Hypertension

Question 1

How is hypertension diagnosed?

Answer 1

Diagnosis is based on the highest of the systolic or diastolic readings

Question 2

What is isolated systolic hypertension?

Answer 2

SBP greater than 140 and DBP less than 90

Question 3

What is normal and high normal blood pressure?

Answer 3

less than 130 SBP, and less than 85 DBP for normal

130-139 SBP, 85-89 DBP for high normal

Question 4

What are the categories and BP readings for hypertension?

Answer 4

MILD: 140-159 sBP, 90-99 DBP
Moderate: 160 - 179 sBP, 100-109 DBP
Severe: over 180 SBP, over 110 DBP

Question 5

When taking BP readings how to know which is the systolic and diastolic respectively?

Answer 5

• Appearance of sound (phase I Korotkoff) = systolic pressure
• Disappearance of sound (phase V Korotkoff) = diastolic pressure

Question 6

What the blood pressure values for hypertension diagnosis?

Answer 6

Ambulatory BP: SBP 130 or greater, DBP 80 or greater (for 24hrs) or same as home based for awake BP
Home based BP: SBP 135 or greater, DBP 85 or greater
Clinic BP: 160 or more OR 100 or more (3 visits)
4-5 visits –> 140 or more OR 90 or more

Question 7

What endocrine conditions may lead to hypertension?

Answer 7

1. Hyperaldosteronism
2. Cushing’s syndrome
3. Pheochromocytoma
4. Hyperthyroidism/hypothyroidism

Question 8

What are some secomdary causes of HTN?

Answer 8

NSAIDs
sleep apnea
alcohol
other drugs
renal parenchymal disease
renovascular hypertension (may be less common than hyperaldosteronism)

Question 9

How to proceed to diagnosis of hyperaldosteronism?

Answer 9

• low serum K+
• renin measurement - suppressed or very low (morning sample)
• increased aldosterone - 24 hr urine aldosterone OR serum aldosterone (morning sample)

Question 10

What may cause hyperaldosteronism?

Answer 10

1) Aldosterone - producing adenoma [APA] (most common, small, not usually seen on CT)
2) Bilateral Adrenal Hyperplasia [Idiopathic hyperaldosteronism - IHA] (next most common)
3) Unilateral Adrenal Hyperplasia [Primary adrenal hyperplasia]

Question 11

Who should be screened for hyperaldosteronism?

Answer 11

those with:

• spontaneous hypokalemia (less 3.5 mmol/L)
• profound diuretic-induced hypokalemis (less 3 mmol/L)
• hypentension unsolved with 3 or more drugs
• incidental adrenal adenomas

Question 12

Why is Selective adrenal vein sampling used?

Answer 12

Used to differentiate APA and IHA

Question 13

Whats the significance of NP-59 scanning?

Answer 13

• the uptake of radioactive cholesterol is recorded

- -> faster than 5 days in both adrenals suggest BAH; only one suggest APA or IHA

Question 14

In 11C metomidate-PET, why would a APA have high activity?

Answer 14

11C metomidate binds to 11-b-hydroxysteroid dehydrogenase, which is over-expressed in APA (and Cushing’s)

Question 15

What are some symptoms of Pheochromocytoma?

Answer 15

headache, sweating, palpitations (95% sensitive); pallor, anxiety, nausea, weight loss, tremor

Question 16

Diagnostic steps for Pheochromocytoma are?

Answer 16

• urinary metanephrines (particularly when symptomatic)
• increased: blood glucose, rbc’s, calcium
• once metanephrines high: MRI and/or MIBG scan

Question 17

What are the signs and symptoms of Cushing’s Disease?

Answer 17

signs: centripital obesity, plethora, striae, bruising
symptoms: back pain, weight gain, easy bruising, fatigue, muscle weakness

Question 18

What are the diagnostic steps for Cushing’s?

Answer 18

1) 24 hr urine cortisol:creatinine ratio (>30)

2) dexamethasone suppression and ACTH to differentiate pituitary vs adrenal vs ectopic