0071643192.pdf

Mild Hypertension

Patients with persistent (not transient) mild elevations of BP without any evi-

dence for end-organ damage

SYMPTOMS/EXAM

■ Patient is typically asymptomatic.

■ Retinal: A-V nicking, narrowing of arterial diameter

■ Cardiac: S4 gallop, signs of LVH

■ Use appropriately sized cuff.

■ Too large →falsely low reading.

■ Too small →falsely elevated reading.

■ Coarctation: Upper extremity hypertension, systolic murmur (best over back),

delayed femoral pulses

■ Renovascular disease: Flank bruits

■ Pheochromocytoma: Palpitations, apprehension, malaise, tachycardia,

diaphoresis

TREATMENT

■ Identify and correct underlying secondary causes.

■ Lifestyle and dietary changes: Mild sodium restriction, weight loss (if

needed), decreased cholesterol and fat intake, exercise, smoking cessation

■ Initiation of antihypertensive therapy if:

■ Stage 2 HTN

■ Two or more risk factors (see Table 2.22) for complications

Hypertensive Urgency

A historical term indicating a persistent and marked elevation of blood pres-

sure in a patient at risk for end-organ damage, but withoutacute organ injury

CARDIOVASCULAR EMERGENCIES

TABLE 2.21. Causes of Secondary Hypertension

CATEGORY EXAMPLES

Renovascular Renal artery stenosis

Fibromuscular dysplasia

Renal parenchymal Glomerulonephritis

Chronic pyelonephritis

Hormonal Estrogens

1° hyperaldosteronism

Glucocorticoids

Illicit drug intoxication/withdrawal Cocaine intoxication

Alcohol withdrawal

Circulating catecholamines Pheochromocytoma

Tyramine

Clonidine withdrawal

Coarctation

Hypercalcemia

Coarctation →upper

extremity HTN, systolic

murmur, delayed femoral

pulses.