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HPN
HPN
1. Renovascular hypertension
2. Renal parenchymal diseases
a. Altered excretory function
b. Altered renin-angiotenism-aldosterone activity
3. Endocrinologic causes
a. Oral contraceptives
b. Mineralcorticosteroid excess syndrome
c. Pheochromocytoma
d. Miscellaneous causes (Acromegaly, Hyperparathyroidism,
Hyperthyroidism, Coarctation of the aorta )
3rd Leading Cause of Morbidity
in the Philippines (WHO)
EPIDEMIOLOGY
• Prevalence
increases with age
• More in women
after that
RISK FACTORS
• Obesity and weight gain 60% of patients
• >20% overweight
• High NaCl intake
• Low calcium and potassium intake
• Alcohol consumption
• Smoking
• Psychosocial stress
• Physical inactivity
PATHOPHYSIOLOGY
VARIATIONS OF BP
• White coat hypertension
– 3 clinic-based measurement of >140/90 and 2 non-
cinic-based measurement of <140/90
• Masked hypertension
– Normal or low BP in a patient with advanced
atherosclerotic dse or evident target-organ damage
• Orthostatic hypotension
– Fall of BP in response to assumption of upright
posture from supine position within 3 mins. Systolic
fall >20mmHg, diastolic fall >10mmHg.
– Postural light-headedness and syncope
Variations of BP
• Prior to labeling a person with hypertension, it is
important to use an average based on ≥2
readings obtained on ≥2 occasions to estimate
the individual’s level of BP.
• Out-of-office and self-monitoring of BP
measurements are recommended to confirm the
diagnosis of hypertension and for titration of BP-
lowering medication, in conjunction with clinical
interventions and health counseling.
Hypertensive Crisis
• Severe rapid increase in blood pressure with the
systolic of 180mm Hg or higher or a diastolic of
120 mm Hg or higher. This can lead to damaged
blood vessels. The blood vessels become
inflamed and can leak fluid or blood.
• Emergency
– Extremely high blood pressure which has caused
damage to organs.
HYPERTENSIVE WORK-UP
• RENAL:
– urinalysis (albumin excretion), serum bun and/or
creatinine
• ENDOCRINE:
– serum sodium, potassium, chloride, or TSH (optional)
• METABOLIC:
– FBS, total cholesterol, HDL, LDL, cholesterol,
triglycerides
• CBC, SGPT/SGOT
• Chest X-ray, Electrocardiogram
PHARMACOLOGIC MANAGEMENT
CLASS MECHANISM OF ACTION ADVERSE EFFECTS DRUGS
THIAZIDE •Inhibit NaCl transport (DCT) •K wasting •Hydrochlorothiazide
DIURETICS •Slow onset of action • Hyperuricemia •Chlorthalidone
•Long duration of action (6- •Impaired glucose
12hrs) tolerance
•Mild or moderated HPN • Hyponatremia
• Impotence
• Allergic reactions