The document discusses hypertension (HTN), defining its stages and types. Isolated systolic HTN mainly affects those over 55 and can be caused by increased cardiac output or stroke volume. Treatment of reversible risk factors can prevent HTN development and cardiovascular disease. The major risk factor is coronary artery disease. Secondary HTN accounts for 5-15% of cases and is commonly due to renal or renovascular disease. Refractory HTN may be caused by poor adherence, secondary HTN, or hyperaldosteronism. Screening those at risk every 6-12 months can help prevent HTN.
Hypertension is defined as persistent blood pressure readings of 140/90 mmHg or higher. It is a major risk factor for cardiovascular disease and premature death. While usually asymptomatic, regular screening is important for detection. Treatment involves lifestyle modifications and medication to lower blood pressure to under 140/90 mmHg to reduce health risks. Malignant hypertension is a medical emergency characterized by severely high blood pressure that requires urgent treatment and hospitalization.
The document discusses hypertensive emergencies, which are severe hypertension with acute impairment of an organ system. It defines different categories of hypertension and provides case examples. It covers the etiology, pathophysiology, symptoms, workup, and treatment of hypertensive emergencies. Treatment involves rapidly lowering blood pressure over minutes to hours for patients with end-organ damage, while those without can have blood pressure controlled over days to weeks. Intravenous medications like nitroprusside, labetalol, and nicardipine are used for rapid blood pressure reduction in emergencies.
This document provides an outline about hypertension in children. It defines hypertension and classifies it into different stages. It discusses hypertensive crisis, risk factors, pathophysiology, clinical presentations, diagnostic approach, and treatment. It notes that approximately 30% of children with a BMI over the 95th percentile have hypertension. It also outlines diagnostic testing, treatment considerations including medication options and goals, and provides algorithms for treating hypertensive urgency and emergencies. The treatment involves gradually lowering blood pressure over 24-48 hours while monitoring for side effects and end organ damage.
This document defines hypertensive crises and hypertensive encephalopathy. It distinguishes between hypertensive urgency, which is elevated blood pressure without end organ damage, and hypertensive emergency, which is elevated blood pressure with end organ damage. Hypertensive encephalopathy is specifically defined as abrupt elevated blood pressure exceeding cerebral autoregulation limits, causing headaches, confusion, and other neurological symptoms. The pathophysiology involves failure of cerebral blood flow regulation and damage to blood vessels from very high blood pressure. Treatment of hypertensive urgency can be done with oral antihypertensives over 1-2 days, while hypertensive emergency requires rapid parenteral treatment to lower diastolic blood pressure by 25%
Hypertension remains a major risk factor for cardiovascular and renal disease. Hypertensive crises are classified as emergencies, with severe elevation of blood pressure and acute target organ damage, or urgencies, with severe elevation but no organ damage. Untreated emergencies have a 1-year mortality of over 79%. Causes include non-adherence to treatment, renal disease, pregnancy disorders, withdrawal of medications, pheochromocytoma, and illicit drug use. Target organ damage includes brain, heart, kidneys, eyes, and aorta. Treatment focuses on rapidly lowering blood pressure with intravenous drugs like sodium nitroprusside, labetalol, or nitroglycerine to prevent further injury. Management depends
This document discusses hypertensive emergencies and urgencies. It defines hypertensive emergency as severe hypertension with acute end-organ damage, requiring rapid BP reduction over hours. Hypertensive urgency is severe hypertension without acute end-organ damage, allowing BP control over days to weeks. The main organs affected are the brain, heart, and kidneys. Initial treatment involves evaluating for end-organ damage and relaxing the patient before considering IV antihypertensives. Goals are to lower BP by 25% over the first hour while maintaining organ perfusion. Specific treatments depend on the damaged organ system. Follow-up after discharge assesses for ongoing hypertension management.
The document provides an outline and objectives for a presentation on hypertension (high blood pressure). It begins with definitions of blood pressure and what constitutes normal versus high blood pressure. It then discusses the different types of primary (essential) and secondary hypertension, identifying causes such as kidney disease. The regulation of blood pressure via the baroreceptor reflex is explained. Prevention and treatment options are covered, such as ACE inhibitors, diuretics, and lifestyle changes like exercise and diet. The objectives are to explain hypertension in detail and discuss causes, consequences, regulation, and treatment.
Hypertension is defined as persistent blood pressure readings of 140/90 mmHg or higher. It is a major risk factor for cardiovascular disease and premature death. While usually asymptomatic, regular screening is important for detection. Treatment involves lifestyle modifications and medication to lower blood pressure to under 140/90 mmHg to reduce health risks. Malignant hypertension is a medical emergency characterized by severely high blood pressure that requires urgent treatment and hospitalization.
The document discusses hypertensive emergencies, which are severe hypertension with acute impairment of an organ system. It defines different categories of hypertension and provides case examples. It covers the etiology, pathophysiology, symptoms, workup, and treatment of hypertensive emergencies. Treatment involves rapidly lowering blood pressure over minutes to hours for patients with end-organ damage, while those without can have blood pressure controlled over days to weeks. Intravenous medications like nitroprusside, labetalol, and nicardipine are used for rapid blood pressure reduction in emergencies.
This document provides an outline about hypertension in children. It defines hypertension and classifies it into different stages. It discusses hypertensive crisis, risk factors, pathophysiology, clinical presentations, diagnostic approach, and treatment. It notes that approximately 30% of children with a BMI over the 95th percentile have hypertension. It also outlines diagnostic testing, treatment considerations including medication options and goals, and provides algorithms for treating hypertensive urgency and emergencies. The treatment involves gradually lowering blood pressure over 24-48 hours while monitoring for side effects and end organ damage.
This document defines hypertensive crises and hypertensive encephalopathy. It distinguishes between hypertensive urgency, which is elevated blood pressure without end organ damage, and hypertensive emergency, which is elevated blood pressure with end organ damage. Hypertensive encephalopathy is specifically defined as abrupt elevated blood pressure exceeding cerebral autoregulation limits, causing headaches, confusion, and other neurological symptoms. The pathophysiology involves failure of cerebral blood flow regulation and damage to blood vessels from very high blood pressure. Treatment of hypertensive urgency can be done with oral antihypertensives over 1-2 days, while hypertensive emergency requires rapid parenteral treatment to lower diastolic blood pressure by 25%
Hypertension remains a major risk factor for cardiovascular and renal disease. Hypertensive crises are classified as emergencies, with severe elevation of blood pressure and acute target organ damage, or urgencies, with severe elevation but no organ damage. Untreated emergencies have a 1-year mortality of over 79%. Causes include non-adherence to treatment, renal disease, pregnancy disorders, withdrawal of medications, pheochromocytoma, and illicit drug use. Target organ damage includes brain, heart, kidneys, eyes, and aorta. Treatment focuses on rapidly lowering blood pressure with intravenous drugs like sodium nitroprusside, labetalol, or nitroglycerine to prevent further injury. Management depends
This document discusses hypertensive emergencies and urgencies. It defines hypertensive emergency as severe hypertension with acute end-organ damage, requiring rapid BP reduction over hours. Hypertensive urgency is severe hypertension without acute end-organ damage, allowing BP control over days to weeks. The main organs affected are the brain, heart, and kidneys. Initial treatment involves evaluating for end-organ damage and relaxing the patient before considering IV antihypertensives. Goals are to lower BP by 25% over the first hour while maintaining organ perfusion. Specific treatments depend on the damaged organ system. Follow-up after discharge assesses for ongoing hypertension management.
