Management of Systemic Hypertension Flashcards
What is the normal systolic BP for a calm/relaxed dog or cat?
110-140 mmHg
(10mmHg higher for hounds)
What is considered the “grey zone” for BP in cats and dogs?
141-159
What is situational hypertension?
High BP due to autonomic nervous system (SNS)
Ex: Anxiety, pain, stress at the vet
(does not req drug therapy)
What is secondary hypertension?
High BP due to an underlying condition
Ex: Hyperthyroid, pheochromocytoma
(Requires anti-hypertensive meds)
___________ is when BP is increased in the absence of any underlying cause
Idiopathic hypertension
Which patients should have their BP checked? (3)
- Target organ damage
- Associated condition
- Medication/toxin associated with hypertension
Which organs are most susceptible to damage from systemic hypertension?
CORN
- Cardiovascular system
- Ophthalmic
- Renal
- Neurologic
What are potential clinical findings you might see in a patient with renal damage secondary to systemic hypertension?
PU/PD, Azotemia, Proteinuria,
due to ischemia, necrosis, atrophy
What drug is beneficial in treating renal damage secondary to systemic hypertension?
Amlopidine
- Reduces proteinuria which is shown to improve survival time
Which of the following is a complication that occurs in 50+% of cats and dogs with systemic hypertension?
A. Neurological damage
B. Ophthalmic damage
C. Cardiovascular damage
D. Renal damage
B. Ophthalmic damage
- Vision loss
- Retinal detachment
- Retinal hemorrhage/edema
- Hyphema
What are potential clinical findings you might see in a patient with ocular damage secondary to systemic hypertension?
- Vision loss
- Retinal detachment
- Retinal hemorrhage/edema
- Hyphema
(ocular damage occurs in 50+% of cats and dogs with systemic hypertension)
What are potential clinical findings you might see in a patient with neurological damage secondary to systemic hypertension?
- Seizures
- Vestibular signs
- Stroke
- May be transient or persistent - impt for collecting history
What are potential clinical findings you might see in a patient with cardiovascular damage secondary to systemic hypertension?
- Left apical systolic murmur
- L CHF
- L sided cardiomegaly
- Hemorrhage (epistaxis, stroke, aortic rupture)
Explain the pathophysiology on how systemic hypertension can lead to heart disease
- LV can’t pump against high systemic pressure = Increased afterload
- Pressure overload, LV concentric hypertrophy
- Results in diastolic dysfunction (can’t fill)
- L-CHF causes LA dilation
- Mitral regurg and left apical systolic murmur can develop
(similar to HCM pathophys except this is due to a secondary underlying cause)
What type of murmur can result from systemic hypertension ?
Left apical systolic murmur (due to mitral regurg)
Ventricular _________ dysfunction occurs in most dogs secondary to systemic hypertension
diastolic
(due to LV concentric hypertrophy)
What is the therapeutic approach for a patient with a BP > 180 and no evidence of TOD?
- Repeat BP twice within 14 days
- If BP still > 160, look for underlying condition and give antihypertensive drug
- If BP < 160, recheck in 3-6 months
What is the therapeutic approach for a patient with a BP between 160-179 and no evidence of TOD?
- Repeat BP once a month for 2 months
- If BP still > 160, look for underlying condition and give antihypertensive drug
- If BP < 160, recheck in 3-6 months
What is the therapeutic approach for a patient with a BP > 160 and evident TOD?
- Look for underlying cause
- Tx with antihypertensive drug
Which of the following is considered low TOD risk?
A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180
B. BP 140-159
“pre hypertensive”
Which of the following is considered high TOD risk?
A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180
D. BP > 180
severely hypertensive
Which of the following is considered normotensive in majority of small animals?
A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180
A. BP < 140
Which of the following is considered moderate TOD risk?
A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180
C. BP 160-179
What is the drug of choice for treatment of systemic hypertension in dogs?
ACEi - Benazepril, Enalapril
(Blocks Ang II, Indirect vasodilator)
- Add amlodipine if BP > 200
What is the drug of choice for treatment of systemic hypertension in cats?
Amlodipine (Ca+ channel blocker)
can add ACEi, or telmisartan if refractory to initial therapy
The minimal goal for treating systemic hypertension is for systolic BP to be < _________, the optimal goal is for systolic BP to be < ___________
<160 , <140
When first starting a new medication for treatment of systemic hypertension, the patients BP should be rechecked _____________ if otherwise doing well with no TOD
A. In 7-10 days
B. In 14 days
C. In 1 month
D. In 3 months
A. In 7-10 days
Kidney disease, diabetes mellitus, and hyperadrenocortism are some of the conditions in dogs that can cause systemic hypertension. How often should a normotensive patient with one of these conditions have BP monitoring done?
2x a year
