B.39 Hypertension - Etiology, DX Flashcards
B.39 Hypertension - Etiology, DX
Primary (Essential) Hypertension Etiology
- No Specific Cause: Multifactorial etiology involving genetic, epigenetic, and environmental influences.
- Prevalence: Represents 85–95% of hypertension cases in adults.
- Pediatric Cases: Accounts for 15–20% of hypertension cases in children under 12 years old.
- Age of Onset: Typically occurs between 25 and 55 years, with increasing prevalence noted in adolescents.
B.39 Hypertension - Etiology, DX
Primary (Essential) Hypertension Risk Factors
Nonmodifiable Risk Factors:
- Positive family history
- Ethnicity
- Advanced age
Modifiable Risk Factors:
- Obesity
- Diabetes
- Smoking, excessive alcohol, or caffeine consumption
- High sodium diet and low potassium intake
- Physical inactivity
- Psychological stress
B.39 Hypertension - Etiology, DX
Secondary Hypertension
Causes: Results from an identifiable underlying condition.
- Prevalence in Adults: Represents 5–15% of hypertension cases.
- Prevalence in Children: Accounts for 70–85% of hypertension cases in children under 12 years.
- Age of Onset: Typically occurs in individuals under 25 years or over 55 years.
B.39 Hypertension - Etiology, DX
Secondary Hypertension Causes - Endocrine
Endocrine Hypertension
- Primary Hyperaldosteronism (Conn Syndrome): Most common cause of secondary hypertension.
- Cushing’s Syndrome: Resulting from hypercortisolism.
- Hyperthyroidism
- Pheochromocytoma
- Primary Hyperparathyroidism
- Acromegaly
- Congenital Adrenal Hyperplasia
B.39 Hypertension - Etiology, DX
Secondary Hypertension Causes - Renal Hypertension
Renal Hypertension
- Renovascular Hypertension: Related to renal artery stenosis.
- Polycystic Kidney Disease (ADPKD)
- Hypertensive Nephropathy: Including renal parenchymal hypertension.
- Glomerulonephritis
- Systemic Lupus Erythematosus (SLE)
B.39 Hypertension - Etiology, DX
Secondary Hypertension Causes - Other Causes
- Coarctation of the Aorta
- Obstructive Sleep Apnea
- Medications: Such as sympathomimetics, corticosteroids, NSAIDs, and oral contraceptives.
- Recreational Drug Use: Includes amphetamines, cocaine, and PCP.
B.39 Hypertension - Etiology, DX
Clinical Features
Hypertension
- Typically asymptomatic until complications arise related to organ damage or significant increases in blood pressure.
Secondary Hypertension
- Often presents with symptoms indicative of the underlying condition, such as:
- Abdominal bruit in renovascular disease
- Edema in chronic kidney disease (CKD)
- Daytime sleepiness in obstructive sleep apnea (OSA)
Nonspecific Symptoms of Hypertension
- Headaches, especially in the early morning or upon waking
- Dizziness, tinnitus, or blurred vision
- Flushed appearance
- Epistaxis (nosebleeds)
- Chest discomfort or palpitations; a strong, bounding pulse upon palpation
- Nervousness and sleep disturbances
B.39 Hypertension - Etiology, DX
DX BP Monitoring
In the general approach to blood pressure monitoring, it is essential to measure blood pressure in both arms.
Hypertension is diagnosed if the average of two readings taken on separate visits is elevated.
Long-term monitoring may also involve a 24-hour assessment.
Blood pressure categories are defined as follows:
Normal blood pressure is considered to be less than 120 mm Hg for systolic and less than 80 mm Hg for diastolic.
Prehypertension is classified as a systolic reading of 120 to 139 mm Hg or a diastolic reading of 80 to 89 mm Hg.
Stage 1 hypertension is identified with a systolic range of 140 to 159 mm Hg or a diastolic range of 90 to 99 mm Hg.
Stage 2 hypertension is defined as a systolic reading of 160 mm Hg or higher, or a diastolic reading of 100 mm Hg or higher.
B.39 Hypertension - Etiology, DX
Screening
Stratification of Cardiovascular Risk:
- Measure fasting blood glucose and lipid profile (HDL, LDL, and triglycerides).
B.39 Hypertension - Etiology, DX
Evaluation of End-Organ Effects:
- Perform a complete blood count (CBC).
- Conduct renal function tests, including serum creatinine and estimated glomerular filtration rate (eGFR).
- Check serum levels of Na+, K+, and Ca2+.
- Evaluate thyroid function with TSH.
- Obtain an ECG.
B.39 Hypertension - Etiology, DX
Screening for Hypertension (HTN):
- Individuals aged 18 to 39 with normal blood pressure (<130/85 mm Hg) and without other risk factors should be screened every 3 to 5 years.
- Individuals over 40 years of age or those at increased risk for high blood pressure should be screened more frequently.
B.39 Hypertension - Etiology, DX
Approach to Secondary Hypertension:
Investigate and identify the underlying cause.
