Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypertension 761

Hypertension – European Society of Cardiology guidelines for the man-

agement of arterial hypertension. J Hypertens. 2003 Jun;21(6):1011–53.]

History

■Over 50 million in US have hypertension (HTN; SBP >140 or DBP

>90); 70% aware of disease, 59% treated for HTN, 34% treated to goal

of BP < 140/90

■59 million in US have pre-hypertension (SBP 120–139 or DBP 80–89)

■Incidence increases with age, blacks > whites

■Usual age of onset 25–55 years of age

■Family history of HTN

■Salt intake in context of genetic predisposition

■Patients with HTN at early age or new onset >50 y more likely to have

secondary HTN

■Estrogen use (5% women on estrogen have BP > 140/90; more com-

mon in women >35 y,=5 y use, or obese)

■Renal disease

Signs & Symptoms

■Most commonly asymptomatic

■Headache (suboccipital, pulsating)

■Accelerated HTN: somnolence, confusion, visual disturbances, nau-

sea/ vomiting

■Pheochromocytoma: occasional attacks last minutes-hours with

nausea/ vomiting, excessive perspiration, palpitations, pallor, tre-

mor, anxiety.

■Primary hyperaldosteronism: generalized weakness, paralysis,

paresthesias, polyuria/ nocturia

■Other symptoms related to end organ damage from HTN (i.e. dysp-

nea, edema with CHF or renal failure)

■Blood pressure (BP): examine both arms (legs, if lower extremity

pulses decreased; consider aortic coarctation); orthostasis (pheo-

chromocytoma)

■Osler’s sign: palpable brachial/ radial artery with BP cuff above sys-

tolic BP

■Retinas: K-W Class=II (poor prognosis; arteriolar narrowing, cop-

per/ silver wire appearance, exudates, hemorrhage, papilledema)

■Heart: loud aortic S2, early systolic ejection click, LV heave, systolic

ejection murmur, S4

■Pulses: check timing between upper and lower extremities (aortic

coarctation)