The document provides an outline and objectives for a presentation on hypertension (high blood pressure). It begins with definitions of blood pressure and what constitutes normal versus high blood pressure. It then discusses the different types of primary (essential) and secondary hypertension, identifying causes such as kidney disease. The regulation of blood pressure via the baroreceptor reflex is explained. Prevention and treatment options are covered, such as ACE inhibitors, diuretics, and lifestyle changes like exercise and diet. The objectives are to explain hypertension in detail and discuss causes, consequences, regulation, and treatment.
Mr. A is a 61-year-old retired police officer who presented with headache and giddiness. His blood pressure was 150/90 mmHg. Tests showed grade 1 hypertension, obesity, impaired glucose tolerance, and dyslipidemia. He has a high cardiovascular risk level. An ACE inhibitor would be an appropriate initial treatment to aim for a target blood pressure of below 140/90 mmHg. Appropriate response would be a reduction in blood pressure of at least 25% over 24 hours without going below 160/90 mmHg. Hypertensive emergencies require rapid blood pressure reduction of 25% over 3-12 hours while monitoring for specific organ involvement.
This document discusses hypertension (HTN), including its definition, prevalence, causes, complications, evaluation, treatment goals, and management. Some key points:
- HTN is defined as BP over 140/90 mmHg and affects over 50 million Americans. It increases risk of heart disease, stroke, and kidney disease.
- Causes include primary HTN in 95% of cases and secondary HTN related to other conditions like kidney disease. Target organ damage can occur in the heart, brain, kidneys, and eyes.
- Evaluation includes assessing risk factors, screening for secondary causes, and checking for target organ damage. Treatment goals are BP under 140/90 mmHg or 130/80 for those with
This document provides an overview of hypertension for pharmacotherapy students. It defines hypertension and classifies blood pressure levels. It discusses the underlying causes, risk factors, symptoms, complications, goals of treatment, and appropriate evaluation. It also describes the major classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and beta blockers. Treatment approaches are outlined based on clinical guidelines. The document is intended to help students understand the diagnosis and management of hypertension.
This document provides an overview of the management of hypertension, including hypertensive emergencies. It discusses the prevalence and pathophysiology of hypertension, outlines treatment goals, and reviews pharmacologic treatment options. Key points include:
1) Hypertensive emergencies require rapid blood pressure control to prevent end-organ damage, while avoiding precipitous drops in pressure.
2) Intravenous antihypertensive agents discussed include labetalol, esmolol, nicardipine, sodium nitroprusside, and fenoldopam.
3) Nicardipine is highlighted as an effective option for hypertensive emergencies due to its rapid onset, titratability, and limited
Hypertension, also known as high blood pressure, is a major public health problem worldwide. It is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. While there is no cure, lifestyle modifications and medication can help prevent and manage hypertension. The goal of treatment is to reduce cardiovascular and renal risks and complications through lowering blood pressure. Treatment typically involves a combination of lifestyle changes and medications, with regular monitoring needed to control the condition.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
Hypertension emergency is characterized by severely elevated blood pressure (>180/120 mm Hg) and evidence of impending organ damage. Hypertension urgency also involves severely elevated blood pressure but without organ damage. The goal of treatment is to gradually lower blood pressure over minutes to hours in emergencies and over 24 hours in urgencies to prevent organ damage. Intravenous drugs are used for emergencies while oral drugs are preferred for urgencies with close monitoring. Specific treatment depends on the underlying cause and affected organs.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
This document discusses hypertensive emergencies. It defines hypertensive emergency as acute end-organ damage from severely high blood pressure that requires rapid control. Over 500,000 Americans experience this each year. Treatment involves quickly starting intravenous drugs to lower blood pressure 20% within 60 minutes to prevent further damage, while oral medications are initiated. Conditions like stroke, aortic dissection and eclampsia may require specific approaches. Rapid diagnosis and management of hypertensive emergencies is critical to reducing mortality rates that can be as high as 90%.
This document provides an overview of hypertension including:
1. Definitions of hypertension and classifications of blood pressure levels.
2. Techniques for measuring blood pressure such as in-office or ambulatory monitoring.
3. Epidemiology and risk factors for hypertension including increased prevalence with age.
4. Approaches to evaluating and managing patients with hypertension including lifestyle modifications, pharmacologic treatments, and treatment goals.
The document defines hypertension and discusses changes made to definitions in guidelines from 2003 and 2017. It also covers the epidemiology of hypertension, risk factors, mechanisms, etiologies (essential vs. secondary), diagnosis, evaluation, target organ damage, clinical presentation, and patient workup. The summary provides an overview of key points:
1. The document defines normal, prehypertension, stage 1 and 2 hypertension based on guidelines from 2003 and 2017.
2. Hypertension is the most prevalent risk factor for cardiovascular disease, affecting about 30% of people over 18 and 50% over 60.
3. Patient evaluation for hypertension includes history, exam, and tests to define blood pressure levels, identify risk factors,
This document discusses hypertension (high blood pressure). It defines hypertension and normal blood pressure readings. It covers the objectives of understanding hypertension, classifying blood pressure levels, identifying causes, measuring blood pressure appropriately, recommending lifestyle modifications and medications for treatment, and constructing monitoring plans. Risk factors for hypertension include age, family history, obesity, smoking, and more. Long-term complications if untreated include damage to organs like the brain, eyes, heart and kidneys. Treatment involves lifestyle changes and medications to control blood pressure and reduce risks of health problems.
This document discusses accelerated hypertension and provides information on defining and classifying hypertension. It begins by defining hypertension as a blood pressure of 140/90 mmHg or higher. It then discusses classifying hypertension based on severity from prehypertension to stage 1 and 2 hypertension. The document notes accelerated hypertension is associated with a rapid rise in blood pressure that causes retinal damage. It emphasizes controlling blood pressure to reduce risks of stroke, heart attack, and heart failure. The document provides guidelines for properly measuring blood pressure and evaluating patients with hypertension.
The document discusses hypertension including its definition, types, symptoms, risk factors, pathophysiology, classifications, causes, complications, and treatment. It defines normal and abnormal blood pressure values and classifications. It describes primary and secondary hypertension and their causes. Untreated hypertension can damage the heart, kidneys, retina and brain. Treatment includes lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies targeting the renin-angiotensin-aldosterone system.
Hypertension- High blood pressure is a common condition that affects the body's arteries. It's also called hypertension.
If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.
A condition in which the force of the blood against the artery walls is too high.
Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.
High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.
Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.
Hypertension is rarely accompanied by symptoms, and its identification is usually through health screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.[23] These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself.[24]
On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy.[25] The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate.[25] The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension
(1) The document discusses the evaluation, classification, and treatment of hypertensive emergencies and urgencies. It defines the differences between the two conditions and outlines the goals and approaches for treating each.
