Hypertension

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Hypertension

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HYPERTENSION osms.it/hypertension PATHOLOGY & CAUSES ▪ Condition in which blood pressure is regulated maladaptively, elevating blood pressure over 140/90mmHg ▪ Isolated systolic hypertension: systolic blood pressure is elevated, diastolic is not ▪ Isolated diastolic hypertension: diastolic blood pressure is elevated, systolic is not ▪ ▪ ▪ CAUSES Primary/essential hypertension ▪ Most cases (90%) Secondary hypertension ▪ Known etiology, often reversible ▪ Renovascular hypertension: anything partially obstructing blood ﬂow to kidneys (e.g. atherosclerosis, vasculitis, ﬁbromuscular dysplasia). ▫ Decreased blood ﬂow to kidneys → kidneys secrete renin → renin converts angiotensinogen to angiotensin I → angiotensin converting enzyme converts angiotensin I to angiotensin II (active) → angiotensin II effects: ▫ Vasoconstriction: directly increases blood pressure ▫ Stimulation of sodium reabsorption: increases water reabsorption ▫ Stimulation of adrenal cortex to release aldosterone from adrenal cortex → aldosterone increases reabsorption of sodium + water → increased volume → high blood pressure ▪ Primary hyperaldosteronism: increased aldosterone → increased reabsorption of sodium + water → increased volume → increased blood pressure ▪ Nonsteroidal anti-inﬂammatory drugs (NSAIDs) → inhibit cyclooxygenase in kidneys → ↓ production of PGE-2 (renal vasodilator) → vasoconstriction of afferent arterioles in kidneys → ↓ renal blood ﬂow, 80 OSMOSIS.ORG ▪ glomerular ﬁltration rate → ↓ secretion of sodium + water → ↑ volume → ↑ blood pressure Preeclampsia/eclampsia in pregnancy: mechanism unknown Coarctation of the aorta: low pressure past coarctation → low renal perfusion → activation of renin angiotensin-aldosterone system (RAAS) → secondary hypertension Cushing’s syndrome: combination of several pathophysiological mechanisms (e.g. elevated cortisol) that regulate plasma volume, cardiac output, peripheral vascular resistance Chronic kidney disease: ﬂuid overload, sodium retention MNEMONIC: RHNECCK Causes of Secondary hypertension Renovascular hypertension 1° Hyperaldosteronism NSAIDs Pre-Eclampsia / Eclampsia Coarctation of the aorta Cushing’s syndrome Kidney Disease (chronic) RISK FACTORS Primary hypertension ▪ Risk increases with age, biological male, obesity, stress, sedentary lifestyle, family history of hypertension ▪ Race (in decreasing order of risk): African descent > white European descent > Asian descent ▪ Diet: excessive sodium, alcohol intake ▪ Abnormal lipid panel (high low-density lipoproteins, low high-density lipoproteins, high triglycerides)

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Hypertension

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A 58-year-old man comes to the office for a routine check-up. His medical history includes a year of poorly-controlled hypertension and diabetes. His temperature is 36.5°C (97.7°F), pulse is 82/min, respirations are 15/min, and blood pressure is 143/85 mm Hg. He is well-appearing. An ECG is obtained and is shown below. Which of the following is the most likely diagnosis?

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