Investigations of Hypertension

Group 1

Definition of Hypertension
Hypertension :Persistently at or above 140/90 mmHg. Categorized as Primary and Secondary. Based on recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the classification of BP for adults aged 18 years or older is as follows : o Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg o Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg o Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg o Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater

Blood Pressure and Age

Age 17-40 41-50 >60 Normal (mmHg) <140/80 <140/80 <150/90 Borderline (mmHg) 150/90 150/90 160/90 Definite (mmHg) >160/100 >160/100 >170/100

Type of Hypertension and Possible Causes

Primary :by definition, has no identifiable cause, consequence of an interaction between environmental and genetic factors. Eg : lifestyle, age, family history Secondary: by definition is caused by an identifiable underlying secondary cause. Eg : coarctation of aorta, renal disease, endocrine disease, pregnancy associated hypertension

Investigations Of Hypertension
Biochemical investigations play no part in the diagnosis of essential hypertension, although they are important in assessing possible adverse effects of medication and complication. Investigations are of value in diagnosing some causes of secondary hypertension, particularly renal and endocrine disease.

Possible Causes of Secondary Hypertension

Coarctation of aorta Renal disease, eg: CRF, renal artery stenosis Endocrine disease, eg: Conns syndrome, Cushings syndrome, phaechromocytoma, hyperparathyroidism Pregnancy-associated hypertension, eg: preeclampsia, eclampsia

Biochemical investigations in Patients with Hypertension

Investigation Urine analysis Plasma Creatinine Explanation For protein (renal disease) and glucose ( diabetic, a cardiovascular risk factor ) Renal disease

Plasma potassium
Plasma calcium Plasma cholesterol and triglyceride Plasma renin and aldosterone Overnight dexamethasone suppression Urinary Catecholamines/metabolites

Mineralocorticoid excess ( primary/ secondary)

Hyperparathyroidism Cardiovascular Risk Assessment Conns syndrome Cushings syndrome phaechromocytoma

ABCDE Mnemonic for Potential causes of Secondary Hypertension

A : Accuracy of diagnosis, Aldosteronism, Apnea B: Bruits, Bad kidneys C: Catecholamines, Coarctation of aorta, Cushings Syndrome D: Drugs (oral contraceptives), Diets (excess sodium intake) E: Erythropoietin in excess, Endocrine disorder

YOUR JOB.
*complication Details of biochemical test ( definitive values)

Ps minimum 15 slides. Excluding this one.