(2) For hypertensive urgencies, the goal is to lower blood pressure within several hours to prevent further increases without causing too rapid of a drop. For emergencies, the goal is to reduce blood pressure more quickly to prevent end-organ damage, while maintaining adequate perfusion.
(3) Several intravenous antihypertensive drugs are discussed as options for treatment in hypertensive emergencies, including nitroprusside, nicardipine, labetalol, and
Hypertension, or high blood pressure, affects nearly 1 billion people worldwide. It is a leading cause of death and is poorly controlled in many countries. May 14th is recognized as World Hypertension Day to increase awareness. Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Lifestyle modifications like weight loss, dietary changes, and increased physical activity can help control blood pressure but medication is often required. Treatment goals are to reduce blood pressure below 140/90 mmHg or 130/80 for those with diabetes or kidney disease to lower the risks of complications.
This document discusses hypertension including its prevalence, definition, accurate measurement, classification, secondary causes, target organ damage, evaluation, treatment goals, and lifestyle modifications. Some key points:
- Hypertension is very common, affecting over 50 million Americans. It increases risks of heart disease, stroke, and kidney disease.
- It is defined as a systolic blood pressure over 139 mmHg or diastolic over 89 mmHg based on multiple readings.
- Lifestyle changes like following the DASH diet, reducing sodium, weight loss, and exercise are effective non-pharmacological interventions. The treatment goal is a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or kidney disease.
This document discusses hypertension including its definition, prevalence, causes, complications, evaluation, treatment goals, and lifestyle and pharmacological interventions. Some key points:
- Hypertension is defined as blood pressure over 140/90 mmHg and affects over 50 million Americans. It is a primary risk factor for heart disease and stroke.
- Accurate blood pressure measurement requires proper technique and equipment. Target organ damage from uncontrolled hypertension can affect the heart, brain, kidneys, and eyes.
- Evaluation involves assessing cardiovascular risk factors, identifying secondary causes, and checking for target organ damage. Treatment goals are blood pressure under 140/90 mmHg or 130/80 for those with diabetes or kidney disease.
- Lifestyle
This document discusses neurologic diseases in HIV-infected individuals, focusing on Toxoplasmosis and Cryptococcosis. It covers the epidemiology, clinical presentation, diagnosis, treatment and prevention of these two opportunistic infections. Toxoplasmosis commonly causes focal brain lesions that enhance with contrast. Cryptococcosis typically presents as subacute meningitis with fever and headache. Both require prolonged antifungal therapy and secondary prophylaxis to prevent recurrence in those with advanced HIV infection.
This document provides an overview of spinal cord diseases. It begins with an introduction noting that spinal cord diseases can cause paralysis and sensory deficits due to the concentration of motor and sensory pathways in the spinal cord. Many diseases are reversible if recognized early, making them neurologic emergencies. The document then covers the approach to localizing spinal cord lesions based on anatomy and symptoms, different patterns of lesions, distinguishing features of various lesions and diseases, and key details about specific compressive and non-compressive myelopathies.
Mr. A is a 61-year-old retired police officer who presented with headache and giddiness. His blood pressure was 150/90 mmHg. Tests showed grade 1 hypertension, obesity, impaired glucose tolerance, and dyslipidemia. He has a high cardiovascular risk level. An ACE inhibitor would be an appropriate initial treatment to aim for a target blood pressure of below 140/90 mmHg. Appropriate response would be a reduction in blood pressure of at least 25% over 24 hours without going below 160/90 mmHg. Hypertensive emergencies require rapid blood pressure reduction of 25% over 3-12 hours while monitoring for specific organ involvement.
This document discusses hypertension (HTN), including its definition, prevalence, causes, complications, evaluation, treatment goals, and management. Some key points:
- HTN is defined as BP over 140/90 mmHg and affects over 50 million Americans. It increases risk of heart disease, stroke, and kidney disease.
- Causes include primary HTN in 95% of cases and secondary HTN related to other conditions like kidney disease. Target organ damage can occur in the heart, brain, kidneys, and eyes.
- Evaluation includes assessing risk factors, screening for secondary causes, and checking for target organ damage. Treatment goals are BP under 140/90 mmHg or 130/80 for those with
This document provides an overview of hypertension for pharmacotherapy students. It defines hypertension and classifies blood pressure levels. It discusses the underlying causes, risk factors, symptoms, complications, goals of treatment, and appropriate evaluation. It also describes the major classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and beta blockers. Treatment approaches are outlined based on clinical guidelines. The document is intended to help students understand the diagnosis and management of hypertension.
This document provides an overview of the management of hypertension, including hypertensive emergencies. It discusses the prevalence and pathophysiology of hypertension, outlines treatment goals, and reviews pharmacologic treatment options. Key points include:
1) Hypertensive emergencies require rapid blood pressure control to prevent end-organ damage, while avoiding precipitous drops in pressure.
2) Intravenous antihypertensive agents discussed include labetalol, esmolol, nicardipine, sodium nitroprusside, and fenoldopam.
3) Nicardipine is highlighted as an effective option for hypertensive emergencies due to its rapid onset, titratability, and limited
Hypertension, also known as high blood pressure, is a major public health problem worldwide. It is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. While there is no cure, lifestyle modifications and medication can help prevent and manage hypertension. The goal of treatment is to reduce cardiovascular and renal risks and complications through lowering blood pressure. Treatment typically involves a combination of lifestyle changes and medications, with regular monitoring needed to control the condition.
Essential hypertension management and treatmentFabio Grubba
This document discusses hypertension (high blood pressure), including its classification, causes, symptoms, diagnosis, and treatment. It defines the different stages of hypertension according to blood pressure readings. Lifestyle modifications are recommended initially, including diet changes and exercise. If lifestyle changes do not control blood pressure, medications such as diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and other drug classes may be used. The goal of treatment is to prevent complications in target organs like the heart, brain, and kidneys by maintaining a blood pressure below 140/90 mmHg.
Hypertension emergency is characterized by severely elevated blood pressure (>180/120 mm Hg) and evidence of impending organ damage. Hypertension urgency also involves severely elevated blood pressure but without organ damage. The goal of treatment is to gradually lower blood pressure over minutes to hours in emergencies and over 24 hours in urgencies to prevent organ damage. Intravenous drugs are used for emergencies while oral drugs are preferred for urgencies with close monitoring. Specific treatment depends on the underlying cause and affected organs.
Hypertension, or high blood pressure, is one of the most common diseases worldwide. It is a major risk factor for heart disease and stroke. The document discusses the definition, classification, evaluation, causes, treatment, and prevention of hypertension. Prevention strategies recommended by WHO include reducing salt intake, maintaining a healthy weight, regular exercise, stress reduction, not smoking, and modifying lifestyle behaviors. Treatment aims to lower blood pressure below 140/90 mmHg through lifestyle changes and lifelong medication if needed.
This document discusses hypertensive emergencies. It defines hypertensive emergency as acute end-organ damage from severely high blood pressure that requires rapid control. Over 500,000 Americans experience this each year. Treatment involves quickly starting intravenous drugs to lower blood pressure 20% within 60 minutes to prevent further damage, while oral medications are initiated. Conditions like stroke, aortic dissection and eclampsia may require specific approaches. Rapid diagnosis and management of hypertensive emergencies is critical to reducing mortality rates that can be as high as 90%.
