HTN

Question 1

Definition

Answer 1

Constant increase in systolic blood pressure(SBP)and or diastolic blood pressure(DBP) values are both values considered normal for age and sex

Question 2

Generally over____ by conventional office BP measurement

Answer 2

140/90 mmHg

Question 3

Automated Multiple BP(AOBP)=

Answer 3

3-6 meas(>3)/4-7 min

Patient alone in the examination room

Question 4

Threshold values =

Answer 4

135/85 mmHg( 131/85 mmHg - 140/90 mmHg)

Question 5

7. Feocromocytoma (1)

Answer 5

mechanism: excess and autonomic secretion of catecholamines
⊕ inotropism
↑ PVR
Clinical:
HTA with different patterns (depending on the type and mode of secretion)
Mild chronic sistolo-diastolic HTA
HTA paroxysms on a background of normo/hypertension
!!! orthostatic hTA
Crisis:
can be triggered by lumbar microtraumas, urination, pregnancy, anesthesia, surgery
Symptoms: anxiety, intense headache, palpitations, nonspecific thoracic or even angina attacks
objective: pale, sweaty, arrhythmias

Complications:
acute catecholaminic myocarditis
APE (acute pulmonary oedema)
Arrhythmias
HT encephalopathy or cerebral hemorrhages

Question 6

7. Feocromocytoma (2)

Paraclinical

Answer 6

paraclinical:
plasma and urinary catecholamine dosing
regitin test
Imaging:
SR glond ultrasound
iv urography
CT/MRI
scintigraphy (meta-I131-benzyl guanidine)
Selective arteriography of SR

Question 7

8. Primary hyperaldosteronism

Answer 7

mechanism:
1. excess and autonomous secretion of aldosterone
2. retention of Na+ and water
3. iinhibitionR-AT-A

Clinical:

1. Systolic HTA (mild or moderate)manifestations due to hypoK+:
2. Arrhythmias
3. intestinal muscle paralysis (dynamic ileus)
4. Polyuria
5. metabolic alkalosis

paraclinical:
1.hipoK+ (<3,5 mEq/L)
2.hiperpotasiuria (> 30 mEq/L)
↑ increased serum and urinary concentration of aldosterone or its metabolites
3.low PRA (plasma renin activity)
4.CT/RMN/Scintigrafie (Scintandren)

Question 8

VI. Secondary forms of HT

Answer 8

Complementary paraclinical explorations
Required in a limited group of hypertensive people, which requires special evaluation for the diagnosis of a secondary HTA:

1. Patients in whom history, physical examination or common laboratory data, suggest a cause of secondary HT.
2. Stable HT in young people (under 35–40 years) or adolescents, where the prevalence of secondary HT is particularly high.
3. HT with poor response or “resistance” to correct treatment.
4. Accelerating or suddenly worsening HT

Question 9

History of snoring + daytime sleepiness + morning headache

Answer 9

OSA

Question 10

Repetitive episodes of sweating + pulsating headache + anxiety + palpitations

Answer 10

pheochromocytoma

Question 11

Episodes of muscle weakness and tetany

Answer 11

HYPERALDOSTERONISM

Question 12

secondary HT screening

clinical examination

Answer 12

Cushing symptom
acromegaly
pheochromocitoma
myxedema

Question 13

Palpable abdominal formations

Answer 13

polycystic kidneys

Question 14

reduction/delay/absence of pulse mb

Answer 14

coarctation of Ao, aortic disease, BAP

Question 15

Abdominal breaths

Answer 15

stenosis of A.Renal

- Precordial /thoracic sulfels ->coarctation of Ao,aortic disease,stenosis A.subclavie

Question 16

Arrhythmic heart noises

Answer 16

primary hyperaldosteronism with severe hypoK

TA mara differential between the two arms