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Hypertension – [High Blood Pressure]

Hypertension is one of the most commonly made diagnoses in the United States. It is a condition that, with appropriate treatment, can be well-controlled, with significant benefits to the patient in both expected morbidity and mortality.

Hypertension is defined as:

  • SBP (Systolic Blood Pressure) > 140 or
  • DBP (Diastolic Blood Pressure) > 90

Workup: The basic workup is focused on both determining underlying cause and on assessing any damage. The most common sites for end-organ damage include the heart, kidneys, eyes, brain, and vascular system.

The vast majority of patients have “essential,” or primary hypertension. History should include prior treatment, family history, prior BP readings, tobacco use, EtOH use, weight gain, exercise, meds, diet, and evidence of end-organ damage.

Physical exam includes:

  • Fundoscopic exam, looking for A-V nicking, hemorrhages, arterial narrowing, exudates, edema
  • Thyroid exam
  • Check for bruits (carotid, aortic, renal artery, femoral)
  • Check for distal pulses
  • Thorough cardiac exam
  • Signs of CHF (edema, JVD, lung congestion)
  • Neuro exam

Baseline labs can include:

  • BUN/Creatinine
  • CBC
  • EKG
  • Fasting lipids and fasting glucose
  • Lytes
  • TSH
  • U/A

Possible “zebras” include, but are not limited to:

  • Pheochromocytoma (adrenal tumor with excess epinephrine production) – VMA, HVA – episodic HTN, associated palpitations and sweating
  • Renal Artery Stenosis (reduced renal blood flow “fools” kidney into believing systemic pressure is low, results in increased renin release) – captopril renal scan, MRA, renal angiogram – refractory to Tx, often abdominal bruits, Hx of flash pulmonary edema
  • Primary Hyperaldosteronism (aldo is produced in adrenals, and functions by causing the kidney to retain Na+ and expel K+) – check serum aldo and renin – unexplained hypokalemia
  • Hyperparathyroidism (PTH raises serum Ca+) – check serum PTH – hypercalcemia, hypophosphatemia
  • Renal Disease (screwed-up electrolyte control, fluid imbalances, unpredictable renin release) – check U/A, BUN/Creat, lytes
  • Cushing’s (excessive cortisol release from adrenals) – dexamethasone suppression test, 24 hour urine cortisol – buffalo hump, moon facies, truncal obesity, striae, proximal weakness

DISCLAIMER: The information provided here is for general informational purposes only, and is provided as a supplement for students enrolled in Meditec’s medical career training courses. The information should NOT be used for actual diagnostic or treatment purposes or in lieu of diagnosis or treatment by a licensed physician.