Hypertension/Hypotension

Question 1

What are some reversible risk factors for hypertension?

Answer 1

smoking, obesity, excessive alcohol intake, physical inactivity, renal disease, dyslipidemia, and Diabetes

Question 2

What are non-reversible risk factors for hypertension?

Answer 2

Age, race, family history of a male <65 y.o. that had a heart attack or stroke

Question 3

Define Systole

Answer 3

-phase of cardiac cycle in which ventricles CONTRACT -point of maximal arterial pressure

Question 4

Define Diastole

Answer 4

-phase of cardiac cycle in which the ventricles RELAX -point of lowest arterial pressure

Question 5

Essential Hypertension

Answer 5

-The cause of the hypertension is unknown

Question 6

Secondary Hypertension

Answer 6

• high blood pressure that’s caused by another medical condition

Question 7

Causes of Secondary Hypertension (Endocrine Disorders)

Answer 7

Endocrine disorders -Pheochromocytoma -Cushing’s Syndrome -Primary Aldosteronism -Congenital Adrenal Hyperplasia -Hyperparathyroidism -Hyperthyroidism, Hypothyroidism

Question 8

Causes of Secondary Hypertension

Answer 8

Endocrine, Renal, Mechanical, Medication-Induced, “White Coat” Hypertension

Question 9

Causes of Secondary Hypertension (Renal)

Answer 9

-Renovascular disease (stenosis) -Preeclampsia -Renal parenchymal disease

Question 10

Causes of Secondary Hypertension (Mechanical)

Answer 10

-Coarctation of Aorta -A/V Fistula, Patent ductus arteriosus

Question 11

Causes of Secondary Hypertension (Medication-Induced)

Answer 11

-Stimulant use -Corticosteroids -SSRIs -Abrupt withdrawal of medication -Oral contraceptives -Black Licorice

Question 12

White Coat Hypertension

Answer 12

-Falsely elevated blood pressure secondary to measurement in a clinical setting -20-25% of patients will have false mild elevation of pressure -Pearl: LOOK AT DIASTOLIC PRESSURE -Key word: MILD -Can be clarified by ambulatory monitoring

Question 13

Malignant Hypertension

Answer 13

-SBP ≥180 or DBP ≥120 -Most often w/ long-standing, uncontrolled HTN -Multiple other causes (see secondary HTN) -Can lead to hypertensive encephalopathy Symptoms: Headache, nausea, vomiting, non-localizing neurologic symptoms (restlessness, confusion) -Urgency/Emergency, treatment based on symptoms and exam findings -Risk for seizures and/or coma if not treated

Question 14

What damage can occur with the Brain in association with HTN

Answer 14

Stroke Transient ischemic attack reversible ischemic neurological deficit

Question 15

What damage can occur with the eye in association with HTN

Answer 15

Retinopathy - Papilledema - A/V Nicking - Hemorrhage - Exudates - Cotton Wool Spots

Question 16

What damage can occur with the heart in association with HTN

Answer 16

Left Ventricular Hypertrophy

Question 17

What damage can occur with the kidney in association with HTN

Answer 17

Proteinuria Renal insufficiency

Question 18

What damage can occur with the vascular system in association with HTN

Answer 18

Peripheral Arterial Disease

Question 19

What can cause orthostatic hypertension?

Answer 19

• ANS Disorders:
  
  • Multiple sclerosis
  • Parkinson’s disease
  • Peripheral Neuropathy (diabetic or other)
  • Guillain-Barre syndrome
  • Raynaud’s syndrome
  • Reflex sympathetic dystrophy (RSD)
• Other:
  
  • Drugs (antihypertensives, vasodilators, antidepressants)
  • Physical deconditioning
  • Sympathectomy
  • Decreased blood volume (GI bleed, dehydration, adrenal insufficiency)
  • Idiopathic postural hypotension (familial)
  • Advanced Age

Question 20

What are some characteristics of Orthostatic Hypotension?

Answer 20

• Significant drop in arterial blood pressure with position change
• Represents a defect in vasomotor reflexes
• Frequent cause of syncope in elderly
• Prominent feature in many ANS disorders

Question 21

How do you diagnose Orthostatic Hypotension?

Answer 21

• Orthostatic Testing
  
  • Measure BP and HR from supine-standing
  • Lying —> Sitting —> Standing
  • Wait 2 minutes between position changes
  • Sustained drop of SBP >20mmHg or DBP >10mmHg
  • Absence of compensatory HR increase (15bpm) suggests neurogenic etiology
  • Compensatory HR increase suggests non-neurogenic etiology
• Upright Tilt Table Testing

Question 22

How do you manage Orthostatic Hypotension?

Answer 22

• Reduce/eliminate offending drugs
• Caution patient on position changes
• Elevate head of bed
• Compressive stockings
• Some patients require high sodium diets
• May require drug therapy