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    Hypertension

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    Mahrah AlRaeesi
    Hypertension is defined as systolic blood pressure above 140 mmHg or diastolic above 90 mmHg. It can be primary, caused by multiple physiological and environmental factors, or secondary, caused by specific diseases or substances. Insulin resistance is associated with hypertension by promoting sodium retention and increasing vascular smooth muscle growth and intracellular calcium levels. Hypertension is often asymptomatic until end organ damage occurs, so screening is important. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, calcium channel blockers or ACE inhibitors to lower blood pressure, especially for diabetics or those with kidney disease.

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    Hypertension

    Uploaded by

    Mahrah AlRaeesi
    32 views3 pages
    Hypertension is defined as systolic blood pressure above 140 mmHg or diastolic above 90 mmHg. It can be primary, caused by multiple physiological and environmental factors, or secondary, caused by specific diseases or substances. Insulin resistance is associated with hypertension by promoting sodium retention and increasing vascular smooth muscle growth and intracellular calcium levels. Hypertension is often asymptomatic until end organ damage occurs, so screening is important. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, calcium channel blockers or ACE inhibitors to lower blood pressure, especially for diabetics or those with kidney disease.

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    Hypertension is defined as systolic blood pressure above 140 mmHg or diastolic above 90 mmHg. It can be primary, caused by multiple physiological and environmental factors, or secondary, caused by specific diseases or substances. Insulin resistance is associated with hypertension by promoting sodium retention and increasing vascular smooth muscle growth and intracellular calcium levels. Hypertension is often asymptomatic until end organ damage occurs, so screening is important. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, calcium channel blockers or ACE inhibitors to lower blood pressure, especially for diabetics or those with kidney disease.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    32 views3 pages

    Hypertension

    Uploaded by

    Mahrah AlRaeesi
    Hypertension is defined as systolic blood pressure above 140 mmHg or diastolic above 90 mmHg. It can be primary, caused by multiple physiological and environmental factors, or secondary, caused by specific diseases or substances. Insulin resistance is associated with hypertension by promoting sodium retention and increasing vascular smooth muscle growth and intracellular calcium levels. Hypertension is often asymptomatic until end organ damage occurs, so screening is important. Treatment involves lifestyle modifications and medications like diuretics, beta blockers, calcium channel blockers or ACE inhibitors to lower blood pressure, especially for diabetics or those with kidney disease.

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    © All Rights Reserved
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    of 3

    Hypertension

    - Systolic BP>140mmHg or Diastolic BP >90mmHg


    Causes
    - Primary hypertension  complex process of physiological and environmental factors
    - Secondary hypertension
     Exogenous substances  stimulants, alcohol, NSAIDs
     Renal failure
     Sleep apnea
     Renovascular disease
     Primary aldosteronism
     Pheochromocytoma
     Cushing syndrome
    Pathogenesis
    - Insulin resistance is associated with increased arterial BP
     Promote Na retention
     Promote hypertrophy or hyperplasia of vascular smooth muscles
     Increased intracellular calcium
     Sympathetic activation
    History
    - Silent killer because usually its asymptomatic until there is end organ damage
    - Diagnosed during routine office visit screening
    - Clinical manifestation as ischemic heart disease, stroke, peripheral vascular disease,
    renal insufficiency, retinopathy, papilledema
    - History focus on symptoms of end organ damage or risk factors for CVD
    - CVD symptoms
     Chest pain
     Shortness of breath
     Prior TIA or stroke
     Renal disease
    - Family history of heart disease, hypertension, hyperlipidemia, diabetes and renal
    disease
    - Risk factors  smoking, alcohol use, exercise and diet
    - Medication that can increase BP
     NSAIDs
     Decongestants
     Estrogen
     Progesterone
     Appetite suppressants
     MAOIs
    - Features of secondary cause
     Early or late onset of HTN <20yrs, >50yrs
     Personal or family history of renal disease
     Symptoms consistent with sleep apnea
     History of amphetamine, cocaine, alcohol abuse
     Use of oral contraceptives, estrogens, corticosteroids, NSAIDs
     History of hirsutism or easy bruising
    Physical examination
    - Require SBP>140mmHg and DBP>90mmHg on at least 2 consecutive visits for 2
    weeks apart
     Except if SBP>210 or DBP >120 or presence of end organ damage at time of first
    reading
    - Skin examination
     Cushing syndrome
     Neurofibromatosis
    - Funduscopic exam
     Retinal hemorrhage
     Increased vascular tortuosity
     AC nicking
    - Auscultate carotid for bruits
    - Examine abdomen for bruits or masses
    - Neurologic examination for focal deficit
    - Examine for pulses and presence of edema
    Differential diagnosis
    - Pseudo hypertension  elevated BP reading with transient factors (stress, or acute
    illness)
     Generally, elderly patient with calcified rigid blood vessels and intraarterial BP is
    lower than what can be measured
    - Primary
    - Secondary
    Diagnosis
    - 4 main questions
     Is it primary or secondary?
     How many risk factors present?
     Evidence of target organ damage?
     Any comorbid conditions that would affect choice of therapy?
    Lab test
    - CBC as baseline for evaluation of medication induced neutropenia or agranulocytosis
    - Fasting blood glucose
     High indicate DM
    - Metabolic panel (K)
     Unprovoked hypokalemia suggest hyperaldosteronism
    - Serum creatinine
     High creatinine indicate renal insufficiency
    - Urinalysis
     Proteinuria and microalbuminuria indicate renal end organ damage
    - Lipid profile
    - Calcium and uric acid
     Hypercalcemia or hyperuricemia  preclude use of thiazide diuretics
     Hypercalcemia can identify hyperparathyroidism
    - TSH
    - ECG to assess for prior MI, heart block, left ventricular hypertrophy
    - Chest Xray can detect cardiomegaly, CHF, coarctation of aorta
    - Suspected pseudo hypertension
     Ambulatory BP monitoring determine HTN diagnosis
    Treatment
    - Diabetics and patients with renal disease should target BP of <130/80
    - Normal renal function and non diabetic, pre HTN  life style modification
     Na restriction <2.4g/day
     Weight reduction
     Regular aerobic exercise 30-60min for 3-4x/wk
     Limit alcohol intake
     If patient remain hypertensive after 3-6months of lifestyle modification  then
    start antihypertensive medication
    - Patients with stage 2 hypertension and diabetics SBP>130 or DBP>80
    - Therapeutic goal for all patients BP of 120/80
    - Systolic HTN in elderly program
     Treatment of patients over 60yrs by using low dose diuretics and beta blockers 
    reduce incidence of stroke and MI
    - 4 classes of medication are used as first line agents  diuretics, beta blockers,
    calcium channel blockers and ACE inhibitors
    Diuretics
    -

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