Hypertension

Question 1

How does breed affect BP?

Answer 1

Sighthounds 10-20 higher

Question 2

What conditions are associated with hypertension?

Answer 2

CKD/ AKI
HAC
Diabetes (dogs, rare)
Obesity (mild)
Hyperaldosteronism
Phaeochromocytoma
Hypothyroidism (rare)
Hyperthyroidism

Question 3

Which drugs are associated with hypertension?

Answer 3

Glucocorticoids
Mineralocorticoids (not when given at levels needed for Addisons
EPO type drugs
Phenylpropanolamine
Phenylephrine hydrochloride
Ephedrine
Pseudo ephedrine
Toceranib phosphate
Chronic, high dose sodium chloride

Question 4

Which intoxicants are assciaoted with hypertension

Answer 4

Cocaine
Methamphetamine/amphetamin
5‐hydroxytryptophan

Question 5

How can BP affect SG?

Answer 5

Can lower SG without CKD

Question 6

Outline idiopathic hypertension

Answer 6

suspected when reliable BP measurements demonstrate a sustained increase in BP concurrent with normal CBC, serum biochemistry, and urinalysis results.

Question 7

What signs suggest target organ damage to the eye?

Answer 7

Acute onset blindness
Exudative retinal detachment 
Retinal hemorrhage/edema
Retinal vessel tortuosity or perivascular edema
Papilledema
Vitreal hemorrhage
Hyphema
Secondary glaucoma
Retinal degeneration

Question 8

Which organs can hypertension damage?

Answer 8

Kidneys - progression of kidney disease
Eyes
Brain - encephalopathy/ stroke
Heart and blood vessels - Left ventricular hypertrophy
Left‐sided congestive heart failure (uncommon)
Aortic aneurysm/dissection (rare)

Question 9

What is the relation between hypertension and proteinuria

Answer 9

magnitude of BP has been associated with proteinuria, and this has been associated with shortened survival times.
Hypertension also was associated with shorter renal survival, but only if proteinuria was excluded from the analysis.
Proteinuria was directly related to the extent of increase in BP and to the rate of decrease in GFR in an experimental study in dogs

Question 10

How does Leishmania affect BP?

Answer 10

Dogs with leishmaniasis frequently have proteinuria and systemic hypertension, even when nonazotemic, although in this setting the proteinuria is thought to relate mainly to immune‐mediated glomerular lesions, rather than occurring as a consequence of the hypertension

Question 11

What do you call damage to the eye because of hypertension?

Answer 11

hypertensive retinopathy and choroidopathy

Question 12

At what level of hypertension can blindness occur?

Answer 12

Most likely when above 180, rarely can be lower

Question 13

How do you diagnose hypertension?

Answer 13

results should be confirmed by measurements repeated on multiple (>2) occasions. In cases of prehypertension (140‐159 mm Hg) or hypertension at moderate risk of TOD (160‐179 mm Hg), these measurement sessions can occur over 4‐8 weeks. With more severe hypertension (≥180 mm Hg), however, the risk of TOD dictates that the measurement sessions be completed in 1‐2 weeks.

Question 14

What are the categories of hypertension?

Answer 14

Normotensive (minimal TOD risk) SBP <140 mm Hg
Prehypertensive (low TOD risk) SBP 140‐159 mm Hg
Hypertensive (moderate TOD risk) SBP 160‐179 mm Hg
Severely hypertensive (high TOD risk)SBP ≥180 mm Hg

Question 15

What are the common RAAS inhibitors used to control hypertension in dogs?

Answer 15

An ACEi (eg, 0.5‐2.0 mg enalapril or benazepril/kg PO q12h) usually is recommended as the initial drug of choice in a hypertensive dog. An ARB (eg, 1.0 mg telmisartan/kg PO q24h) is an alternative method for RAAS inhibition

Question 16

When is it not appropriate to just start a hypertensive dog on an ACEi?

Answer 16

The exception to the use of a RAAS inhibitor as initial, sole agent, treatment is severely hypertensive dogs (SBP > 200 mm Hg) for which the initial coadministration of a RAAS inhibitor and a CCB (eg, 0.1‐0.5 mg/kg amlodipine PO q24h) is appropriate.

Question 17

Why should you not just use a calcium channel blocker in dogs?

Answer 17

CCB preferentially dilate the renal afferent arteriole potentially exposing the glomerulus to damaging increases in glomerular capillary hydrostatic pressure.

Question 18

What are the oral hypertensive agents available?

Answer 18

ACEi
Calcium channel blockers
Angiotensin receptor blocker (telmisartan)
alpha 1 blocker (prazosin/phenoxybenzamine)
Aldosterone antagonist (spironolactone)

Question 19

How do you start treatment for hypertensive cats?

Answer 19

an initial starting dose of 0.625 mg per cat per day amlodipine besylate is effective in cats in which initial SBP is <200 mm Hg, but that those cats with SBP >200 mm Hg may benefit from a higher starting dosage of 1.25 mg per cat per day. Rarely, dosages of up to 2.5 mg per cat per day however may be required.

Question 20

What is the approach to a hypertensive emergency?

Answer 20

The therapeutic target in patients with acute hypertensive emergencies is an incremental decrease in SBP rather than acute normalization of BP. In cases of chronic hypertension, autoregulatory vascular beds in the brain and kidneys may have adapted to higher perfusion pressure, and acute marked BP reduction may result in hypoperfusion. Initial SBP should be decreased by approximately 10% over the first hour and another approximately 15% over the next few hours

Question 21

What in fenoldapam?

Answer 21

Possible treatment for hypertensive emergencies
Through its dopamine‐1 agonist action, fenoldopam causes renal arterial vasodilation, natriuresis, and increased GFR in normal dogs, and it is associated with diuresis in healthy cats, all of which may be beneficial in veterinary patients with hypertensive emergencies. Fenoldopam is delivered as a constant rate infusion (CRI),