Chronic hypertension resident survival guide: Difference between revisions
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:❑ [[Hypokalemia]] (suggestive of [[hyperaldosteronism]])<br> | :❑ [[Hypokalemia]] (suggestive of [[hyperaldosteronism]])<br> | ||
❑ [[calcium|Serum calcium]]<br> | ❑ [[calcium|Serum calcium]]<br> | ||
❑ [[creatinine|Serum creatinine]] with estimated [[glomerular filtration rate]] (eGFR)<br> | ❑ [[creatinine|Serum creatinine]] with estimated [[glomerular filtration rate]] (eGFR)<br> | ||
❑ [[Uric acid|Serum uric acid]]<br> | ❑ [[Uric acid|Serum uric acid]]<br> | ||
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❑ [[Plasma renin activity]] (PRA) (low [[renin]] suggests [[hyperaldosteronism]])<br> | ❑ [[Plasma renin activity]] (PRA) (low [[renin]] suggests [[hyperaldosteronism]])<br> | ||
❑ [[Aldosterone|Plasma aldosterone]] (elevated in [[hyperaldosteronism]])<br> | ❑ [[Aldosterone|Plasma aldosterone]] (elevated in [[hyperaldosteronism]])<br> | ||
❑ [[Thyroid-stimulating hormone|TSH]] <br> | ❑ [[Thyroid-stimulating hormone|TSH]] (may be high or low in [[hypothyroidism|hypo-]] and [[hyperthyroidism]], respectively)<br> | ||
❑ [[parathyroid hormone|Serum parathyroid hormone]] (PTH) (To evaluate parathyroid disease)<br> | ❑ [[parathyroid hormone|Serum parathyroid hormone]] (PTH) (To evaluate parathyroid disease)<br> | ||
❑ [[Dexamethasone suppression test]] <br> | ❑ [[Dexamethasone suppression test]] <br> | ||
:❑ Unchanged levels of [[cortisol]] to high dose [[dexamethasone]] suggests [[Cushing's syndrome]]<br> | :❑ Unchanged levels of [[cortisol]] to high dose [[dexamethasone]] suggests [[Cushing's syndrome]]<br> | ||
❑ 24-hour | ❑ 24-hour free urinary [[cortisol]] (elevated in [[Cushing's syndrome]])<br> | ||
❑ [[Thyroid-stimulating hormone|TSH]] <br> | ❑ [[Thyroid-stimulating hormone|TSH]] <br> | ||
❑ [[Renal artery stenosis ultrasound|Renal duplex ultrasound]] and [[magnetic resonance angiography]] (MRA) of renal arteries <br> | ❑ [[Renal artery stenosis ultrasound|Renal duplex ultrasound]] and [[magnetic resonance angiography]] (MRA) of renal arteries <br> | ||
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❑ [[Aortic coarctation CT|Chest CT angiography]] (To evaluate [[aortic coarctation]])<br> | ❑ [[Aortic coarctation CT|Chest CT angiography]] (To evaluate [[aortic coarctation]])<br> | ||
❑ [[Obstructive sleep apnea polysomnography|Sleep study with O2 saturation]] (To evaluate [[sleep apnea]])<br> | ❑ [[Obstructive sleep apnea polysomnography|Sleep study with O2 saturation]] (To evaluate [[sleep apnea]])<br> | ||
</div>}} | |||
{{familytree | | | | |!| | |}} | {{familytree | | | | |!| | |}} | ||
{{familytree | | | | D01 | | |D01=Does this patient have an identifiable secondary etiology?}} | {{familytree | | | | D01 | | |D01=Does this patient have an identifiable secondary etiology?}} |
Revision as of 15:07, 21 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]
Overview
Classification
Classification | Blood pressure (mmHg) |
---|---|
Normal | < 120/80 |
Prehypertension | 120-139/80-89 |
Stage 1 hypertension | 140-159/90-99 |
Stage 2 hypertension | ≥ 160/110 |
Isolated systolic hypertension | |
Isolated diastolic hypertension |
Causes
Life Threatening Causes
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of
General Approach to Suspected Hypertension
Suspected hypertension BP > 140/90 mmHg | |||||||||||||||||||||||||||||||||||||||||
Blood pressure measurement Before taking the BP
❑ Take 2 readings and find the average Click here for more information regarding blood pressure measurement | |||||||||||||||||||||||||||||||||||||||||
Office BP >140/90 mmHg on 2-3 visits | |||||||||||||||||||||||||||||||||||||||||
Does the patient have any evidence of target organ damage, DM, or CKD? | |||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||
Proceed to hypertensive crisis resident survival guide | Perform home BP/out-of-office monitoring | ||||||||||||||||||||||||||||||||||||||||
Is the average home BP measurement <140/90? | |||||||||||||||||||||||||||||||||||||||||
Yes | Inconclusive | No | |||||||||||||||||||||||||||||||||||||||
Perform 24-hour ABPM | |||||||||||||||||||||||||||||||||||||||||
Is the 24-hour ABPM ≤135/85? | |||||||||||||||||||||||||||||||||||||||||
White-coat hypertension confirmed | Yes | No | Hypertension confirmed | ||||||||||||||||||||||||||||||||||||||
❑ Continue BP monitoring ❑ Follow-up appointment in .... | Classify the patient based on the BP reading | ||||||||||||||||||||||||||||||||||||||||
SBP 120-139 mmHg DBP - 80-89 mmHg | SBP 149-159 mmHg DBP 90-99 mmHg | SBP >160 mmHg DBP >110 mmHg | |||||||||||||||||||||||||||||||||||||||
Prehypertension | Stage 1 hypertension Proceed to complete diagnostic approach | Stage 2 hypertension
Proceed to hypertensive crisis resident survival guide | |||||||||||||||||||||||||||||||||||||||
Determine who to treat based on the following: | |||||||||||||||||||||||||||||||||||||||||
Complete Diagnostic Approach
Obtain a detailed history: History of present hypertension
❑ Excessive sodium intake >2.4g per day ❑ Eyes:
❑ Cardiovascular:
❑ Kidneys:
| |||||||||||||||||||
Examine the patient: General examination: Neck
Respiratory examination Abdominal examination
| |||||||||||||||||||
Order tests: Routine
❑ Serum calcium
Additional tests based on results of the routine tests above:
❑ 24-hour free urinary cortisol (elevated in Cushing's syndrome)
❑ Chest CT angiography (To evaluate aortic coarctation) | |||||||||||||||||||
Does this patient have an identifiable secondary etiology? | |||||||||||||||||||
Yes | No | ||||||||||||||||||
Primary hypertension | Secondary hypertension | ||||||||||||||||||
Proceed to treatment | |||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of