Management of Systemic Hypertension

Question 1

What is the normal systolic BP for a calm/relaxed dog or cat?

Answer 1

110-140 mmHg
(10mmHg higher for hounds)

Question 2

What is considered the “grey zone” for BP in cats and dogs?

Answer 2

141-159

Question 3

What is situational hypertension?

Answer 3

High BP due to autonomic nervous system (SNS)

Ex: Anxiety, pain, stress at the vet

(does not req drug therapy)

Question 4

What is secondary hypertension?

Answer 4

High BP due to an underlying condition

Ex: Hyperthyroid, pheochromocytoma

(Requires anti-hypertensive meds)

Question 5

___________ is when BP is increased in the absence of any underlying cause

Answer 5

Idiopathic hypertension

Question 6

Which patients should have their BP checked? (3)

Answer 6

1. Target organ damage
2. Associated condition
3. Medication/toxin associated with hypertension

Question 7

Which organs are most susceptible to damage from systemic hypertension?

Answer 7

CORN

1. Cardiovascular system
2. Ophthalmic
3. Renal
4. Neurologic

Question 8

What are potential clinical findings you might see in a patient with renal damage secondary to systemic hypertension?

Answer 8

PU/PD, Azotemia, Proteinuria,

due to ischemia, necrosis, atrophy

Question 9

What drug is beneficial in treating renal damage secondary to systemic hypertension?

Answer 9

Amlopidine

• Reduces proteinuria which is shown to improve survival time

Question 10

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

Answer 10

B. Ophthalmic damage

• Vision loss
• Retinal detachment
• Retinal hemorrhage/edema
• Hyphema

Question 11

What are potential clinical findings you might see in a patient with ocular damage secondary to systemic hypertension?

Answer 11

• Vision loss
• Retinal detachment
• Retinal hemorrhage/edema
• Hyphema

(ocular damage occurs in 50+% of cats and dogs with systemic hypertension)

Question 12

What are potential clinical findings you might see in a patient with neurological damage secondary to systemic hypertension?

Answer 12

• Seizures
• Vestibular signs
• Stroke
• May be transient or persistent - impt for collecting history

Question 13

What are potential clinical findings you might see in a patient with cardiovascular damage secondary to systemic hypertension?

Answer 13

• Left apical systolic murmur
• L CHF
• L sided cardiomegaly
• Hemorrhage (epistaxis, stroke, aortic rupture)

Question 14

Explain the pathophysiology on how systemic hypertension can lead to heart disease

Answer 14

1. LV can’t pump against high systemic pressure = Increased afterload
2. Pressure overload, LV concentric hypertrophy
3. Results in diastolic dysfunction (can’t fill)
4. L-CHF causes LA dilation
5. Mitral regurg and left apical systolic murmur can develop

(similar to HCM pathophys except this is due to a secondary underlying cause)

Question 15

What type of murmur can result from systemic hypertension ?

Answer 15

Left apical systolic murmur (due to mitral regurg)

Question 16

Ventricular _________ dysfunction occurs in most dogs secondary to systemic hypertension

Answer 16

diastolic

(due to LV concentric hypertrophy)

Question 17

What is the therapeutic approach for a patient with a BP > 180 and no evidence of TOD?

Answer 17

• 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

Question 18

What is the therapeutic approach for a patient with a BP between 160-179 and no evidence of TOD?

Answer 18

• 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

Question 19

What is the therapeutic approach for a patient with a BP > 160 and evident TOD?

Answer 19

• Look for underlying cause
• Tx with antihypertensive drug

Question 20

Which of the following is considered low TOD risk?

A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180

Answer 20

B. BP 140-159

“pre hypertensive”

Question 22

Which of the following is considered high TOD risk?

A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180

Answer 22

D. BP > 180

severely hypertensive

Question 22

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

Answer 22

A. BP < 140

Question 22

Which of the following is considered moderate TOD risk?

A. BP < 140
B. BP 140-159
C. BP 160-179
D. BP > 180

Answer 22

C. BP 160-179

Question 23

What is the drug of choice for treatment of systemic hypertension in dogs?

Answer 23

ACEi - Benazepril, Enalapril
(Blocks Ang II, Indirect vasodilator)

• Add amlodipine if BP > 200

Question 24

What is the drug of choice for treatment of systemic hypertension in cats?

Answer 24

Amlodipine (Ca+ channel blocker)

can add ACEi, or telmisartan if refractory to initial therapy

Question 25

The minimal goal for treating systemic hypertension is for systolic BP to be < _________, the optimal goal is for systolic BP to be < ___________

Answer 25

<160 , <140

Question 26

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

Answer 26

A. In 7-10 days

Question 27

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?

Answer 27

2x a year