DIAGNOSIS and Investigations OF SECONDARY HYPERTENSION

DIAGNOSISClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... » OF SECONDARY HYPERTENSIONHypertension Definition Classification. Read more ... » with Investigations

• nursing diagnosis for high blood pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... »
• secondary hypertensionThyrotoxic crisis or Thyroid storm. Read more ... » differential diagnosis
• diagnosis high blood pressure
• Age of patients of secondary hypertension may be <25 or >50 years.
• Phaeochromoc toma and renovascular hypertensiof.l are t e likel causesClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... ».
• In phaeochromocytoma there is anxiety, headacheHeadache. Read more ... », weight loss, hyperglycemiaDiabetes Insipidus (DI) Causes Diagnosis and Treatment. Read more ... », palpitations and sweat­ing.
• In Renovascular hypertensionSecondary hypertension Renovascular hypertension. Read more ... » there is abdominal bruit. In polycystic renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » diseaseClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... » abdominal masses can be palpated bilaterally along with hypertension.

• Ultrasound, IVP, serum creatinine (increased), blood urea (increased), proteinuria, hematuria.

Pheochromocytoma – c

• atecholamine and its me­tabolites are seen in 24 hours urine sample.
• Measurement of plasma catecholamines is done.

Cushing‘s syndrome -

• 24 hours urine for cortisol and creatinine.
• 1 mg dexamethasone is given at bed time and plasma cortisol measured at 7 am.
• A urine cortisol of less than 100 IJg or suppression to less than 5 IJg / dl rules out Cushing’s.

DIAGNOSIS OF SECONDARY HYPERTENSION with Investigations

Renovascular hypertension

• Rapid sequence IVP.
• Captopril enhanced radionuclide renal scan.
• Duplex doppler flow study.
• agnetic resonance angiographyCoronary Angiography -Indications of Coronary Arteriography (Angiography). Read more ... ».
• CT scan with IV contrast agent.
• For surgically treatable patients evaluate by renal angiogram and renal vein renin determination.
• renal angiogram is done for location and type of le­sion which may be atheromatous, or fibrous dyspla­sia.
• renal artery stenosis is a frequent finding in normal individuals and at post mortem.
• essential hypertensionHypertension Definition Classification. Read more ... » may occur in presence of renal artery stenosis.
• right and left renal vein catheterization and PRA from each side with reveal if ischemic kidneyDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » is producing “ore renin.
• he ischemic kidney has venous PRA more than 1.5 more compared to normal kidney.
• on normal kidney PRA is same as inferior vena cava lood before entrance of renal veins.
• before this test restrict sodiumRenin and Hypertension Low renin and High Renin essential hypertension with Treatment. Read more ... » intake, given ACE in­-ibitors, stop beta blockersMANAGEMENT of Acute Myocardial Infarction (AMI) -1. Read more ... » (beta blockers suppress renin formation).
• Primary aldosteronism – ere is hypokalemia.
• Idosterone concentration is increased.
• aldosteroneLABORATORY TESTS FOR ADRENAL FUNCTIONS. Read more ... » : renin ratio is high. is decreased.
• disease is unilateral surgical removal of lesion may _ e hypertension.

Tests for Evaluation of Hypertension

• Urine for sugar,
• albumnuria,
• hematuria,
• micro­scopic examinationHow to take good medical history & examination. Read more ... »
• Hematocrit
• Total cholesterol/lipid profile ECGMYOCARDITIS Physical Examination Symptoms Clinical Manifestations Diagnosis. Read more ... »
• TSHACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... »
• WBC count
• Serum sodium potassium
• Serum creatinine and blood urea nitrogen Fasting glucoseGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... »
• Serum calcium and phosphate Chest X-ray
• Echocardiogram.

HYPERTENSION from JNC –  EXPRESS

• systolic blood pressure of more than 140 mmHg in persons older than 50 years is an important cardio­vascular disease (CVD) risk factor.
• The risk of CVD after 115 / 75 mmHg doubles with each rise of 20 / 10 mmHg.

The JNC-7 classifies hypertension into 4 classes:

1. Normal -
   • Blood pressure < 120/80 mmHg
2. Pre hypertension
   • - BP 120 – 139 / 80-89 mmHg
3. Stage 1 hypertension
   • - 140 ·159/90-99 mmHg
4. Stage 2 hypertension
   • - BP > 160/ > 100 mmHg

DrugClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... » treatmentClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... » can be started with thiazide-like di­uretics and other drugs like angiotensin converting enzyme inhibitors, angiotensin receptor blockersHeart Failure Treatment Heart Failure GENERAL PRINCIPLES. Read more ... », beta blockers and calcium channel blockers added as re­quired.

• Patients of diabetes and chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » kidney disease must maintain a BP of < 130/80 mmHg.

Blood pressure measurement  :

• Patient should be seated quietly for 5 minutes on a chair with feet on the floor and arm supported at heartMYOCARDITIS Physical Examination Symptoms Clinical Manifestations Diagnosis. Read more ... » level on a table.
• In case of postural hypotensionHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » the BP should be measured in the standing position also.
• The cuff of the BP instrument should encircle at least 80% of the arm. SBP (systolic blood pressure) is the point at which 1st 2 sounds are heard and DBP (dias­tolic blood pressure) is the point of the disappear­ance of sounds.

Ambulatory blood pressure monitoring (ABPM) is done for patients with white coat hypertension (raised blood pressure in the presence of the doctor), hypotensive symptomsClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... », labile hypertension, and autonomic dys­function.

Identifiable causes of hypertension must be detected and treated like:

• · Sleep apnoea
• · Drug induced hypertension (Oral contraceptivesPrimary Hypertension due to Endocrine adrenal Hypertension Adrenogenital syndrome Oral Contraceptives. Read more ... », NSAIDs, cyclosporin, erythropoietin, deconges­tants, cocaine etc.)
• · Chronic kidney disease
• · ECG
• · Urinalysis
• · Blood glucose
• · Serum Na, K
• · Serum creatinine
• · Serum calcium
• · Chronic steroid therapy
• · PheochromocytomaPheochromocytoma Clinical Features Diagnosis Treatment. Read more ... »
• · Primary aldosteronism
• · Renovascular disease
• · Coarctation of aorta
• ·ThyroidThyrotoxic crisis or Thyroid storm. Read more ... » or parathyroid disease Advise tests:
• · Lipid profile after 9-12 hrs fast – TC, HDL, LDL, TG.