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NOTES - Hypertension

Hypertension is defined as blood pressure readings of 140/90 mmHg or higher. It can be further classified as prehypertension, stage 1 hypertension, stage 2 hypertension, hypertensive crisis, or secondary hypertension due to other medical conditions. Risk factors include family history, obesity, stress, smoking, excessive salt intake, and older age. Evaluation of hypertension involves basic tests like electrolytes, kidney function, and ECG, as well as further tests if secondary causes are suspected, such as imaging of the kidneys if renovascular disease is possible. Management focuses on lifestyle changes and medication to control blood pressure and prevent target organ damage like heart disease or stroke.

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35 views

NOTES - Hypertension

Hypertension is defined as blood pressure readings of 140/90 mmHg or higher. It can be further classified as prehypertension, stage 1 hypertension, stage 2 hypertension, hypertensive crisis, or secondary hypertension due to other medical conditions. Risk factors include family history, obesity, stress, smoking, excessive salt intake, and older age. Evaluation of hypertension involves basic tests like electrolytes, kidney function, and ECG, as well as further tests if secondary causes are suspected, such as imaging of the kidneys if renovascular disease is possible. Management focuses on lifestyle changes and medication to control blood pressure and prevent target organ damage like heart disease or stroke.

Uploaded by

eva halim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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HYPERTENSION

1. Definition

a.
b. Hypertension
i. >= 140/90
ii. DM : >= 130/80
iii. Age >=80 yo : >=150/90
c. Isolated systolic HTN
i. sBP >=140 and dBP <90
ii. Associated with progressive reduction in vascular compliance
iii. Usually begins in 5th decade
d. Hypertensive urgency
i. sBP >210 or dBP >120 with minimal or no target organ damage
e. Hypertensive emergency
i. Severe HTN : dBP >120 + acute target-organ damage
ii. Accelerated HTN
1. Significant recent increase in BP over previous hypertensive levels
associated with evidence ofvascular damage on funduscopy, but
without papiledema
iii. Malignant HTN
1. Sufficient elevation in BP to cause papiledema and other
manifestations of vascular damage (retinal hemorrhages, bulging
discs, mental status changes, increasing creatinine)
f. White coat hypertension
i. High clinic BP with normal home BP and 24 ambulatory BP, caused by
anxiety in clinic
g. Masked hypertension
i. Normal clinic BP with high BP in home and/or ambulatory setting, often
provoked by anxiety, job stress, exercise

2. Etiology
a. Primary HTN
b. Secondary HTN
i. Renal → renovascular HTN, glomerulonephritis, pyelonephritis
ii. Endocrine → hyperaldosteronism, pheochromocytoma, cushing’s
syndrome, hyperthroidism/hyperparathyroidism, hypercalcemia
iii. Vascular → coarctation of the aorta, renal artery stenosis
iv. Drug induced → estrogens, cocaine, steroids, lithium, amphetamine,
nsaids, alcohol

3. Risk factors
a. Family history
b. Obesity
c. Stress
d. Sedentary lifestyle
e. Smoking
f. Male
g. Age >30
h. Excessive salt intake / fatty diet
i. Dylipidemia

4. Investigations
a. All patients with HTN
i. Electrolytes, creatinine, fasting glucose and/or HbA1c, lipid profile, ECG,
urinalysis
ii. Self measurement of BP at home
b. Specific patient subgroups
i. DM or chronic kidney dz : urinary protein excretion
ii. Suspected renovascular HTN : renal USG, captopril renal scan (GFR
>60), MRA/CTA (normal renal function)
iii. Suspected endocrine cause : plasma aldosterone, plasma renin
1. Measured from morning samples after resting 15 mn
2. Discontinue aldosterone antagonists, ARBs, beta blocker,
clonidine
iv. Suspected pheochromocytoma : 24 hr for metanephrines and creatinine
v. Echocardiography for left ventricular dysfunction assessment if indicated

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