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{{ | {{Chronic hypertension}} | ||
{{CMG}}; '''Assistant Editor-In-Chief:''' | {{CMG}}; '''Assistant Editor-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]] | ||
==Overview== | ==Overview== | ||
Thorough history-taking is crucial for the diagnosis and assessment of hypertension. Not only should history-taking be targeted to identify symptoms consistent with high blood pressure, but more importantly it should address risk factors and target organ damage. History-taking alone may be sufficient to diagnose some causes of [[secondary hypertension]], such as drug-induced hypertension, and may allow a more targeted evaluation of the cause and treatment of the hypertension. | |||
== | ==Symptoms of Hypertension== | ||
Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below: | |||
*[[Headache]] | |||
*[[Blurry vision]] | |||
*[[Dyspnea]] | |||
*[[Epistaxis]] | |||
*[[Tinnitus]] | |||
*[[Fatigue]] | |||
*[[Drowsiness]] | |||
==Symptoms Suggestive of Secondary Hypertension== | |||
Other symptoms that might suggest secondary etiologies of hypertension include: | |||
* | *[[Sleep apnea]] is suggested by [[obesity]], [[snoring]] and [[apnea]] | ||
* | *[[Hyperaldosteronism]] is suggested by [[fatigue]], [[headache]], intermittent [[paralysis]], [[muscle weakness]], and [[numbness]] | ||
* | *[[Pheochromocytoma]] is suggested by the triad of a [[headache]], [[sweating]], and [[palpitations]] in a young person | ||
* | *[[Cushing's syndrome]] is suggested by a rapid [[obesity|weight gain]], particularly of the trunk and face with sparing of the limbs ([[central obesity]]), a round face often referred to as a "[[moon face]]", excess [[sweating]], [[insomnia]], reduced [[libido]], [[impotence]], [[amenorrhoea]], [[infertility]] and psychological disturbances, ranging from [[Euphoria (emotion)|euphoria]] to [[psychosis]]. [[clinical depression|Depression]] and [[anxiety]].<ref>{{cite book |title=The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences |last=Yudofsky |first=Stuart C. |coauthors=Robert E. Hales |edition=5th |year=2007 |publisher=American Psychiatric Pub, Inc. |isbn=1585622397 }}</ref> | ||
*An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, [[oral contraceptive pills]], some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.<ref name="pmid12537168">{{cite journal| author=Onusko E| title=Diagnosing secondary hypertension. | journal=Am Fam Physician | year= 2003 | volume= 67 | issue= 1 | pages= 67-74 | pmid=12537168 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12537168 }} </ref> A more extensive list of drugs includes [[almotriptan]], [[dihydroergotamine]], [[ergotamine]], [[frovatriptan]], [[isometheptene]], [[rizatriptan]], [[sumatriptan]], [[zolmitriptan]], [[amitriptyline]], [[cyclosporine]], [[desipramine]], [[doxepin]], [[ephedrine]], [[glucocorticoid resistance ]], [[imipramine]], [[monoamine oxidase inhibitor]]s, [[nasal decongestants]], [[nortriptyline]], [[NSAIDs]], [[combined oral contraceptive pill]], [[phencyclidine]], [[phenylpropanolamine]], [[protriptyline]], [[pseudoephedrine]], [[sedative dependence]], [[serotonin toxicity]], [[steroid abuse]], and [[cocaine]]. | |||
* | |||
==Assess Risk Factors== | |||
*Age | *Age | ||
*Ethnicity | *Ethnicity | ||
*Tobacco | *[[Tobacco]] | ||
*Alcohol | *Medications | ||
*Dyslipidemia | *Family history | ||
*Diabetes mellitus | *[[Alcohol]] | ||
*[[Dyslipidemia]] | |||
*[[Diabetes mellitus]] | |||
*Known cardiovascular diseases | *Known cardiovascular diseases | ||
*Known kidney diseases | *Known kidney diseases | ||
*Diet | *Diet | ||
*Obesity | *[[Obesity]] | ||
*Sedentary lifestyle | *Sedentary lifestyle | ||
== | ==Symptoms of Target Organ Damage== | ||
===Eyes=== | |||
*Angina | *[[Retinopathy]] | ||
*Prior MI | |||
===Heart=== | |||
*[[Angina]] | |||
*Prior [[MI]] | |||
*Prior coronary revascularizations | *Prior coronary revascularizations | ||
*Aneurysm | *[[Aneurysm]]s | ||
*Symptoms of heart failure | *Symptoms of [[heart failure]] | ||
*Symptoms of peripheral vascular disease (PVD) | *Symptoms of [[peripheral vascular disease]] ([[PVD]]) | ||
===Kidneys=== | |||
*Proteinuria | *[[Proteinuria]] | ||
*Hematuria | *[[Hematuria]] | ||
*Renal failure | *[[Renal failure]] | ||
===Brain=== | |||
* | *[[Stroke]] | ||
*[[Intracranial hemorrhage]] | |||
*[[Transient ischemic attack]] ([[TIA]]) | |||
*[[Dementia]] | |||
