Medications
These are associated with dose-related pedal edema
Calcium channel blockers. More commonly in females than men.
Lipid profile
Fasting blood glucose
Baseline Potassium level
Baseline Sodium
Serum Creatinine
Serum calcium
TSH
Urinalysis
EKG
Urinary albumin excretion
What is essential hypertension?
Chronically higher bp readings with no underlying identifiable cause.
What are some risk factors for hypertension?
Diabetes
Hypercholesterolemia
Obesity
Smoking
Increased age
Family history of premature CVD (males under age 55, females under age 65)
Physical inactivi
Chronic kidney disease (estimated GFR less than 60 mL/minute)
Unhealthy diet
When using thiazides, what should you monitor for?
Monitor for hyponatremia and hypokalemia
Monitor uric acid and calcium levels.
(Because of this, use with caution in patients his history of gout)
Why would one measure TSH?
Screen for hypothyroidism or hyperthyroidism (causes of secondary hypertension)
How is a diagnosis of hypertension made?
(Organs: heart, brain, kidneys, blood vessels, eyes)
Heart - Left ventricular hypertrophy, angina or myocardial infarction, heart failure
Brain - Cerebrovascular accident or transient ischemic attack
Kidneys - Chronic renal failure
Blood vessels - Peripheral vascular disease
Eyes - Retinopathy
ACEs and ARBs should be avoided in patients who...
Severe bilateral renal artery stenosis: acute renal failure
Interested in pregnancy: risk of fetal renal damage
Why measure urinary albumin excretion or albumin/creatinine ratio?
Monitor progression of renal disease related to hypertension.
Why measure in two arms?
Vascular disease (plaque) coudl cause pressure differential with coartctation.
What are some secondary causes of hypertension?
Obstructive sleep apnea
Primary aldosteronism
Renovascular disease
Renal parenchymal disease
Drug or alcohol induced (including NSAIDS, sympathomimetics, cocaine, etc.)
Pheochromocytoma
Coarctation of the aorta
Thyroid or parathyroid disease
Cushing's syndrome
Primary hyperparathyroidism