Hypertension

Question 1

What are the steps in the workup of hypertension?

Answer 1

1. Establish the diagnosis (Multiple readings over a period of time, with ambulatory, home and school measurements often required)
2. History and examination looking for causes
3. Ix: UEC, UA, Uric acid, ECG, ECHO
4. Assess other CVS risk factors
   - Obesity, FHx, Dyslipidaemia, smoking, diabetes, inactivity

Question 2

What features on Hx may give clues for the cause of hypertension?

Answer 2

1. Acute severe HTN: Headache, dizziness, N&V, irritability, neurological manifestations, CHF, renal dysfunction, stroke
2. Primary aldosteronism: Weakness and muscle cramps from low K+
3. Catecholamines or high T4: palpitations, sweating, headache
4. Neonatal: Use of UA catheters –> renovascular complications
5. COA
6. Renal: Obstructive uropathies, UTI, radiation, trauma and surgery
7. Medications

Question 3

What are the most common causes of secondary hypertension?

Answer 3

90% caused by
1- Renal parenchymal disease
2- Renovascular disease
3- COA (20%)
4- Endocrine and others