==2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844 }} </ref>== | ==2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844 }} </ref>== | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[EHS ESC guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[EHS ESC guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''It is recommended to obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, detect causes of | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''It is recommended to obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, detect causes of secondary hypertension, record CV risk factors, and to identify OD and other CVDs.. ''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2. '''Obtaining a | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2. '''Obtaining a family history is recommended to investigate familial predisposition to hypertension and CVDs.''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|} | |} | ||
Latest revision as of 14:03, 17 May 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian
Overview
Thorough history-taking is crucial for the diagnosis and assessment of hypertension. Not only should history-taking be targeted to identify symptoms consistent with high blood pressure, but more importantly it should address risk factors and target organ damage. History-taking alone may be sufficient to diagnose some causes of secondary hypertension, such as drug-induced hypertension, and may allow a more targeted evaluation of the cause and treatment of the hypertension.
Symptoms of Hypertension
Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:
Symptoms Suggestive of Secondary Hypertension
Other symptoms that might suggest secondary etiologies of hypertension include:
- Sleep apnea is suggested by obesity, snoring and apnea
- Hyperaldosteronism is suggested by fatigue, headache, intermittent paralysis, muscle weakness, and numbness
- Pheochromocytoma is suggested by the triad of a headache, sweating, and palpitations in a young person
- Cushing's syndrome is suggested by a rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity), a round face often referred to as a "moon face", excess sweating, insomnia, reduced libido, impotence, amenorrhoea, infertility and psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety.[1]
- An extensive list of drugs can be associated with hypertension. The most common agents include immunosuppressive agents, non-steroidal anti-inflammatory drugs, oral contraceptive pills, some weight loss agents, stimulants, monoamine oxidase inhibitors, triptans, ergotamines, and sympathomimetics.[2] A more extensive list of drugs includes almotriptan, dihydroergotamine, ergotamine, frovatriptan, isometheptene, rizatriptan, sumatriptan, zolmitriptan, amitriptyline, cyclosporine, desipramine, doxepin, ephedrine, glucocorticoid resistance , imipramine, monoamine oxidase inhibitors, nasal decongestants, nortriptyline, NSAIDs, combined oral contraceptive pill, phencyclidine, phenylpropanolamine, protriptyline, pseudoephedrine, sedative dependence, serotonin toxicity, steroid abuse, and cocaine.
Assess Risk Factors
- Age
- Ethnicity
- Tobacco
- Medications
- Family history
- Alcohol
- Dyslipidemia
- Diabetes mellitus
- Known cardiovascular diseases
- Known kidney diseases
- Diet
- Obesity
- Sedentary lifestyle
Symptoms of Target Organ Damage
Eyes
Heart
- Angina
- Prior MI
- Prior coronary revascularizations
- Aneurysms
- Symptoms of heart failure
- Symptoms of peripheral vascular disease (PVD)
Kidneys
Brain
2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)[3]
Summary of Recommendations on History (DO NOT EDIT)[3]
| Class I |
| "1. It is recommended to obtain a comprehensive medical history and physical examination in all patients with hypertension to verify the diagnosis, detect causes of secondary hypertension, record CV risk factors, and to identify OD and other CVDs.. (Level of Evidence: C)" |
| "2. Obtaining a family history is recommended to investigate familial predisposition to hypertension and CVDs.(Level of Evidence: B)" |
References
- ↑ Yudofsky, Stuart C. (2007). The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences (5th ed.). American Psychiatric Pub, Inc. ISBN 1585622397. Unknown parameter
|coauthors=ignored (help) - ↑ Onusko E (2003). "Diagnosing secondary hypertension". Am Fam Physician. 67 (1): 67–74. PMID 12537168.
- ↑ 3.0 3.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.