Hypertension Complications Flashcards
Complications of HTN?
complications are related to persistent elevation of BP and the development of atherosclerosis
Target organs?
- heart
- brain
- kidneys
- eyes
Hypertensive heart disease?
Arterial hypertension is the most common risk factor for cardiovascular disease
1. Left ventricular hypertrophy, hypertrophic cardiomyopathy, dilated cardiomyopathy
2. Congestive heart failure
3. Coronary artery disease and myocardial infarction
4. Atrial fibrillation
5. Aortic aneurysm
6. Aortic dissection
7. Carotid artery stenosis
8. Peripheral artery disease
9. Atherosclerosis
Cerebrovascular disease?
- Stroke
- TIA
- cognitive changes e.g. memory loss
What to do in Peripheral vascular disease?
do a ABPI
Hypertensive nephrosclerosis?
- a renal vascular injury secondary to long-standing arterial hypertension
- CKD
Investigations of hypertensive nephrosclerosis?
- Initially microalbuminuria and microhematuria
- ↑ BUN, Cr, and uric acid levels
- Nephrosclerosis with proteinuria (usually < 1 g/day) and progressive renal failure occur with disease progression
Diagnostics of hypertensive nephrosclerosis?
renal biopsy shows vascular, glomerular and tubulointerstitial changes
Treatment of hypertensive nephrosclerosis?
- ACE inhibitors
- ARBs
Hypertensive retinopathy?
- Arteriosclerotic and hypertension-related changes of the retinal vessels
- Initial reactive vasoconstriction (vasospasm), followed by sclerosis with breakdown of blood-retinal barrier and subsequent hemorrhage and exudation
Fundoscopic examination in hypertensive retinopathy?
- Cotton wool spots
- Retinal hemorrhages (i.e., flame-shaped hemorrhages)
- Microaneurysms
- Macular star (results from exudation into the macula)
- Hard exudates
- Arteriovenous nicking
- a tapering of a retinal venule at the point where a retinal arteriole crosses the retinal venule - Hourglass shape on fundoscopic examination
- Associated with advanced hypertensive retinopathy
Eye examination in hypertension?
- Marked swelling and prominence of the optic disk with indistinct borders due to papilledema and optic atrophy (end-stage disease)
- The presence of papilledema in a hypertensive patient may indicate a hypertensive crisis and warrants urgent lowering of blood pressure
Hypertensive retinopathy classification?
Grade 1 - 4
Grade I hypertensive retinopathy?
minimal narrowing of retinal arteries
- non-malignant
Grade II hypertensive retinopathy?
narrowing of the retinal arteries in conjuction with regions of focal narrowing and arterio-venous nipping
- non-malignant
Grade III hypertensive retinopathy?
abnormalities seen in Grades I and II as well as retinal hemorrhages, hard exudation and cotton wool spots
- malignant
Grade IV hypertensive retinopathy?
abnormalities encounters in Grades I - III as well as swelling of the optic nerve head and macular star
- malignant
Hypertensive crisis?
Acute severe HTN; Severe abrupt elevation in BP
Causes of hypertensive crisis?
- Common in patients with a history of HTN who have failed to comply with medications or who have been under-medicated.
- Drugs that may exacerbate hypertension (e.g., MAO inhibitors, TCAs, NSAIDS, cocaine, amphetamines, ecstasy, stimulant diet pills)
- Phaeochromocytoma, hyperthyroidism
- Acute and rapidly progressive renal disorders
- Collagen vascular diseases (e.g., SLE)
- Eclampsia/Pre-eclampsia
- Head trauma, spinal cord disorders
Manifestations of hypertensive crisis?
asymptomatic, non-specific symptoms (headache dizziness, epistaxis)
Signs and symptoms of neurological end organ dysfunction?
- Hypertensive encephalopathy (headache, N&V, seizures,papilledema, confusion, coma)
- CVA
- focal neurological deficits
- altered mental status
Signs and symptoms of opthalmic end organ dysfunction?
Acute hypertensive retinopathy
1. blurry vision
2. decrease in visual acuity
3. retinal flame hemorrhages
4. papilledema
Signs and symptoms of renal organ dysfunction?
- Renal insufficiency
- AKI
- acute hypertensive nephrosclerosis
Signs and symptoms of cardiac dysfunction?
- heart failure
- flash pulmonary edema
- MI
- aortic dissection
Management?
Confirm BP manually and on bilateral upper limbs
1. First hour: goal of reduction inmean arterial pressureby no more than 25%
2. Over the next 2–6 hours: Reduce to160/100–110 mm Hg.
3. Once at goal (typically< 160/110 mm Hg) Transition to PO medications.
- If left untreated, hypertensive emergencies are associated with a 1-year mortality rate of > 80% and a median survival of 10–11 months.
Management of hypertensive urgency?
- Initiate, reinstitute, or modify oral antihypertensive therapy
- Refer for evaluation of newly diagnosed hypertension and assessment for secondary hypertension
- Arrange follow-up, monitoring, and counselling.
Management of hypertensive emergency?
ABCDE approach
1. IV antihypertensives (Labetalol, sodium nitroprusside, hydralazine)
2. Monitor cardiac and renal function, determine cause
3. May need HDU or ICU admission
4. Determine cause
