Hypertension Renal Flashcards
What are the criteria for Hypertension?
Stage 1: Systolic: 140-159, Diastolic: 90-99
Stage2: Systolic: ≥ 160, Diastolic: ≥ 100
How do you treat Stage 1 HTN vs Stage 2 HTN?
Stage 1: give one drug
Stage 2: give two drugs
What are some risk factors for Primary (essential) Hypertension?
Age (70% of 70 yr olds have HTN) Fam Hx Race - African Americans Decreased Nephron # High sodium diet booze inactivity Diabetes + dyslipidemia personality traits/depression
Why are African Americans predisposed to HTN? What can this lead to at an earlier age?
ApoL1 gene
-resists sleeping sickness from the tsetse fly but predisposes for HTN
progress to ESRD at a younger age
What is Masked HTN
BP that is consistently elevated by out-of-office measures
-does not meet criteria for hypertension based upon office readings
How common is HTN in the US?
29%-31% of adults in the US have hypertension
How do Angiontensin II and Aldosterone alter BP
Angiotensin II - potent vasoconstrictor
Aldosterone - mad salt reabsorption
What are some life changes that can prevent HTN?
- WEIGHT REDUCTION
- DASH eating plan (fruits, veggies)
- Sodium reduction
- physical activity
- low booze drinking
The dietary intake of what is associated with lowered BP?
Potassium, Magnesium, Fish oil, fiber, flavinoids, folic acid
dietary changes is equivalent to 1 medication
What is the follow up time window for Normal BP, Prehypertension, Stage 1, Stage 2, >180 mmHg?
Normal: 2 years Prehypertension: 1 year Stage 1: confirm within 2 months Stage 2: refer to care within 1 month >180mmHg: evaluate immediately
What are causes of Secondary HTN (hint: SCCORE)
Sleep apnea Chemotherapeutic agents (VEGF inhib) --reduces NO in the blood Coarctation of Aorta Oral contraceptives Renovascular Hypertension, Renal disease Endocrine - Cushings, pheo, hyperthy
Most common: Renovascular, Endocrine
What are 4 reasons to work up patient for secondary hypertension?
- severe/resistant HTN
- pt w/ hx of controlled htn, becomes uncontrolled
- <30yrs old, non obese, non black
- Electrolyte abnormalities
What are the 2 causes of High Renin + High Aldo
- Renin Secreting Tumor (Increased renin = increased aldo)
2. Renal artery stenosis (renin, aldo try to increase perfusion)
What causes Low Renin + High Aldo
primary hyperaldosteronism (high aldosterone suppresses renin)
What are the 2 causes of Low Renin and low Aldo?
- Liddles syndrome: hyperactive ENaC in principal cells = Salt retention suppresses renin/aldosterone by negative feedback
- Cushings syndrome: Cortisol acts as aldosterone = salt retention
What are 2 causes of Renovascular Hypertension and what demographic does this usually appear in?
Atherosclerosis
Fibromuscular Dysplasia
present in 10-45% of white patients with severe HTN
What a suspicious signs of Renovascular HTN?
- new onset HTN after 55
- increase in creatinine w/ antihyptertensive therapy (does decrease in 6 weeks)
- atherosclerosis in other organs
- ATROPHIC kidney
- abdominal bruit that localized to one side
- recurrent pulmonary edema, HF
What disease does Fibromuscular Disease appear with and what demographic (age, sex)
appears with renovascular hypertension (35-50% of CHILDREN, 5-10% adults)
more common in FEMALES (90%)
What is the Imaging, and Tx of Fibromuscular Disease Renal Artery Stenosis
Imaging: Digital subtraction angiography
Tx: RAAS blocker (watch for creatinine, potassium increase)
Surgery (Revascularization)
When should you treat with Revascularization?
Recent, Med resistant, Bilateral disease
in PVD: recurrent flash pulmonary edema, refractory HF
When should you suspect Hyperaldosteronism as a cause of secondary HTN?
hypokalemia and metabolic alkalosis
What are signs of Hypertensive Emergency and how do you treat?
>180/120 mmHg WITH target organ damage LVH, CHD, HF RETINOPATHY TIA, stroke Renal failure PVD
Lower blood pressure slowly (if lowered too fast pt can present with symptoms of stroken b/c elevated BP was used to perfuse parts of the brain)
When should you suspect Hypertensive Nephrosclerosis?
Long Hx of HTN
BLAND URINE SEDIMENT
no other etiology of renal disease
RENAL BX: sclerosis, hyaline
