HTN + End organ damage

Question 1

General guidelines for HTN diagnosis

Answer 1

> 180/110 2nd visit, even if no organ damage
160/>100 averaged from 3 visits

140-160/90-100 for 4-5 visits

> 135/>85 average for ambulatory

Question 2

Target blood pressure for normal and diabetes/chronic renal failure

Answer 2

<130/80 diabetes/chronic renal failure

Question 3

Primary vs. Secondary Hypertension

proportion of each

Answer 3

Primary: no cause identified. Part genetics, part environment, partly lifestyle (obesity), partly diet (hyperlipidemia). 90%

Secondary: something else is causing the high blood pressure. 10%

Question 4

Causes of secondary hypertension

Answer 4

A: lack of Accuracy in readings
A: aldosteronism
A: sleep apnea
B: bruits (renovascular hypertension)
B: bad kidneys
C: catecholamines, coarctation, Cushing's
D: diet, drugs (corticosteroids, NSAIDs, OCP, nicotine, ephedra, methamphetamines, cocaine)
E: erythropoietin, endocrine disorders

Question 5

Target organ damage in HTN

Answer 5

Hypertensive rentinopathy: can be graded (e.g. arteriovenous nicking)

Cerebrovascular disease: HTN #1 risk factor. Hemorrhage or thrombosis.

Hypertensive heart disease: left ventricular hypertrophy due to increased afterload, or coronary artery disease

Chronic renal failure: loss of autoregulation, rarefaction of some vessels, hypertensive nephrosclerosis.

Peripheral vascular disease

Abdominal/thoracic aortic aneurysm

Coronary artery disease

Question 6

Hypertensive emergencies

Answer 6

Usually BP 240/140

• hypertensive encephalopathy
• aortic dissection (shearing intima from media)
• acute renal failure

Question 7

Consider secondary hypertension when

Answer 7

• sudden onset
• extremes of age + organ damage
• atypical response to therapy
• renal failure present
• hypokalemia or hypercalcemia

Question 8

What proportion of males and females aged 6-79 are hypertensive?

What is the cost of antihypertensive medications across the country in a year?

Answer 8

• around 20%.

- $1 billion