hypertension Flashcards
what are the three main goals for new HTN patients
identify any co morbidities
asses target organ damage
exclude any secondary causes
what are some drugs that elevate blood pressure ?
estrogen NSAIDS antidepressants corticosteroids diet pills
on examination what would indicate coartication of the aorta ?
arm-leg discrepancy or a decrease in femoral pulse
what would renal bruit on examination suggest ?
renal artery stenosis
what would a buffalo hump or moon face suggest ?
cushing syndrome
what would unprovoked hypokalemia suggest ?
hyperaldosternism (Conn’s syndrome)
what would elevated hematocrit suggest ?
polycythemia
what would azotemia or proteinurea suggest ?
renal disease
what is the ABCDE approach with hypertension
A - Accuracy , apnea aldosteronism B - bad kidneys C - cortications catecholamines cortisol D - Diet Drugs E - Endocrine erythropoeitn
what is the most common etiology causing 2ry hypertension in children
renal parenchymal disease
coartication of the aorta
left ventricular hypertrophy
what is the most common etiology causing secondary hypertension in older patients
hypothyroidism
atherosclerotic renal artery stenosis
renal failure
most children with hypertension secondary or primary ?
secondary hypertension (70-85%)
what routine testings could you add for children with hypertension
urine culture and renal ultrasonography
how would we confirm hypertension ?
Ambulatory blood pressure monitoring
what is the second most common cause of HTN in children
coartication of the aorta
what can confirm aortic coartication ?
arm-leg discrepancy and decrease in femoral pulse along with the classic 3 sign oor rib notching on the chest x ray
what is resistant hypertension ?
when the patient isn’t improving and not responding to medications
what is the best initial test when suspecting hyperaldosteronism ?
aldosterone :renin ratio
when should a sample be takin for the aldosterone/renin ratio?
preferabbly in the morning at least 2 hrs after waking up and in the upright position
what are the causes of hyperaldosteronism ?
adrenal hyperplasia ( rarley a carcinoma) aldosterone secreting adenoma
what drugs should the patient stop before taking a sample for aldosteron renin ratio
Any of : spironolactone (aldosterone receptor agonist) NSAIDS potassium wasting diuretics licorice (causes potassium wasting) ACE/ARBs inhibitors
what drugs are okay to use when preparing to test for aldosteron renin ratio
calcium channel blockers : verapamil
hydralazine
alpha blockers
what to do when aldosterone;renin ratio is high ?
diagnostic for hyperaldosternism
if the cause is an adenoma then surgical resection
If hyperplasia, mineralocorticoid antagonist: Spironolactone - non selective
what to consider with an old patient that has a new onset of hypertension ?
renal artery stenosis
atherosclerotic disease
what are the diagnostic investigations for renal artery stenosis ?
- Colour doppler ultrasound of renal arteries
- MRA renal arteries
- CT renal angiography
when to use MRA and when to use CTA ?
if the patient has renal insufficiency then use MRA no contrast
what is the problem with using renal doppler ?
operator dependent and can be changed by body habitus
when to suspect obstructive sleep apnea ?
patients with resistant hypertension , obese and have a wide neck circumfrence
what can be used to treat OSA
CPAP
what is the diagnostic criteria for coartication of the heart?
echocardiograph
what is the diagnostic criteria for cushing?
24hr urinary cortisol
dexamethasone suppression test
what is the diagnostic criteria for phaeochromocytoma?
urinary and plasma metanephrines
what is the diagnostic criteria for renal parenchymal disease ?
renal ultrasound
serum creatinine , urea eGFR
Urinary albumin
Kidney biopsy
if i am still suspecting 2ry hypertension in a child what test should you do first ?
renal ultrasound
if i am still suspecting 2ry hypertension in a young adult ?
renal artery MRI or CTA
if i am still suspecting 2ry hypertension in a middle aged patient what test should i do first?
measure renin/aldosterone levels