This document provides an overview of hypertension including:
1. Definitions of hypertension and classifications of blood pressure levels.
2. Techniques for measuring blood pressure such as in-office or ambulatory monitoring.
3. Epidemiology and risk factors for hypertension including increased prevalence with age.
4. Approaches to evaluating and managing patients with hypertension including lifestyle modifications, pharmacologic treatments, and treatment goals.
The document defines hypertension and discusses changes made to definitions in guidelines from 2003 and 2017. It also covers the epidemiology of hypertension, risk factors, mechanisms, etiologies (essential vs. secondary), diagnosis, evaluation, target organ damage, clinical presentation, and patient workup. The summary provides an overview of key points:
1. The document defines normal, prehypertension, stage 1 and 2 hypertension based on guidelines from 2003 and 2017.
2. Hypertension is the most prevalent risk factor for cardiovascular disease, affecting about 30% of people over 18 and 50% over 60.
3. Patient evaluation for hypertension includes history, exam, and tests to define blood pressure levels, identify risk factors,
This document discusses hypertension (high blood pressure). It defines hypertension and normal blood pressure readings. It covers the objectives of understanding hypertension, classifying blood pressure levels, identifying causes, measuring blood pressure appropriately, recommending lifestyle modifications and medications for treatment, and constructing monitoring plans. Risk factors for hypertension include age, family history, obesity, smoking, and more. Long-term complications if untreated include damage to organs like the brain, eyes, heart and kidneys. Treatment involves lifestyle changes and medications to control blood pressure and reduce risks of health problems.
This document discusses accelerated hypertension and provides information on defining and classifying hypertension. It begins by defining hypertension as a blood pressure of 140/90 mmHg or higher. It then discusses classifying hypertension based on severity from prehypertension to stage 1 and 2 hypertension. The document notes accelerated hypertension is associated with a rapid rise in blood pressure that causes retinal damage. It emphasizes controlling blood pressure to reduce risks of stroke, heart attack, and heart failure. The document provides guidelines for properly measuring blood pressure and evaluating patients with hypertension.
The document discusses hypertension including its definition, types, symptoms, risk factors, pathophysiology, classifications, causes, complications, and treatment. It defines normal and abnormal blood pressure values and classifications. It describes primary and secondary hypertension and their causes. Untreated hypertension can damage the heart, kidneys, retina and brain. Treatment includes lifestyle modifications like diet, exercise, and weight loss as well as pharmacological therapies targeting the renin-angiotensin-aldosterone system.
Hypertension- High blood pressure is a common condition that affects the body's arteries. It's also called hypertension.
If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.
A condition in which the force of the blood against the artery walls is too high.
Usually hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.
High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke.
Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.
Hypertension is rarely accompanied by symptoms, and its identification is usually through health screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.[23] These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself.[24]
On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy.[25] The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate.[25] The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension
(1) The document discusses the evaluation, classification, and treatment of hypertensive emergencies and urgencies. It defines the differences between the two conditions and outlines the goals and approaches for treating each.
(2) For hypertensive urgencies, the goal is to lower blood pressure within several hours to prevent further increases without causing too rapid of a drop. For emergencies, the goal is to reduce blood pressure more quickly to prevent end-organ damage, while maintaining adequate perfusion.
(3) Several intravenous antihypertensive drugs are discussed as options for treatment in hypertensive emergencies, including nitroprusside, nicardipine, labetalol, and
Hypertension, or high blood pressure, affects nearly 1 billion people worldwide. It is a leading cause of death and is poorly controlled in many countries. May 14th is recognized as World Hypertension Day to increase awareness. Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg. Lifestyle modifications like weight loss, dietary changes, and increased physical activity can help control blood pressure but medication is often required. Treatment goals are to reduce blood pressure below 140/90 mmHg or 130/80 for those with diabetes or kidney disease to lower the risks of complications.
This document discusses hypertension including its prevalence, definition, accurate measurement, classification, secondary causes, target organ damage, evaluation, treatment goals, and lifestyle modifications. Some key points:
- Hypertension is very common, affecting over 50 million Americans. It increases risks of heart disease, stroke, and kidney disease.
- It is defined as a systolic blood pressure over 139 mmHg or diastolic over 89 mmHg based on multiple readings.
- Lifestyle changes like following the DASH diet, reducing sodium, weight loss, and exercise are effective non-pharmacological interventions. The treatment goal is a blood pressure under 140/90 mmHg or under 130/80 for those with diabetes or kidney disease.
This document discusses hypertension including its definition, prevalence, causes, complications, evaluation, treatment goals, and lifestyle and pharmacological interventions. Some key points:
- Hypertension is defined as blood pressure over 140/90 mmHg and affects over 50 million Americans. It is a primary risk factor for heart disease and stroke.
- Accurate blood pressure measurement requires proper technique and equipment. Target organ damage from uncontrolled hypertension can affect the heart, brain, kidneys, and eyes.
- Evaluation involves assessing cardiovascular risk factors, identifying secondary causes, and checking for target organ damage. Treatment goals are blood pressure under 140/90 mmHg or 130/80 for those with diabetes or kidney disease.
- Lifestyle
This document discusses neurologic diseases in HIV-infected individuals, focusing on Toxoplasmosis and Cryptococcosis. It covers the epidemiology, clinical presentation, diagnosis, treatment and prevention of these two opportunistic infections. Toxoplasmosis commonly causes focal brain lesions that enhance with contrast. Cryptococcosis typically presents as subacute meningitis with fever and headache. Both require prolonged antifungal therapy and secondary prophylaxis to prevent recurrence in those with advanced HIV infection.
This document provides an overview of spinal cord diseases. It begins with an introduction noting that spinal cord diseases can cause paralysis and sensory deficits due to the concentration of motor and sensory pathways in the spinal cord. Many diseases are reversible if recognized early, making them neurologic emergencies. The document then covers the approach to localizing spinal cord lesions based on anatomy and symptoms, different patterns of lesions, distinguishing features of various lesions and diseases, and key details about specific compressive and non-compressive myelopathies.
This document provides an overview of disorders of skeletal muscles. It defines different types of myopathies including muscular dystrophies, myositis, myotonias, metabolic myopathies, and congenital myopathies. Key details are provided on Duchenne muscular dystrophy, Becker muscular dystrophy, and myotonic dystrophy. Duchenne dystrophy is an X-linked disorder causing progressive weakness. Becker dystrophy has a less severe course. Myotonic dystrophy involves muscle weakness, myotonia, and multi-system involvement. Diagnostic testing and clinical features are summarized for each condition.
This document provides an overview of various febrile illnesses including typhus, typhoid fever, and relapsing fever. It discusses the etiology, transmission, pathogenesis, clinical presentation, treatment and prevention of these diseases. Key points include that typhus is caused by Rickettsia prowazekii and transmitted by human body lice, typhoid fever is caused by Salmonella typhi and transmitted through contaminated food/water, and relapsing fever involves recurrent fevers caused by Borrelia bacteria and transmitted by body lice or ticks. The document provides details on the symptoms, complications, diagnostics and management of these important infectious diseases.
