Systemic Hypertension

Question 1

a condition where arterial/arteriolar walls are diseased and vessel lumen is narrowed resulting in reduced blood flow to tissues and/or hemorrhage due to vessel/capillary fragility

Answer 1

systemic hypertension

Question 2

T/F: hypertension doesn’t cause heart disease but heart disease causes hypertension

Answer 2

FALSE, opposite

Question 3

what two groups should we test for systemic hypertension?

Answer 3

patients with target organ damage (TOD) and associated conditions

Question 4

what are the four targeted organs included in target organ damage?

Answer 4

renal, opthalmic, neurologic, cardiovascular

Question 5

T/F: many dogs and cats with TOD and systemic hypertension show clinical signs

Answer 5

FALSE, many are asymptomatic

Question 6

what clinical signs might you find in terms of renal damage in patients with TOD?

Answer 6

isosthenuria, azotemia, proteinuria, and structural abnormalities (atrophy)

Question 7

what drug was shown to reduce proteinuria in cats with renal damage and hypertension?

Answer 7

amlodipine

Question 8

T/F: opthalmic damage occurs in over 50% of cats and dogs with hypertension

Answer 8

TRUE

Question 9

what clinical signs might you in terms of opthalmic damage in patients with TOD?

Answer 9

vision loss, retinal hemorrhage/edema, retinal detachment, and intraocular hemorrhage (hyphema)

Question 10

what clinical signs might you find in terms of neurologic damage in patients with TOD?

Answer 10

seizures, vestibular sings, disorientation, and mentation or behavior change

Question 11

T/F: the prognosis is poor for patients with neurologic deficits even with normalization of blood pressure

Answer 11

FALSE, prognosis is good

Question 12

what is the major cardiovascular damage with systemic hypertension?

Answer 12

LV concentric hypertrophy, diastolic dysfunction, and mitral regurgitation

Question 13

what clinical signs might you find in terms of cardiovascular damage in patients with TOD?

Answer 13

L-CHF, epistaxis, mitral murmur (left apical systolic), cardiac gallop, arrhythmias, left sided cardiomegaly, proximal aortic dilation

Question 14

what is the most common condition that causes systemic hypertension in dogs and cats?

Answer 14

renal disease

Question 15

what condition might you want to watch out for when trying to diagnose a patient with systemic hypertension?

Answer 15

stress-induced (“white coat”) because if it’s a true hypertension it usually requires lifelong therapy and monitoring and anti-hypertensive treatments can have adverse effects

Question 16

T/F: primary hypertension is more common than secondary hypertension

Answer 16

FALSE, opposite + idiopathic

Question 17

At what BP would you want to start treatment for systemic hypertension?

Answer 17

180+

• if TOD start treatment
• if no TOD and BP <180 reassess w/in a week

Question 18

what are some medications you might use in patients in the ICU for systemic hypertension?

Answer 18

nitroprusside CRI, hydralazine, or acepromazine

Question 19

what is the first choice medication for dogs with systemic hypertension?

Answer 19

ACE inhibitor (indirect vasodilator, blocks formation of angiotension II)

-benazepril or enalapril

Question 20

what patients with systemic hypertension are ACE inhibitors contraindicated?

Answer 20

dehydrated and hypovolemic

Question 21

patients with systemic hypertension and a BP >180 often need what two medications?

Answer 21

ACE inhibitor and amlodipide

Question 22

what is the MOA of amlodipine?

Answer 22

dihydropyridine-type calcium channel blocker, inhibits calcium influx across vascular smooth muscle cells

Question 23

amlodipine is the first choice medication for what species with systemic hypertension?

Answer 23

cats

Question 24

prazosin, phenoxybenzamine, hydralazine, spironolactone, and beta blockers are medications used in what case?

Answer 24

refractory cases in patients with systemic hypertension

Question 25

once BP is controlled in patients with long-term systemic hypertension how often should you monitor them?

Answer 25

every 3-6 months

Question 26

how often should patients taking hypertensive medications or patients with associated conditions be monitored?

Answer 26

two times a year

Question 27

how many blood pressure readings should you achieve in the technique of diagnosing systemic hypertension?

Answer 27

> 3 consecutive consistent values (<20% variability in systolic values)