hypertension
hypertension
risk factors for hypertension
older age
obesity
genetics:
high sodium diet
high alcohol intake
sedentary lifestyle
diabetes
personality traits
depression
? role of T
EM cells activated by CD70 on Antigen Presenting Cells:
2)
these memory cells can be long lived, lasting decades, and reside in the bone marrow and can potentially sensitize the host to repeated mild hypertensive stimuli and may play a critical role in salt-sensitive and angiotensin II–induced hypertension
these cells are major sources of IL-17A and IFN-γ, which are thought to be prime mediators of hypertension
recurrent hypertensive stimuli which appear to activate CD70 and TEM cells include:
secondary causes of hypertension
medications such as:
renal disease
renovascular disease
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obstructive sleep apnoea
Cushing's syndrome
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coarctation aorta
possibly, but unproven:
cervical spondylosis / cervical disc prolapse (often also causes vertigo, headaches which are not due to vertebrobasilar insufficiency from cervical disease, but perhaps due to stimulation of sympathetic nerve fibres around the proximal vertebral artery or perhaps due to pain)
chronic pain syndromes
initial Dx of hypertension
initial Ix of newly diagnosed hypertension
assess end organ damage:
CXR, ECG, U&E, urinalysis
fundus exam for retinopathy
if evidence of cardiac failure, LV dysfunction, then consider echocardiogram
consider a random timed urine albumin-to-creatinine ratio
assess potential life style modifications:
cease smoking
weight control
reduce dietary sodium to 4g (65mmol) per day
start aerobic exercise 3 x 10min per week initially then increase
avoid heavy weight-lifting / Valsalva until BP under control
medications known to increase BP
assess other risk factors:
consider targeted approach to excluding secondary causes in subgroup of:
prepubertal onset
age < 30 with no overt risk factors
presentation in Stage 2
severe HT (> 180/120 mmHg) at age > 55yrs or with small kidney (<9cm or > 1.5cm smaller than other kidney)
acute rise in BP or malignant HT
renal impairment with sustained rise of > 50% in serum CRN after starting
ACE inhibitors
resistant hypertension
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abdominal bruit ⇒ ? renovascular
Cushingoid
sleep apnoea risk
brachio-femoral delay ⇒ ? coarctation
renal impairment or abnormal urinalysis
initial Rx of hypertension without end organ damage
US targets 2014
patient category | BP target (mmHg) |
most adult patients under 60yrs | < 140/90 |
most adult patients 60yrs and over | < 150/90 |
targets as of 2007
patient category | BP target (mmHg) |
adults with proteinuria > 1g/day | < 125/755) |
adults < 65yrs or diabetic or renal impairment or proteinuria 0.25-1g/day | < 130/85 or 130/80 if diabetic6) |
adults 60yrs and older without above factors | < 140/90 |
Mx of asymptomatic high BP in the ED
this group of patients are those who:
they thus do NOT need Ix in ED
they also do NOT need urgent Rx in ED
urgent reduction of blood pressure in the ED in hypertensive "emergency"
parenteral Rx in resus setting with close haemodynamic monitoring
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otherwise, consider:
sodium nitroprusside 0.3 microgram/kg/minute IV for 10 minutes, then increasing or decreasing by 0.3 microgram/kg/minute every 5 to 10 minutes (up to a maximum of 10 micrograms/kg/minute), or,
hydralazine 5 to 10 mg slowly IV, repeating at 20 minute intervals if necessary, or,
GTN infusion
oral Rx when Rx is less urgent
podcasts and other references
hypertension.txt · Last modified: 2020/06/13 23:38 by gary1