Rad Seminar CHEST IMAGING By Dr Siraj.pptxImanuIliyas
The document provides an overview of chest radiographic anatomy and an approach to interpreting chest x-rays (CXRs). It discusses the normal anatomy seen on CXRs including the lungs, heart, blood vessels, trachea, bronchi, ribs and diaphragm. CT anatomy is also reviewed. The presentation outlines a systematic approach to interpreting CXRs which involves identifying structures, assessing technical adequacy, and interpreting findings based on knowledge of normal radiographic anatomy.
This document summarizes the monthly clinical audit activities of the internal medicine department at HFSUH for the month of Sene 2015 E.C. It provides data on outpatient department activities including the regular OPD, MRC, neurology clinic, TB clinic, and ART clinic. It also summarizes inpatient activities in the male/female wards, neurology ward, ICU, and intermediate care ward. Key findings included increased OPD volume, improved chronic case linkage, and decreased number of patients leaving against medical advice. Gaps identified were inadequate equipment and staffing, incomplete documentation, and issues with radiology and laboratory services.
A 30-year-old female was admitted to the hospital with diagnoses of thyrotoxicosis secondary to Graves' disease and pneumonia. On physical examination, she had a fever and coarse crepitations in her right lower chest. Laboratory tests showed elevated white blood cell count and thyroid function tests. She was started on medications including PTU, propranolol, antibiotics, and was referred for surgical and ophthalmology consultations.
This document presents a case of organophosphate poisoning in a 17-year-old female patient who ingested pesticide. It discusses the patient's presentation with symptoms of cholinergic excess including urinary and fecal incontinence, shortness of breath, and altered mental status. The patient was resuscitated and treated with atropine. She later arrested and required intubation and mechanical ventilation. Her condition gradually improved with treatment and she was successfully extubated and discharged. The document also provides background information on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of organophosphate poisoning.
Acute pancreatitis is an inflammatory process of the pancreas that can involve surrounding tissues or remote organ systems. The most common causes are gallstones and alcohol. The pathogenesis involves premature activation of digestive enzymes within the pancreas that cause autodigestion. Clinical presentation includes severe upper abdominal pain and elevated pancreatic enzymes. Diagnosis requires abdominal pain consistent with pancreatitis plus elevated pancreatic enzymes or radiologic findings. Complications can include pancreatic necrosis, pseudocyst formation, and systemic inflammatory response.
This document discusses venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism. It notes that VTE can be caused by material traveling to the lungs through the pulmonary circulation. Risk factors include surgery, pregnancy, cardiorespiratory disease, lower limb problems, malignant disease, and immobility. Symptoms range from none for small embolisms to chest pain and circulatory collapse for large embolisms. Diagnosis involves assessing risk factors and alternative causes, with tests like chest x-rays, electrocardiograms, and D-dimer levels. Treatment is anticoagulation with heparin or warfarin and supportive measures.
This document discusses various types of cerebrovascular diseases including stroke, TIA, and aneurysms. It defines stroke as a focal neurological disturbance lasting over 24 hours caused by a blood vessel problem in the brain. TIA is similar but symptoms resolve within 24 hours. The document outlines risk factors for stroke including hypertension, atrial fibrillation, and diabetes. It describes clinical manifestations of strokes in different brain arteries and associated neurological deficits.
dvt and Pulmonary Thromboembolism 43.pptxImanuIliyas
This document provides an overview of deep vein thrombosis (DVT) and pulmonary embolism (PE), including their epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, and differential diagnosis. Some key points include:
- VTE, which includes DVT and PE, is a major cause of death. PE can be fatal if large or recurrent. DVT survivors may develop post-thrombotic syndrome.
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2. INTRODUCTION
Definition= at 2 separate occasions(6
hours).
Systolic BP > or = 140
Diastolic BP > or = 90
Stages
Normal: SBP< 120, D BP< 80
Pre HTN: S BP- 120-139, D BP- 80-89
Stage-I : SBP- 140-159, D BP- 90-99
Stage II : SBP- > or= 160, D BP> or=100
Isolated SHTN: S BP>or=140, D BP<90
2
3. Isolated systolic hypertension
* is defined as systolic blood pressure
≥140 mm Hg with diastolic pressure <90 mm Hg.
*mainly affects people older than 55 years.
Secondary causes include
1.increased cardiac output (anemia,
thyrotoxicosis,arteriovenous fistula, Paget disease
of bone, and beriberi)
2. increased cardiac stroke volume (aortic
insufficiency and complete heart block).
3
4. • Exclude= recent physical exercise, use of tobacco
or caffeine, or a full urinary bladder.
•Office (white coat) hypertension: elevated BP in
the clinic environment.Diagnosis made by self-
measurement or average awake ambulatory level=
≥135/85 mm Hg.
• Pseudohypertension: inaccurately high cuff blood
pressure as a result of a stiff vascular tree in older
persons= an indication to IA BP measurment.
4
5. Risk factor for HTN
1.Nonreversible risk : older age, being African
American, and having a family history of
hypertension.
2. Reversible : prehypertension,
overweight,sedentary lifestyle, high-sodium–low-
potassium diet,excessive alcohol intake and
metabolic syndrome.
3.Genetic factor: Polygenic= two or greater
factors plus environmental factor, Monogenic- on
study
5
6. Metabolic syndrome
•is defined by the presence of at least three of the
following:
•.abdominal obesity (waist circumference >40
inches in men or >35 inches in women) vs BMI.
• impaired fasting blood glucose(fasting glucose
≥110 mg/dL),
•blood pressure ≥130/85 mmHg,
• plasma triglycerides ≥150 mg/dL, or
•HDL cholesterol <40 mg/dL in men or
• <50 mg/dL in women.
6
7. TOG
• Individual risk from hypertension is related to its
level, duration, and the presence of other risk
factors for cardiovascular disease or target organ
injury.
• At any given level of blood pressure, African
Americans and men are at the greatest risk.
*The MCOD is coronary artery disease(CHD).
• Target organ damage increases the risk of
cardiovascular disease events even if blood
pressure is subsequently controlled.
7
8. Risk factors for CHD
*HTN, tobacco use, hyperlipidemia, diabetes
mellitus, obesity, sedentary lifestyle,metabolic
syndrome, male gender, postmenopausal state,
older age, family history of premature cardiovascular
disease,PAD,Stroke and CKD.
8
9. Summary of basic facts on HTN
*Treatment of reversible risk factors can prevent or
delay the development of hypertension and lower
the risk of cardiovascular disease.
• Treatment of metabolic syndrome can prevent
cardiovascular disease and the development of
hypertension.
• Diastolic blood pressure is the best predictor of
cardiovascular disease in young people.
• Systolic blood pressure is the dominant predictor of
risk of cardiovascular disease in older people.
9
10. …
Mechanism of HTN
COP = SV =SHTN
TPR = D HTN = amount of blood return to the
heart due to arteriolar contraction at diastole=MCC
Intra vascular volume elevation.
Autonomic Nervous system over activity.
Renin Angiotensin Aldosterone System over
activity
Vascular factors:
*includes arterial stiffness, Increased vascular
smooth muscle tone and growth, Endothelial
damage( decreased NO & vasodilator peptide).
