1. B) I then write up my short version of the reading - call it G-notes
Hypertension:
Overview:
Chronic elevation of blood pressure - defined in 2017 Hypertension guidelines (normal, elevated, stage 1 hypertension, stage 2 hypertension)
Presentation:
Most people asymptomatic - so true biological index date is not possible? Headache, dizziness or blurred vision.
Assessment:
Etiology unknown in 90% - essential hypertension, but rule out secondary correctable form of hypertension especially if <= 30 or >= 55 years.
Terms associated with Hypertension:
- Normal, Elevated, Stage 1, Stage 2
- Isolated Systolic hypertension
- Controlled vs uncontrolled hypertension
- Incident vs Prevalent hypertension
- Malignant Hypertension - medical emergency
- SPRINT hypertension definition - resting blood pressure.
Secondary causes:
- Renal artery stenosis (renovascular hypertension)
- Renal Parenchymal Disease (Chronic Kidney Disease)
- Coaractation of Aorta - children or young adults
- Pheochromocytoma- sudden episodes, elevated plasma metanephrine
- Hyperaldosteronism
- Drugs - drugs (oral contraceptives, erythropoetin, decongestants, NSAIDs, glucorticoids, cyclosporine) obstructive sleep apnea, cushings disease, thyroid disease, hypercalcemia, acromegaly
Differential Diagnosis:
Secondary causes - Hyperaldosteronism, coarctation of the aorta, renal artery stenosis, chronic kidney disease, and aortic valve disease
Plan:
Screen:
- Kidney related: Serum creatinine, BUN, urinalysis,
- Cardiovascular evaluation: CXR, ECG
- Thyroid: TSH
Manage:
- Control blood pressure with minimal side effect
- First line treatment: Diuretics, ACE inhibitors, ARB, CCB, beta blockers
Prognosis:
Except for secondary hypertension, is chronic. If untreated, will most likely progress
Cardiovascular diseases and complications - acute myocardial infarction, congestive heart failure, stroke etc.
Other:
Definition:
Normal blood pressure – Systolic <120 mmHg and diastolic <80 mmHg
Elevated blood pressure – Systolic 120 to 129 mmHg and diastolic <80 mmHg
Hypertension:
Stage 1 – Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Stage 2 – Systolic at least 140 mmHg or diastolic at least 90 mmHg
If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage.
Anecdotes:
High prevalence
Hypertension treatment is most common reason for office visit + source of hypertensive medication dispensation
Adequate blood pressure is low