1. Approach to a
young
hypertensive
patient:
Investigations
and diagnosis

2. Overview

3. Introduction
SBP, systolic blood pressure;
DBP, diastolic blood pressure
Classification of Hypertension:
The Seventh Report of the Joint National Committee
(JNC VII)
NIH Publication No. 04-
5230 August 2004

4. General Approach to the
Patient
Hypertension. 2003;42(6):1206-1252,
Am Fam Physician. 2009;79(10):863-869.

5. General Approach to the
Patient (Contd)
J Clin Hypertens (Greenwich) 2008;10(7):556-566.HT - hypertension

6. General Approach to the
Patient (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

7. General Approach to the
Patient (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

8. Most Common Causes of
Secondary Hypertension by
Age*
Am Fam Physician 2010 Dec 15;82(12):1471-8.
Must remember
that these are
not absolute
categories;
There may be
overlap of causes
between age
groups

9. Signs and Symptoms That Suggest
Specific Causes of Secondary
Hypertension
Am Fam Physician 2010 Dec 15;82(12):1471-8.

10. Signs and Symptoms That Suggest
Specific Causes of Secondary
Hypertension (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

11. Children and Adolescents
(Birth to 18 Years of Age)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

12. Renal parenchymal disease
Am Fam Physician 2010 Dec 15;82(12):1471-8.

13. Renal parenchymal disease
(Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

14. Coarctation of the aorta
Am Fam Physician 2010 Dec 15;82(12):1471-8.

15. Coarctation of the aorta
(Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

16. Coarctation of the aorta
(Contd)
Red arrows - rib notching
caused by the dilated
intercostal arteries
Yellow arrow - the aortic
knob,
Blue arrow - the actual
coarctation and
Green arrow -the post-
stenotic dilation of the
descending aorta

17. Coarctation of the aorta
(Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

18. Young Adults
(19 to 39 Years of Age)

19. Takayasu’s arteritis (TA)
Eur J Vasc Endovasc Surg 2007;33, 578-82
RVH-Renovascular
hypertension

20. TA: Indian studies
Angiology 1985; 36: 370-8

21. TA: Indian studies (Contd)
Q J Med. 1992;85:833-43.

22. TA: Indian studies (Contd)
Q J Med. 1992;85:833-43.

23. TA: Indian studies (Contd)
32nd Annual Conference of Indian
Society of Nephrology September, 2001

24. TA (Contd)
Eur J Vasc Endovasc Surg 2007;33, 578-82

25. TA: Aetiology
Eur J Vasc Endovasc Surg 2007;33, 578-82

26. TA: Diagnostic criteria
Eur J Vasc Endovasc Surg 2007;33, 578-82

27. TA: Diagnostic criteria
Eur J Vasc Endovasc Surg 2007;33, 578-82
Modified
diagnosis criteria
for TA: Sharma
et al

28. TA: Diagnostic criteria (Contd)
Eur J Vasc Endovasc Surg 2007;33, 578-82
Modified diagnosis
criteria for TA:
Sharma et al
(Contd)

29. TA: Diagnostic criteria (Contd)
Eur J Vasc Endovasc Surg 2007;33, 578-82

30. TA: Clinical features
Eur J Vasc Endovasc Surg 2007;33, 578-82

31. TA: Clinical features (Contd)
Eur J Vasc Endovasc Surg 2007;33, 578-82

32. Fibromuscular dysplasia
(FMD)
US Nephrology 2009;5(2):56–59,
Proc (Bayl Univ Med Cent) 2010;23(3):246–49

33. FMD (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

34. FMD (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

35. FMD (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

36. FMD (Contd)
CT angiogram obtained in
a 45 y.o. woman presenting
with new onset RVH
Aneurysmal dilation and
vascular occlusion beyond a
fibromuscular lesion is
present in the right kidney
associated with loss of
perfusion to the entire upper
pole of the kidney

37. Fibromuscular Dysplasia, before and after PTRA
Safian & Textor. NEJM 344:6;

38. FMD (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

39. FMD (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

40. Thyroid dysfunction
Am Fam Physician 2010 Dec 15;82(12):1471-8.

41. Thyroid dysfunction Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

42. Thyroid dysfunction (Contd)
Am Fam Physician 2010 Dec 15;82(12):1471-8.

43. Accuracy of
Diagnostic
Tests for
Causes
of Secondary
Hypertension
Am Fam Physician 2010 Dec 15;82(12):1471-8.

44. Algorithmic
approach to the
initial evaluation
of patients with
suspected
secondary
hypertension
CT = computed
tomography; MRI
= magnetic
resonance
imaging; TSH =
thyroid-stimulating
hormone
Am Fam Physician 2010 Dec 15;82(12):1471-8.

45. Conclusions
s/o- suggestive of

46. Conclusions (Contd)