April 15, 2016 - SG4 - Hypertension I

Question 1

Hypertensive Urgency vs. Emergency

Answer 1

Hypertensive urgency is a blood pressure of >180/110

Hypertensive emergency is a blood pressure of >220/140 with organ dysfunction

Think of hypertensive urgency almost as a diagnosis of exclusion, simply because you do not want to miss a hypertensive emergency. If you treat an urgency like an emergency, it is not big deal, but if you treat an emergency like an urgency, you are going to run into big trouble.

Question 2

Fundus

Answer 2

The fundus of the eye can be examined to visualize the arterioles.

These arterioles serve as a surrogate for all other small blood vessels in the body. If the vessels are messed up, it is likely small vessels are messed up all over the body.

Question 3

Exogenous Factors Influencing Hypertension

Answer 3

Stress

Oral contraceptives

NSAIDs

Medications

Smoking

Alcohol

Question 4

White Coat Hypertension

Answer 4

When a patient’s blood pressure is higher than normal because of the stress of being in a doctor’s office.

In order to address this, home-monitoring can be used as well as 24h ambulatory monitoring (which you are also looking for a nocturnal dip of 15%)

Question 5

Nocturnal Dip

Answer 5

Healthy individuals should have a decrease in their blood pressure by about 15% at night time when they are asleep.

Individuals who do not experience this nocturnal dip are at an increased risk for cardiovascular events.

Question 6

Diagnostic Tests to Order for HTN

Answer 6

You always want to do a full workup which includes…

ECG

Electrolytes

Fasting glucose

Creatinine

Albumin

Lipids

Question 7

Age and HTN

Answer 7

As a patient gets older, systolic hypertension often occurs because of decreased vascular compliance.

A young individual has a stretchy aorta which squeezes open and allows the blood to be accommodated. When your’e older and the aorta becomes stiff and all the blood is transmitted straight out instead.