10
11. Hypertension during pregnancy:
*developing before the 20th week of gestation is
more likely to have a secondary form (caused by
renovascular disease, primary aldosteronism,
Cushing syndrome, or pheochromocytoma).
*Blood pressure ≥140 mm Hg systolic or ≥90 mm
Hg diastolic.
• Transient hypertension is a predictor of the future
development of essential hypertension.
• Consider secondary causes of hypertension in this
age group.
11
12. Mx of chronic HTN in pregnancy
*Lifestyle modifications can be used initially to
treat mild hypertension.
* Use drug therapy if
1.diastolic blood pressure is ≥100 mm Hg or
2.systolic blood pressure
* is ≥150 mm Hg in the second trimester or
• ≥160 mm Hg in the third trimester.
• Recommended initial drug therapy:
methyldopa.
12
13. … Types of TOD
Atherosclerosis is the cause
Heart
Diastolic dysfunction=stiff ventricle=SOB
-Early sign, caused by LVH and ischemia and
ejection fraction is ok.
-Diagnosis- Echocardiography and cardiac
catheterization
Left ventricular hypertrophy
- Genetic and hemodynamic risk factors - Wall
thickness – LVOO / CHD.
-CP=range No Symptom to syncope, chest pain,
palpitation, exercise intolerance, stroke,
sudden cardiac death
- Diagnosis – ECG, Echo
13
14. …
Management of LVH
Antihypertensive drugs: Lasix, Beta blockers,
ACEI
- decreases LV mass and prevent LVH and
progression
- Decreases CVD risks
- Due to decreased BP but mechanism of
action on the mass unknown
Treatment of HTN
- Decreases: CHF by 50%, CHD by 12-16%, SCD
by 21%, LVH by 35%.
14
15. Central Nervous System
•Stroke: Ischemic and Hemorrhagic.
•Treatment of HTN decreases stroke by 35-50%
•Decreased Cognition and dementia
•Hypertensive Encephalopathy=pupil edema.
15
16. …
Renal
• ARF =secondary to fibrinoid necrosis
• Chronic: Glomerulosclerosis and tubular ischemia
with atrophy
• HTN due to primary Vs CKD
- PU < 1 gm/d and no active Urine sediment in
cases of primary HTN
PAD
• Due to atherosclerosis: aneurysm, dissection,
rupture, stenosis
16
17. …
Primary HTN
Accounts for 85-95%, Familial, increases with age,
in twins concordance rate M=60%, W=35%.
Majority due to increased PVR but COP normal, in
the young due to increased COP and normal PVR
Peak age= 25-55
Low renin modulators accounts for 20% and are
diuretic responsive.
High renin non modulators accounts for 10-15%,
more in whites and ACEI /ARB responsive.
High aldosterone and low renin is common in
blacks and DM Pts, increased LVH, AS and PVR
with SCD and are spironolactone sensitive.
Associated with metabolic syndrome.
17
18. …
Secondary HTN
Accounts for 5-15% of HTN and major cause is
Renal paranchymal, next is renovascular HTN.
Indication of screening: age <25 and >55, poor
drug response; Hx, PE, Lab evidence of
underlying cause
Presentation
Majority asymptomatic found accidentally
Target organ damage
Hypertensive Emergency
Sn Sm of underlying cause
Basic Lab tests
CBC, RFT, UA, FBS, Lipid profile, Electrolyte,
TSH, T3 & T4, ECG, CXR
18
19. HYPERTENSIVE CRISIS
Emergency(TOD) Vs Urgency( no TOD)
Imminent / overt target organ damage in
association with acute onset or worsening of HTN
Needs urgent lowering BP with in two hrs for
emergency ( S BP < 160, D BP b/n 100 and 110)
or decreasing MAP by 1/4th
RAAS is activated
I- Encephalopathy
If focal sign R/O stoke by CT
Drug : Nitroprusside, Nicardipine, Labetolol
II-
19
20. Malignant HTN
Clinical syndrome associated with abrupt rise in
BP recognized by
Progressive retinopathy( arteriolar spasm,
hemorrhages, exudates, papilledema)
Deteriorating RF with PU
Microangiopathic hemolytic anemia
Encephalopathy
Rate of rise more important than the absolute
level of BP
Pathophysiology: Fibrinoid necrosis in the
arterioles of kidney, brain and retina, increased
plasma renin activity (pressure natiuresis, RV
injury), tissue renin activity
20
21. Management
If no Encephalopathy or other catastrophic
event lower BP over several minutes (over
hours) with PO short acting drugs with
frequent dosage
Captopril, Clonidine, Labetalol
21
22. HTN-Encephalopathy
oPresence of cerebral edema X-ized by non
localizing neurologic manifestations.
*Headache, nausea, vomiting, restlessness,
confusion, seizure, coma could occur
*CT- R/O ischemia or infarction
oPathophysiology: disrupted cerebral auto regulation
leading to vasodilatation of cerebral microvasculature
*Level of BP: in chronic HTN at DBP >120, could
occur at DBP <100.
22
23. Treatment
*Rapidly lowering BP may precipitate ischemia(
brain, kidney, heart)
*Goal: to reduce BP to 160/100-110, with in minute
to 2hrs with initial fall of MAP not exceeding 25%
of the presenting value
*Drugs: IV Nitroprusside, Labetalol, Nicardipine
*After the target level of BP is achieved oral agents
should be started to bring DBP b/n 85-90 over two
to three months
*Prognosis: at continued risk for coronary, CV and
renal disease, survival improves with time (90% by
the 4th yr Vs 52 % in the 1st yr)
23
24. II.Stroke
1.Ischemic =Acute reatment is indicated= if S BP
>220 and DBP >130 ,provided no other indication
to RX, if fibrinolytic agent is indicated BP should
be < 185 and 110.
*ACEI+HCT after 7-10 days.
2.ICH= indication is when MAP > 130 or SBP
>220 and DBP >130.
3.SAH =when MAP > 130
24
25. …
III- Acute CHF
Treat with ACEI plus loop diuretic plus Digoxin
plus Nitrates
IV- ACS=Treat with Labetolol, Esmolo, Nitrates,
Nicardipine, ACEI.
V- ARF=Treat with CCB, Lasix, Dopamine, Dialysis
VI- Aortic dissection.Goal =SBP<125 with in 30-60
minute.
Treat with Esmolol, Labetolol, Nitroprusside
*CCB & Duretic are CI to avoid tachycardia.
VII- Pre ecclampsia and Ecclampsia
Hydralazine, Labetolol, Nicardipine, Aldomate
VIII-Hypertensive Urgency: Goal to put SBP< 160,
DBP<110 over 24hrs to few days
25
26. Hypertensive Retinopathy:
Defn
systolic BP >= 140
diastolic >= 90
The strong correlation linking arterial
hypertension with heart disease, stroke, and
renal failure makes it a leading cause of
morbidity and mortality among adults in the
United States.
26
27. Clinical findings of the retina in
hypertensive retinopathy are as follows:
Hemorrhages
Retinal and macular edema ¤
Edema residues (hard exudates) ¤
Inner retinal ischemic spots (cotton- wool
spots) ¤
¤ - indicate a more serious stage.
