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Source: Saseen JJ, MacLaughlin
EJ. Hypertension. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7969921.
Accessed June 29, 2012.
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- Persistently elevated arterial blood pressure (BP).
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- Primary (essential) hypertension: unknown cause.
- Secondary hypertension
- Chronic
kidney disease (CKD) or renovascular disease
- Cushing’s syndrome
- Coarctation of aorta
- Obstructive sleep apnea
- Hyperparathyroidism
- Pheochromocytoma
- Primary aldosteronism
- Drugs, including:
- Corticosteroids
- Estrogens
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Amphetamines
- Sibutramine
- Cyclosporine
- Tacrolimus
- Erythropoietin
- Venlafaxine
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- Abnormalities involving renin–angiotensin–aldosterone
system, natriuretic hormone, or insulin resistance.
- Disturbance in the central nervous system (CNS), autonomic
nerve fibers, adrenergic receptors, or baroreceptors.
- Abnormalities in renal or tissue autoregulatory processes
for:
- Sodium excretion
- Plasma volume
- Arteriolar constriction
- Deficiency in synthesis of vasodilators in vascular endothelium
(prostacyclin, bradykinin, nitric oxide) or excess vasoconstrictors
(angiotensin II, endothelin I).
- High sodium intake or lack of dietary calcium.
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- Approximately 31% of Americans (74.5 million
people) have elevated BP.
- Overall incidence is similar between men and women, but varies
depending on age.
- Prevalence rates are highest in non-Hispanic blacks, followed
by non-Hispanic whites, Mexican Americans, American Indians/Alaska
Natives, and Asians.
- Most diagnoses occurring between third and
fifth decades.
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- Increase physical activity.
- Limit alcohol consumption.
- Limit sodium intake.
- Consume diet rich in fruits, vegetables, and low-fat dairy
products.
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- Increasing age
- Race
- Family history
- Obesity
- Physical inactivity
- Smoking
- Excessive sodium or inadequate potassium intake
- Excessive alcohol consumption
- Chronic conditions (e.g., kidney disease)
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- Symptoms
- Uncomplicated primary hypertension
usually asymptomatic initially.
- Patients with pheochromocytoma may have:
- Headaches
- Sweating
- Tachycardia
- Palpitations
- Orthostatic hypotension
- In primary aldosteronism, hypokalemic symptoms of muscle cramps
and weakness may be present.
- Patients with Cushing’s syndrome may complain of:
- Weight gain
- Polyuria
- Edema
- Menstrual irregularities
- Acne
- Muscular weakness
- Moon face
- Buffalo hump
- Hirsutism
- Signs
- Funduscopic exam:
- Arteriolar
narrowing
- Arteriovenous nicking
- Retinal hemorrhages and exudates
- Papilledema
- Heart:
- Abnormal rate or rhythm
- Left ventricular (LV) hypertrophy
- Coronary heart disease
- Heart failure (HF)
- Peripheral vascular:
- Aortic or abdominal
bruits
- Distended veins
- Diminished or absent peripheral pulses
- Lower-extremity edema
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Means of Confirmation
and Diagnosis
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- Diagnosis based on average of ≥2 readings taken at each
of ≥2 visits (Table 1).
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- First-line tests:
- Blood urea nitrogen
(BUN)/serum creatinine
- Fasting lipid panel
- Fasting blood glucose
- Serum electrolytes
- Spot urine albumin-to-creatinine ratio
- Estimated glomerular filtration rate
- Urinalysis
- For secondary hypertension:
- Plasma norepinephrine
and urinary metanephrine levels
- Plasma and urinary aldosterone concentrations
- Plasma renin ...