguez LAG. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ 2012; 344: d8190. BMJ (DOI)  
  75. Abalos E, Duley L, Steyn DW, Gialdini C. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD002252. DOI: 10.1002/14651858.CD002252.pub4 DOI  
  76. Magee LA, von Dadelszen P, Rey E, et al. Less-Tight versus Tight Control of Hypertension in Pregnancy. N Engl J Med 2015; 372: 407-17. doi:10.1056/NEJMoa1404595 DOI  
  77. Staff A, Andersgaard AB, Henriksen T, et al. Hypertensive svangerskapskomplikasjoner og eklampsi. Veileder i fødselshjelp. Norsk gynekologisk forening 2014.
  78. Aa E, Eriksen AK. Medikamentell behandling av hypertensjon under graviditet. Relis.no. Nyhetsarkiv 2015.
  79. Hypertensjonsbehandling i første trimester, RELIS database 2010; spm.nr. 2188, RELIS Nord-Norge
  80. Aucott L, Poobalan A, Smith WC, Avenell A, Jung R and Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension 2005; 45: 1035-41. PubMed  
  81. Adami G, Murelli F, Carlini F, Papadia F and Scopinaro N. Long-term effect of biliopancreatic diversion on blood pressure in hypertensive obese patients. Am J Hypertens 2005; 18: 780-4. PubMed  
  82. Pisano A, Iannone LF, Leo A, et al. Renal denervation for resistant hypertension. Cochrane Database Syst Rev. 2021 Nov 22;11:CD011499. doi: 10.1002/14651858.CD011499.pub3. DOI  
  83. Ahmed M, Nudy M, Bussa R, et al. A Subgroup Meta-Analysis Comparing the Renal Denervation Sham-Controlled Randomized Trials Among Those With Resistant and Nonresistant Hypertension. Am J Cardiol. 2023;191:119-124. PMID: 36669381 PubMed  
  84. Musini VM, Tejani AM, Bassett K, Puil L, Wright JM. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD000028. DOI: 10.1002/14651858.CD000028.pub3. DOI  
  85. Nazarzadeh M, Bidel Z, Canoy D, et al. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet 2021. pmid:34774144 PubMed  
  86. OBrien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens 2005; 23: 697-701. PubMed  
  87. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD005182. DOI: 10.1002/14651858.CD005182.pub4. DOI  
  88. McManus RJ, Mant J, Roalfe A, Oakes RA, Bryan S, Pattison HM, et al. Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis. BMJ 2005; 331: 493-6.
  89. Green BB, Cook AJ, Ralston JD. Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial . JAMA 2008; 299: 2857-67. PubMed  
  90. Norsk legemiddelhåndbok. L8.6.1 Angiotensinkonverterende enzymhemmere. Publisert 25.01.2017. www.legemiddelhandboka.no  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Tor Ole Klemsdal, M.D., Ph.D., avdelingsoverlege, Preventiv Kardiologi, Avdeling for endokrinologi, sykelig overvekt og forebyggende medisin, Medisinsk Klinikk, Oslo universitetssykehus HF, Ullevål
  • Eivind Meland, dr. med., spesialist allmennmedisin, førsteamanuensis, Institutt for allmennmedisin, Universitetet i Bergen
  • Tor Erik Widerøe, professor, Norges teknisk-naturvitenskapelige universitet og overlege ved Seksjon for nyresykdommer, St. Olavs Hospital, Trondheim