Hypertension (High Blood Pressure)
High blood pressure is the single largest preventable cause of cardiovascular disease in Ireland. For most patients, blood pressure can be controlled in primary care with lifestyle measures and medication. A minority have hypertension that is hard to control, develops at a young age, comes with target organ damage, or has an identifiable underlying cause. These are the patients who benefit most from specialist input.
Dr Rory McQuillan provides specialist hypertension care in Dublin, with particular expertise in resistant and secondary hypertension and in patients with concurrent kidney disease.
What counts as high blood pressure?
A blood pressure of 140/90 mmHg or higher in the clinic, or 135/85 mmHg or higher on home or ambulatory monitoring, is considered high. Treatment targets are usually below 140/90 mmHg, with lower targets for patients with diabetes, chronic kidney disease, or established cardiovascular disease.
Why specialist hypertension care matters
Specialist input adds value for several patient groups:
- Resistant hypertension: blood pressure that remains high despite three or more medications
- Suspected secondary hypertension: a treatable underlying cause such as primary aldosteronism, renal artery stenosis, or pheochromocytoma
- Hypertension in young patients (under 40 years)
- Hypertension associated with chronic kidney disease
- Hypertension during or after pregnancy
- Hypertension with evidence of organ damage to heart, kidney, brain, or eyes
Secondary hypertension
Secondary hypertension means high blood pressure with an identifiable cause. Identifying it matters because some causes are curable. Common secondary causes include:
- Primary aldosteronism (an over-active adrenal gland), more common than previously thought
- Renal artery stenosis (narrowing of an artery to the kidney)
- Chronic kidney disease
- Pheochromocytoma (a rare adrenal tumour)
- Cushing’s syndrome
- Obstructive sleep apnoea
- Coarctation of the aorta
- Medications including NSAIDs, oral contraceptives, and steroids
Specialist investigation
A specialist assessment includes detailed history, examination, and investigations targeted at identifying secondary causes and assessing target organ damage. Investigations may include:
- 24-hour ambulatory blood pressure monitoring
- Blood and urine tests for kidney function, electrolytes, and hormones
- Aldosterone-to-renin ratio to screen for primary aldosteronism
- Renal ultrasound and Doppler studies
- Echocardiography to assess for left ventricular hypertrophy
- Specialist imaging where indicated
Treatment
Treatment combines lifestyle measures, identification and correction of any underlying cause, and individualised medication. Choices include ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and newer agents. For resistant cases, spironolactone is often particularly effective. Lifestyle measures include reduced salt, weight management, exercise, moderation of alcohol, and management of sleep apnoea where present.
Appointments
Appointments for hypertension are arranged through GP referral. Same-week appointments are available for urgent cases.
Frequently Asked Questions
Resistant hypertension is blood pressure that remains above target despite three or more antihypertensive medications, including a diuretic. It affects around one in ten people with hypertension and benefits from specialist assessment.
Most hypertension is lifelong but well-controlled with medication. A minority of patients have a curable underlying cause (such as primary aldosteronism or renal artery stenosis) that can lead to remission with the right treatment.
For most patients, yes. Stopping medication usually causes blood pressure to rise back to dangerous levels. Some patients with a curable cause can come off medication once treated.
The DASH diet (rich in fruits, vegetables, whole grains, low-fat dairy, with reduced salt) is the most evidence-based dietary pattern for blood pressure control.
Have a Question?
If you’d like more information about Dr. McQuillan’s services or need assistance from the practice team, please get in touch below.
Please note: Appointments are arranged via GP referral.