Renal hyptertension I Flashcards
definition: masked HTN
BP that is consistently elevated by out of office measurements but does not meet criteria for HTN based on office readings
definition: hypertensive emergency
severe HTN with evidence of acute end organ damage
definition: hypertensive urgency
severe HTN in asymptomatic patients
CV morality doubles with each ________ mm Hg increase in BP
20/10
how is HTN linked to vascular dementia?
HTN is associated with an increased likelihood of subclinical or silent stroke leading to vascular dementia
HTN retinopathy - grades I - IV
grade I: arteriolar narrowing
grade 2: generalized and focal narrowing, AV nicking
grade 3: hemorrhage, microaneurysm, hard exudates, cotton-wool spots
grade 4: hypertensive retinopathy, optic disk swelling, macular edema
what is the most common cause of end stage renal disease?
diabetes
what % of people have pre HTN?
25%
what % of people have HTN?
31%
what are the causes of secondary HTN?
Apnea, aldosterone Bruits, bad kidneys Catecholamines, coarctation, cushing's Drugs, diet Erythropoietin, endocrine disorders
what is the diagnostic study for sleep apnea?
formal sleep study
what is the pathogenesis of primary aldosteronism?
resulting retention of excess salt and water suppresses renin levels
what is the potassium status of patients with primary aldosteronism? why?
- hypokalemia
- increased urinary excretion
what is the best initial diagnostic test for primary aldosteronism?
aldosterone : renin ratio
what is the PAC / PRA ratio? what does a value over 30 indicate?
- plasma aldosterone concentration : plasma renin activity
- ratio over 30 = primary hyperaldosteronism
PAC : PRA ratio over 30 indicates what disease?
primary hyperaldosteronism
high PAC : high PRA and ratio under 10 indicates what disease?
secondary hyperaldosteronism
low PAC : low PRA indicates what condition?
alternate mineralocorticoid stimulation (hypercortisolism, licorice root ingestion)
what is the presentation that clues you in to renovascular HTN?
hypertensive patient with unexplained CHF / acute pulmonary edema
acute elevation of creatinine after starting ACE / ARB therapy indicates what condition?
bilateral disease - renovascular HTN
what is the gold standard test for abdominal bruit?
renal arteriography
what are the factors that sustain HTN after anatomic correction?
- damage to contralateral kidney in unilateral disease
- vascular remodeling
what is the most common cause of HTN in children (especially pre pubescent)?
renal parenchymal disease
what is the diagnosis for renal parenchymal disease? (labs and test)
- high creatinine
- low GFR
- US
what is the treatment for renal parenchymal disease?
aggressive treatment of HTN (ACE inhibitors)
bilateral renal vascular disease should be suspected after what findings?
increase in creatinine of 30% after ACEi or ARB
what should you suspect in a 30% increase of creatinine after ACEi or ARB?
bilateral renal vascular disease
