Internal Medicine

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

Hypertension 763

■“White-coat” HTN: ambulatory or portable BP measurements may

assist

■Sleep apnea

■Drug-induced: NSAIDs, COX-2 inhibitors, oral contraceptives,

cocaine, amphetamines, sympathomimetics, adrenal steroids,

cyclosporine, tacrolimus, erythropoietin, licorice and some chew-

ing tobacco, selected over-the-counter supplements/medications

■Renal disease (especially related to diabetes mellitus)

■Renal vascular HTN: 1–2% of cases

■Primary hyperaldosteronism

■Cushing’s syndrome or chronic steroid therapy

■Pheochromocytoma

■Coarctation of the aorta

■Pregnancy-associated

■Acromegaly

■Thyroid or parathyroid disease

management

What to Do First

■Initial therapy as per JNC VII by classification (without compelling

indications; for therapy with compelling indications, see Specific

Therapy below):

➣Normal: encourage lifestyle modifications; no antihypertensive

drug indicated

➣Prehypertension: treat with lifestyle modifications; no antihyper-

tensive drug indicated

➣HTN-Stage 1: treat with lifestyle modifications; start with single-

agent antihypertensive therapy (often thiazide diuretic)

➣HTN-Stage 2: treat with lifestyle modifications; most will require

at least two drugs in combination (usually thiazide diuretic and

ACE inhibitor or ARB or beta blocker or calcium channel blocker)

General Measures

■Lifestyle modifications important to preventing/reversing HTN and

limiting complications

➣Lose weight

➣Dietary Approaches to Stop Hypertension (DASH) eating plan:

diet rich in fruits, vegetables, low-fat dairy products; reduce

intake of dietary saturated fats and cholesterol

➣Increase aerobic physical activity

➣Reduce sodium intake (≤6 g NaCl/d)