Hypertension

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Hypertension

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USMLE® Step 1 style questions USMLE

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A 55-year-old man is brought to the emergency department due to the acute onset of diffuse headache, blurry vision, and nausea that started 2 hours ago. His partner states that the patient has not visited a physician in several years. Medical history is significant for type 2 diabetes mellitus, hypertension and smoking 1 pack of cigarettes daily for 30 years. Temperature is 37.7°C (99.8°F), pulse is 90/min, respirations are 20/min, and blood pressure is 189/130 mmHg. On physical examination, the patient is confused and dyspneic. No neck pain or stiffness is noted. Lung auscultation reveals bilateral crackles without wheezing. Fundoscopic examination reveals bilateral blurring of the optic disc margins. The rest of the physical examination is within normal limits. Which of the following is the most likely diagnosis?

External References

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ACE inhibitors p. 628

hypertension p. 320

Alcoholism p. 589

hypertension and p. 304

Angiotensin II receptor blockers p. 628

hypertension p. 320

Antihypertensive drugs

hypertension in pregnancy p. 660

Aortic aneurysm p. 305

hypertension p. 304

Aortic dissection p. 307

hypertension p. 304

Asthma p. 692

hypertension treatment with p. 320

Atrial fibrillation

hypertension as cause p. 304

β -blockers p. 245

hypertension p. 322

Calcium channel blockers p. 323

hypertension p. 323

Chronic kidney disease

hypertension and p. 304

Coronary artery disease

hypertension and p. 305

Diabetes mellitus p. 350-358

hypertension and p. 307, 320

Diuretics

hypertension treatment p. 320

Geriatric patients

isolated systolic hypertension p. 288

Heart failure p. 316

hypertension p. 304

hypertension treatment in p. 320

pulmonary hypertension p. 697

Hyperaldosteronism p. 354

hypertension with p. 304

Hypertension p. 304

ACE inhibitors for p. 628

alcohol withdrawal p. 589

aliskiren for p. 628

α-blockers for p. 243

angiotensin II receptor blockers for p. 628

aortic dissection and p. 307, 731

atherosclerosis and p. 305

atrial fibrillation and p. 296

autosomal recessive polycystic kidney disease p. 622

β -blockers for p. 245

Charcot-Bouchard microaneurysms p. 529

Cushing syndrome p. 352

ecstasy intoxication p. 589

endometrial cancer p. 658

episodic p. 343

Guillain-Barré syndrome p. 538

heart failure p. 320

hyperaldosteronism p. 354

immunosuppressants p. 118

intraparenchymal hemorrhage p. 528

isolated systolic p. 290

leflunomide p. 495

local anesthetics p. 565

loop diuretics for p. 624

MDMA p. 589

microangiopathic anemia p. 415

minoxidil p. 676

nephritic syndrome and p. 616

PCP p. 589

pheochromocytomas p. 343

placental abruption p. 657

polyarteritis nodosa p. 478

preeclampsia p. 660

in pregnancy p. 242

pregnancy p. 660

pseudoepherine/phenylephrine p. 705

renal cyst disorders p. 622

renal failure p. 620

sleep apnea p. 697

thiazides for p. 627

thoracic aortic aneurysms and p. 305

treatment for p. 320

tyramine p. 243

tyramine ingestion p. 593

Hypertensive urgency p. 304, 323

Isolated systolic hypertension p. 290

Kidney disease

hypertension p. 304

Labetalol p. 244

gestational hypertension p. 660

hypertension in pregnancy p. 320

Methyldopa

hypertension in pregnancy p. 320

Nephropathy

hypertension and p. 304

Obesity

hypertension risk factors p. 304

Pregnancy p. 651

hypertension in p. 660

hypertension treatment in p. 242, 320

Primary hyperaldosteronism p. 354

hypertension with p. 304

Primary hypertension p. 320

Refractory hypertension p. 676

Retinopathy

hypertension p. 304

Stroke p. 525

hypertension p. 304

Thiazide diuretics

hypertension p. 320

Transcript

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Over a billion people around the world have hypertension, or high blood pressure, so that pretty much means it’s pretty common. 

Let’s start by defining it. Typically, it’s represented by two numbers: the top number is the systolic blood pressure, which is the arterial pressure when the heart’s contracting; and the lower number is the diastolic blood pressure, which is the arterial pressure when the heart’s relaxing or refilling. Most of the time, blood pressure is taken in the brachial artery in your upper arm, because if the pressure is high there, it’s probably high throughout all of the arteries.

The guidelines for categorizing blood pressure have recently changed to reflect a growing body of evidence that shows that even moderately high blood pressures can significantly increase your risk for developing heart disease. Now, ‘normal’ systolic blood pressure is defined as less than 120 mmHg, and a normal diastolic pressure is less than 80 mmHg. Elevated systolic blood pressure is considered between 120 and 129 mmHg and less than 80 mmHg on the diastolic side. Stage 1 hypertension is between 130 and 139 mmHg on the systolic side, and between 80 and 89 mmHg on the diastolic side. Stage 2 hypertension is defined as anything that is 140 mmHg or higher on the Systolic side and 90 mmHg or higher on the diastolic side.

Typically, both systolic and diastolic pressures tend to climb or fall together, but that’s not always the case. Sometimes, you can have systolic or diastolic hypertension, when one number is normal and the other is really high. This is referred to as isolated systolic hypertension or isolated diastolic hypertension. 

High blood pressure is a serious problem for the blood vessels because it causes wear and tear on the endothelial cells that line the inside of the blood vessels. Just like a garden hose that’s always under high pressure, in the long term, blood vessels can develop tiny cracks and tears that can lead to serious problems, like myocardial infarctions, aneurysms, and strokes.

Sources

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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Arterial hypertension" Hellenic J Cardiol (2013 Sep)
  5. "Arterial hypertension in the light of current recommendations" Terapevticheskii arkhiv (2018)
  6. "Gender-specific therapeutic approach in arterial hypertension – Challenges ahead" Pharmacological Research (2019)