27
28. Modified Scheie classification of
Hypertensive Retinopathy:
Grade 0 - No changes
Grade 1 – barely detectable arterial
narrowing
Grade 2- Obvious arterial narrowing with
focal irregularities.
Grade 3 – Grade 2 plus retinal hemorrhage
and/or exudate.
Grade 4 - Grade 3 plus disc swelling.
28
29. Treatment of stable hypertensive patient
*Risk assessment and stratification: stage of
HTN, comorbid conditions, CVD risk factors,
beneficial effect on CV risks, age, availability
and cost of drugs
*Follow up: drug selection and acceptable
combination, base line clinical and Lab data
should be taken.
29
30. When to start and mode of treatment
Pre hypertension: those with risk factor for CVD
close follow up and risk reduction, treatment of
related disease conditions and life style
modification
Sage I : With out risk factors follow up for 3-6
months and if persistent HTN ,start drug therapy.
Stage I with risk and above: drug therapy from
the outset
Isolated systolic HTN with risk factor other than
age start drug treatment, if with out risk follow up
and treat accordingly oGoal of Rx : BP < 140/80
30
31. …
Single Vs Combination drug treatment
Depending on organ related risk (CVD related risk
reduction)
Patient related risk
Comorbid conditions
Stage of HTN>=II
BP=> 160|95, needs at least 2 drugs.
Degree of control of clinical conditions and BP
level.
31
32. • Combination therapy with two drugs should be
considered for stage 2 hypertension or if initial
blood pressure is >20/10 mm
Hg above the goal.
32
33. Life style changes
*Cessation of smoking.
*salt restriction.
*reduction of saturated and total fat intake.
*High fiber diet, fruits and vegetable.
* supplemental Ca, Mg and K .
*Alcohol: Men < 2 drink/d, women<1drink/d.
*Aerobic exercise: 30min daily or every other day
*Tea and coffee: limited amount.
33
34. …
Specific clinical conditions and drug choices
DM: ACEI, beta blocker, Loop diuretic, ASA,
statin, CCB, Diltiazem (Verapamil ), glycemic
control. If no proteinuria =goal of BP < 130/80
-If PU BP < 125/75
CKD: ACEI, BB, Loop diuretics, CCB, statin,
Warfarin (if needed)
CHF and CHD: ACEI, BB, diuretic
Stroke: ACEI, BB, CCB, HCT, ASA, Statin.
Pregnancy: Aldomate, CCB, Labetolol
Post MI: BB, ACEI, statin, ASA
Blacks: diuretic plus BB/ACEI or CCB plus
BB/ACEI
PAD: ASA plus CCB plus surgery if needed(70%
had IHD=BB+CCB).
Elderly: thiazide, CCB, Labetolol
34
35. …
Refractory HTN
Persistent BP of > 140/90 using three
drugs and above with appropriate
combination, indication and good
adherence
Common in old age
DDx: Pseudo hypertension, poor
adherence, salt intake, obesity, excess
alcohol intake, 2ry HTN,
hyperaldosteronism
35
36. …
Screening and prevention of HTN
For non risk groups once every three
to five years and at any clinic visit.
For risk groups every six to twelve
months Bp measurement
In general when to start screening
and it’s benefit is not well established,
but at age>=3 years.
36
38. History
*Most pts are asymptomatic.
*Severe hypertension may lead to headache,
epistaxis,or blurred vision.
Clues to Specific Forms of Secondary
Hypertension
*Use of OCP& glucocorticoids.
*paroxysms of headache, sweating, or tachycardia
(pheochromocytoma);
*history of renal disease or abdominal bruie (renal
hypertension).
38
39. Physical Examination
*Measure bp in both arms as well as a leg (to
evaluate for coarctation).
•Clues to secondary forms of hypertension
include cushingoid appearance, thyromegaly,
abdominal bruit (renal artery stenosis), delayed
femoral pulses (coarctation of aorta).
39
40. 1.RAS: MR angiography, captopril renogram, renal
duplex ultrasound and measurement of renal vein
renin;
(2) Cushing’s syndrome: dexamethasone
suppression test.
(3) pheochromocytoma: 24-h urine collection for
catecholamines, metanephrines, and
vanillylmandelic acid or measurement of plasma
metanephrine;
40
41. (4) primary hyperaldosteronism: depressed plasma
renin activity and hypersecretion of aldosterone,
both of which fail to change with volume expansion.
(5) renal parenchymal disease= RFT and CAST, PU
and kideny US=small or increased echopaterrn.
6.CBC=Myelo proliferative disorders.
41
42. Renal parenchymal disease:
•the most common secondary cause of
hypertension.
•CKD=elevated RFT&PU>+1.
•*AGN=RBC casts+elevated RFT
•*Chronic pyelonephritis=pus cell+elevated RFT
and WBC casts.
• Treatment include sodium restriction, diuretics
appropriate to level of renal function,and ACEIs.
• ACEIs slow the progression of proteinuric renal
disease.
42
43. • Renovascular disease
*MC=potentially curable secondary hypertension.
•cp=
•*sudden onset of hypertension,refractory to usual
antihypertensive therapy.
•*Abdominal bruit often audible; mild hypokalemia
due to activation of the RAAS.
*• Unilateral disease is associated with renin-
dependent hypertension.
*whereas bilateral disease is associated with
volume-dependent hypertension.
*Drop of BP, decreased UO, elevated k+ and
creatinine after ACEI medication in BRAS.
43
44. • Fibromuscular disease(FMD)=10% of RAS
** especially women of child bearing age.
• Medial fibromuscular dysplasia is the most
common subtype and has a string-of-beads
appearance on angiography.
• Dissection and thrombosis of a renal artery are
complications most commonly seen with rare
subtypes.•
*Renal artery occlusion is rare.
44
45. Atheromatous disease=90% of RAS.
• is the most common cause of renovascular
hypertension in middle-aged>55 years or older
persons.
• The disease is bilateral in 30% of cases and
progressive in 35%.
• It can cause renal artery occlusion unlike FMD.
45
46. Primary aldosteronism:
•Main subtypes:
1.unilateral aldosterone-producing adenoma and
2.bilateral adrenal hyperplasia.
Suspect primary aldosteronism in persons with
*spontaneous hypokalemia & TOD.
* Peripheral edema is rare.
*marked hypokalemia precipitated by usual doses of
diuretics.
*resistant hypertension.
* hypertension and an adrenal mass.
* hypokalemia despite use of ACEIs or ARBs.
46
47. Pheochromocytoma:
*remember “rule of 10.”
• 90% are in one or both adrenal glands.
• Tumors may occur anywhere along the sympathetic
chain (paragangliomas).
• It is malignant in up to 10% of cases.
• An extra-adrenal tumor produces only
norepinephrine.
• An adrenal tumor can produce an excess of
epinephrine or norepinephrine (or both).
47
48. • Classic triad of symptoms= paroxysms of
headache, diaphoresis, and palpitations.
• Paroxysms can be induced by exercise, bending,
urination, defecation,induction of anesthesia,
smoking, or infusion of contrast media.
48
49. Coarctation of the aorta
•is usually just beyond the takeoff of the left
subclavian artery.
