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Primary Hypertension
Secondary hypertension
Primary Aldosterone
Cushing Syndrome
- Presentation:
- -HTN, buffalo hump, moon fancies, hirsutism, easy brusing
Path:- Glucocorticoids (cortisol) excess from adrenal gland due to overproduction of ACTH by pituitary adenoma -> unchecked activation of mineralocorticoid receptor
Diagnosis:- absence of cortisol suppression following dexamethasone administration
Treatment:
Pheochromocytoma
Hyperthyroidism
- Elevated TH stimulates sympathetic nervous system and HTN
Renovascular Hypertension
- Features:
- Most common cause of secondary hypertension, 10-15% of refractory hypertension
- Unilateral or Bilateral
- Episodic malignant hypertension
- Flash pulmonary edema
- Significant rise in creatinine when started on RAAS blocking in bilateral
Causes:
- 1. Fibromuscular dysplasia
- Non-atherosclerotic
- A string of beads on Radiographic of renal artery
- -congested/twisty renal artery
- Commonly seen in young females
- 2. Atherosclerosis
- Most common cause of renovascular hypertension
- Generally patients greater than 50 with known atherosclerosis
- Typically occurs in the optimum or proximal portion of renal artery
- -closer to the aorta
Unilateral vs. Bilateral:- Unilateral:
- -constant elevation of renin/angiotensin/aldosterone out runs the normal kidney
- compensation
- -normal kidney keeps volume low
- -secondary aldosterone
- -treat with hormone blockers
- Bilateral:
- -high BP maintained by retention of salt and water
- -treat with diuretics
- -can have significant rise in creatinine with RAAS blocker
Diagnosis:- Blood test: elevated renin and aldosterone
- Imaging: ultrasound, CT, MRI
- Percutaneous catheter placement to measure Intravascular pressure
Treatment:- RAAS, CCB, Diuretics
- Fibromuscular: balloon dilation
- Atherosclerotic: only use balloon dilation with stents in extreme cases
Renal Parenchymal Hypertension
- Presentation:
- Renal Failure Hypertension
- Elevated Na, increase in RAAS activity, overactivity of a sympathetic nervous system
Treatment:
- -low Na diet
- -diuretics
- -RAAS blockers (ACE-I, Angio REceptor blockers)
- -Beta-Blockers
- -Dialysis
Sleep Apnea
- HTN occurs due to activation of the sympathetic nervous system and RAAS
- Suspect if snore, or ease, thick neck, or daytime sleepiness
- Treat:
- CPAP: continuous positive airway pressure
Coarctation of the aorta
- Congenital narrowing of the aorta, on the downturn
- Hypertension in upper limbs, with reduced BP in lower limbs
- Delayer femoral pulses
- Kids diagnosed with imaging, surgical treatment
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