CR III - Secondary Hypertension Flashcards
What are 6 clinical clues that suggest secondary hypertension?
Severe/resistant to 3 drugs Acute rise in pt with stable BP <30 years and not obese Malignant HTN Electrolyte disorders present Before puberty
What are the 4 common causes of secondary hypertension?
Primary Kidney Disease Renovascular HTN (Renal artery stenosis) Primary Hyperaldosteronism Obstructive Sleep Apnea
Recurrent acute pulmonary edema could point you to:
Renal artery stenosis
What is the gold standard for Renal Artery Stenosis? What is easiest?
Gold standard - CTA or MRA
Easiest - doppler ultrasound
What are the 3 treatments for renal artery stenosis?
Stop smoking
Anti-hypertensive agent
Surgery
What does HTN and hypokalemia suggest?
Primary hyperaldosteronism
What should be done in all patients with primary aldosteronism?
Adrenal scan
What can be used to diagnose primary aldosteronism? What value is indicative?
PAC/PRA (PRC) - plasma aldosterone:plasma renin
Ratio >20
PAC >15ng/dL
What two things will interfere with a PAC/PRA test? How do you overcome this?
Mineralocorticoid receptor antagonists - hold spiralactone and diuretics 6-weeks before
ACEI and ARB increase PRC - hold for 2 weeks
What 2 things must be normalized in someone with primary aldosteronism? Surgery? If not surgery?
Normalize K and BP
Yes, consider surgery
If not surgical candidate or bilateral dz - spironolactone
What is used to diagnose OSA? What is the treatment?
Sleep study - polysomnogram
CPAP machine - treatment
What are 3 uncommon causes of secondary hypertension?
Pheochromocytoma
Cushing’s Syndrome
Coarctation of the aorta
What is the classic triad of symptoms for pheochromocytoma?
Headache
Sweating
Tachycardia
What is found in the plasma or urine to diagnose pheochromocytoma?
Free metanephrines (or unfractionated in urine)
What is metanephrines metabolized to?
Vanillylmandelic acid (VMA)
What is the treatment of choice for pheochromocytoma?
Surgery
What two things must be treated prior to surgery for a phrochromocytoma?
HTN and volume contraction
What must be given first in hyperstensive treatment in someone with a pheochromocytoma? 2nd?
Alpha-blockade first - for 2 weeks
Beta blockage after - to treat tachy
What are symptoms suggestive of Cushing’s syndrome?
Moon faces Glucose intolerance Abdominal striae Hirsutism - unwanted male hair Central obesity/weight gain
What three tests can be used to check for Cushing’s Syndrome? Which one is done most?
Late-night salivary cortisol test - positive if cortisol presence (not suppressed at night like normal)
24hr urinary free cortisol - postive if 3x normal
Low-dose dexamethasone suppression test - 1mg given at 11pm should suppress cortisol - positive if cortisol present in morning
What is a normal cortisol level at 8am?
<2mcg/dL
What is the treatment for Cushing’s syndrome?
Normalize hypothalmic-pituitary-adrenal function
FInd and remove ACTH tumor
What is the second major cause of HTN in young children?
Coarctation of the aorta
What 4 drugs can cause coarctation of the aorta?
Birth control pills
NSAIDs
Decongestants
Nicotine