• It usually is detected in childhood but may not be
identified until adulthood.
•*mechanism =renal artery constriction causing fluid
retention and inappropriate renin secretion.
• Classic feature: increased blood pressure in the
upper extremities and low or unobtainable blood
pressure in the lower extremities.
49
50. • Symptoms: headache, cold feet, and exercise-
induced leg pain.
• Signs: murmurs in the front or back of the
chest, visible pulsations in the neck or chest wall
and weak-delayed femoral pulses.
• Transesophageal echocardiography or MRI is
used to make the diagnosis.
• Treatment is with balloon angioplasty or
surgery.
50
51. Hypothyroidism =sv low.
*can cause diastolic hypertension due to high CAM
to have tissue perfussion
*CP= narrow PP, puffy face, dylipidemia and low
temp.Low tT&T4 with high TSH.
Hyperthyroidism
*can cause systolic hypertension,wide PP
*Dermopathy and exophthalmus.
Hyperparathyroidism=
*nephrolithiasis and increses tissue sensitivity to
CAM &vasospasm.
*Rx of hypercalcemia decreases BP.
51
52. Acromegaly
*may be associated with 35% hypertension.
*CHD due to AS.
*DM,LVH.
*Fluid overload and|or PVR.
Cushings syndrome
*B-hydroxy steroid hydrogenase excess.
*lead to cortxol excess+_mineralocorticoid.
*lead to activation of RAAS.
*DM and low potassium.
*not due to fluid overload.
52
53. Obstructive sleep apnea
*upper body obesity.
*refractory to medication.
*headache+snorring history+day time sleepness.
*hypoxia lead to increased release of SANS
activity=Metanephrine releases.
Brain tumors in the posterior fossa and panic
syndrome
*can cause labile hypertension, suggesting
pheochromocytoma.
Acute stress can increase blood pressure.
53
54. Drug induced HTN
• Oral contraceptives =age>35 years,by inducing
sodium retention, increasing renin substrate, and
facilitating the action of catecholamines.
*D|C of OCP recovery from HTN after 6 months.
*
• NSAIDS=by inducing sodium retention by blocking
the formation of renal vasodilating, natriuretic PG
and also interfere with the effectiveness of diuretics,
β-blockers, and ACEIs.
• TCA= inhibit the action of centrally acting agents
(methyldopa and clonidine).
54
56. Drug Therapy of Essential Hypertension.
*Goal is to control hypertension with minimal side
effects using a single drug if possible.
*First-line agents include diuretics, beta blockers,
ACE inhibitors, angiotensin receptor antagonists,
and calcium antagonists.
56
57. Diuretics
. 1.Thiazides =preferred over loop diuretics because of
longer duration of action; however, the latter are more
potent when GFR 25 mL/min.
Major side effects include
hypokalemia, hyperglycemia&ca+2, and hyperuricemia,
which can be minimized by using low dosage (e.g.,
hydrochlorothiazide 12.5–25 mg qd).
Diuretics are particularly effective in elderly and black
pts. Prevention of hypokalemia is especially important in
pts on digitalis glycosides.
57
58. Beta Blockers
*decreases SCD, AMI& CKD.
*Particularly effective in young pts with
“hyperkinetic” circulation.
*Begin with low dosage (e.g., atenolol 25 mg qd).
*Relative contraindications: bronchospasm, CHF,
AV block, bradycardia, and “brittle” insulin-
dependent diabetes.
58
59. ACE Inhibitors
**decreases SCD, AMI,STROKE& CKD.
*Side effects are uncommon and include rash,
angioedema, proteinuria, or leukopenia, particularly
in pts with elevated serum creatinine.
*A nonproductive cough in up to 10% of
patients,1.2-3% angioedema requiring an
alternative regimen.
•renal function may deteriorate as a result of ACE
inhibitors in pts with bilateral renal artery stenosis.
59
60. CCB.
1.Dihydropyridines
=amlodipine, felodipine, isradipine, nicardipine,
nifedipine, nisoldipine,and nitrendipine.
2. Dihydropyridines
*diltiazem and verapamin.
*Only long-acting forms are approved for
use in hypertension.
*The short-acting forms should not be used.
60
61. furosemide:
*Indication= hypertension associated with chronic
kidney disease and estimated GFR <30 mL/min.
• Metabolic effects: hypokalemia, hyperuricemia,
fasting hyperglycemia,hypochloremic alkalosis, and
increased urinary calcium excretion (hypocalcemia).
• Adverse effects: reversible deafness and postural
hypotension.
61
62. spironolactone
Important indications for : primary aldosteronism
and states of secondary aldosteronism, especially
severe heart failure.
• The diuretic effect is antagonized by the
concomitant use of salicylates.
• Adverse effects: hyperkalemia, gynecomastia,
mastodynia, menorrhagia,and skin rash.
Eplerenone
Eplerenone is a mineralocorticoid receptor
antagonist similar to spironolactone, and its
indications for use are generally the same as
for spironolactone. may be better tolerated than
spironolactone, primarily because of less risk of
gynecomastia in men.
62
63. Triamterene
* inhibits renal potassium wasting by blocking the
epithelial sodium channel in the distal tubule of the
nephron.
• Do not use in combination with indomethacin or
during pregnancy.
Amiloride
Amiloride limits renal potassium wasting by the
same mechanism as triamterene and is used most
often in combination with thiazide diuretics. Its side
effects are hyperkalemia, gastrointestinal distress,
and skin rash.
Summary Of the potassium-sparing diuretics,
only spironolactone and eplerenone can cause
gynecomastia
63
65. oNitroprusside
Dilates arterioles and veins
Dosage- 0.3micg/Kg/min, max 10micg/Kg/min
for 10min
Onset of action- 2-5min
S/E- cyanide poisoning
oNitroglycerine
Relatively greater venodilation
Dosage 5micg/min titrated by 5micg/min Q 3-
5min
S/E- reflex tachycardia
65
66. oNicardipine
Dihydropiridine CCB given as IV form
Dosage- 5mg/hr, titrate by 2.5mg/hr Q 5-15 min,
max 15mg/hr
oLabetalol
Combined alpha-1 & beta-1 blocker
Onset of action in seconds
Dosage- 2mg/min(infusion) or 20mg over 2min
then 40-80mg Q10min, max 300mg
66
67. oEsmolol
Ultra short acting beta adrenergic blocker
Onset of action 1-5min, duration of action
15-30min
Dosage 500micgm/Kg bolus which may be
repeated after 5min or 50-100micgm/Kg/min
and increased to 300micgm/Kg/min
oFenoldopam
A selective peripheral dopamine-1 receptor
agonist that induce systemic vasodilatation
Dosage- initial 0.1micgm/Kg/min, titrated at
15 min interval
67
68. oEnalaprilat
Is an Iv preparation of active form of ACEI.
Dosage- 0.625-1.25mg over 5min q 6-8hr,
max of 5mg/dose
Onset of action with in 15min, duration 12-
24hr
C/I in pregnancy, hypovolemia with high RA
oPhentolamine
Non selective alpha adrenergic blocker,
specially used for Pheochromocytoma
Dosage 5-15mg bolus
oHydralazine
10-50mg at 30min interval, used in
pregnancy
68