PC HTN

causes

Diagnosis

HIGH circulating catecholamines, arteriolar stretch SNS activity,

Renin Release

acts on angiotensinogen to cleave off the ten-amino-acid peptide Angiotensin I.

High renin activity only 10% of patients. 60% have normal levels, and 30% have low levels.

multiple BP reading

Tx

Intracellular Na+ is elevated in primary (essential) hypertension. An increase in intracellular Na+ may lead to increased intracellular Ca2+

Alcoholism

Cigarette smoking raises blood pressure by increasing plasma norepinephrin

NSAIDs increases blood pressure averaging 5 mm Hg.

Resources

primary HTN

secondary HTN

genetic

Glucocorticoid remediable aldosteronism

autosomal dominant cause of early-onset hypertension with normal or high aldosterone and low renin levels

aldosterone antagonists are effective in controlling hypertension

Liddle syndrome

autosomal dominant condition characterized by early-onset hypertension, hypokalemic alkalosis, low renin, and low aldosterone levels.

causes renal disease

hyperaldosteronism

adrenal adenoma or bilateral adrenal hyperplasia

≥60/100 mm Hg

140–159/90–99 mm Hg

EMERGENCY

220/125 mm

Population Specific

women more strokes

delay tx 3 mo = baaad

Rx

nonpharma

African American #

diabetes

more osmlality

LOW renal perfusion pressure, low intravascular volume, & hypokalemia. #

Angiotensin-converting enzyme (ACE) acts on this peptide to create peptide Angiotensin II,

vasoconstriction

Adrenl Cortex-aldosterone secretion

Aging

Diastolic less of a factor at age 50+

more HTN, less repsonse to ACE inhibitors

rest 5min in clinic at home best

men more heart attacks

Black persons with hypertension and older patients tend to have lower plasma renin activity, which may be associated with expanded intravascular volume.

Low K+ intake associated with HTN; an intake of 90 mmol/day is recommended.

JNC 8

age 60, non-diabetic, no chronic kidney disease goal= <150/90

< age 60, all diabetics, all with chronic kidney disease goal= <140/90

ACE Inhibitor #

disrupt RAAS

click to edit

if dystolic and systolic are different classes, choose higher class

90-95% Idiopathic

an intake of 90 mmol/day K+ is recommended.

Intracellular Na+ is elevated

if goal not reached in 1 mo, add Rx or up dose

caused by these


Kidney disease
Pheochromocytoma-benign adrneal tumor
Coarctation of aorta
Thyroid/parathyroid disease
Primary aldosteronism (often in patients with DMT2)
Obstructive sleep apnea
Rx related (e.g., NSAIDs, cold remedies, some antidepressants)
steroid therapy

associated w/ aldosteronism

BP normal but doesn't dip at night

Maybe stroke. Need Tx

genetic

Glucocorticoid remediable aldosteronism (genetic)- aldosterone antagonist #

only randomized clinical trials (5-8 yrs)

JNC 8

Tests

rational De Novo

Obtain a blood pressure every visit.
Recheck in clinic if >130/>80.
Leave alone if <130/<80

click to edit

Creatinine, BUN, serum Na+ K+

Fasting serum glucose

CBC

urinalysis w/ mmicroscopic reading

albumin

creatinine

Organ Damage

Reitnopathy

Cotton wool spots

Heart

hypertrophy

Fasting serum TC, triglycerides, HDl, LDL

sphygmometer best, computer does pulse wave

12 lead EKG

effect readings according to KP 2012

10

pt talking

5-10

Full bladder

feet not on floor

back unsupported

forearm BP

legs crossed

small cuff

140-159/90-99 ->Repeat in ~2 weeks. Educate TLC x 3 months w/wo anti-HTN Rx


≥160/≥100->Repeat in ~2 weeks. HTN, Educate TLC, Initiate anti-HTN Med

macular star

optic disc edema

AV nicking or crossing

swollen axons

CHF

weight loss

5-20 mmHg per 10 kg

DASH diet

8-14 mmHg

Excercise

4-9 mmHg 30+ min most days if not already doing it

Don't increase f, intensity & duration all on same day

if incrèments at least 10 min

AHA no more than 2 drinks day men 1 for women

perhaps by increasing plasma catecholamine

3 medications or more, consider divided dosing (AM/PM). Increasing evidence links sleep-time blood pressure and incidence of CV disease.

AHA

Viet Le

risk of CVD doubles for every 20/10 mmhg over 115/75. That means that at 135/85 we are presumably already at risk

Pre- Hypertension

120–139/80–89 mm Hg

Framingham cohort: 50% of affected individuals do so within 4 years

130-139/81-89 ->Borderline HTN, Counsel TLC

cushing's

purple straiae

hirsutism in women, ED in men

buffalo hump

clonidine

SEE RX MAP