1. 30%stofstAmericanssthavesthypertensionstwhichstincreasesstthestriskstforstcardiova
s-stcular,strenalstdiseasest&ststroke:stTrue
2. Primarys t hypertension:s t -stAlsostcalledstessentialstorstidiopathicsthypertension,stassttherestisstnostknownstcause.
- Possiblystduesttostincreasedstcardiacstoutputst&sttotalstperipheralstresistance,storstboth.
- Untreatedstmaystcausestcomplicationsstorstdeath
- Moststprevalentstformstofsthypertension
3. Secondarys t Hypertensions t causes:s t -stobstructedstrenalstarteries
- kidneystdisease
- endocrinestdisorders.
1) Medicationsst resultingst inst vasoconstrictionst mayst causest temporaryst orst transientst secondaryst hypertension.
2) Chronicstrenalstdiseasest(moststcommonstcause).stFromstchronicstglomerulonephritisstorstrenalstarteryststenosisstinterfere
sstwithstsodiumstexcretion,stthestrenin-angiotensin-aldosteronestsystem,storstrenalstperfusion.
3) Cushing'sstsyndromestcausesstanstincreasestinstcortisolstlevelsstandstraisesstbloodstpressurestbystincreasingstrenalstsodiu
mstretention,stangiotensinstIIstlevels,standstvascularstresponsesttostnorepinephrine.
4) Pheochromocytomastisstastsecretingsttumorstofstchromaflnstcells,stusuallystofstthestadrenalstmedulla,stthatstcausessthypertensio
nstduesttostthestincreasestinstthestcatecholamines,stepinephrine,standstnorepinephrine.stThisstconditionstwillstcausestanstintermit
tentstelevationstinstbloodstpressurestduesttostinconsistentstcatecholaminestrelease.
5) Primarystaldosteronism,stinstwhichstincreasedstintravascularstvolume,stalteredstsodiumstconcentrationsstinstvesselstwalls,st
orstverysthighstaldosteronestlevelsstcausestvasoconstrictionstwithstastresultantstincreasestinstperipheralstresistance.
6) Pregnancy-inducedsthypertension.
7) Congenitalstcardiacstdisorders,stsuchstasstcoarctationstofstthestaorta.
4. Isolateds t systolics t hypertension:s t mostlystseenstinstolderstadultsstthestsystolicstpressurestisstgreaterstthanst1
40stmmstHgstandstthestdiastolicstpressurestisstwithinstnormalstlimitsst(lessstthanst90stmmstHg)
5. Pseudohypertension:s t falsestHTNstduesttostsclerosisstofstlargestarteries
6. ResistantstHypertension:s t AstformstofstHBPstthatstisstdiflcultsttostcontrolstandstmaystrequirestthreestorstmorestdittere
ntstclassesstofstantihypertensivestdrugssttostbeginsttostcontrolstbloodstpressure
7. ModifiablestRiskstfactorsstforstHypertension:stA.)stObesityst(BMIst>30)
B.) Smoking
C.) Physicalstactivity
D.) Dietst(saltst&stfats)
E.) Alcoholstconsumption
st s
t
, F)stStress
Hyperlipidemiast(maystorstnotstmaystmodify)
8. Non-ModifiablestRiskstFactorsstforstHypertension:stA)stFamilysthistory
B) Genderst(morestcommonstinstyoungst&stmiddle-agedstmenst&stinstwomenst65styrsstorstolder)
C) Age
D) Ethnicityst(2xstmorestcommonstinstblacksstvsstwhites)
E) InsulinstResistance
F) Hyperinsulinemia
G) DIABETESst(bookstsaysstnon-
modifiable**)stHyperlipidemiast(maystorstnotst
maystmodify)
9. CasestStudy:stPartst1:stInitialstPresentation.
Darryls t Eastons t iss t as t 45-year-olds t unmarrieds t African-
Americans t man,s t whos t reportss t tos t hiss t MDs t fors t hiss t annuals t physicals t examinatio
n.s t Hes t iss t as t computers t programmer,stsmokesst1stpackstofstcigarettesstperstday,st"eat
sstoutstastlot",standsthasst"4sttost5stbeersstastdaystoverstthestweekend".
Atsthisstlaststexam,sthisstBPstwasst136/78standsthisstcholesterolstpanelstwasstslightlystabn
ormal.
Hestisstgivenstastdiagnosisstofstprimarysthypertension.
Hestisstadvisedstaboutstmodifyingsthisstdietsttostlosestweightstandsttostbringsthisstcholes-
stterolstandstglucosestlevels stunder stcontrolstandstinstructed sttostreturnstinst1stmonth.
Hestisststartedstonsthydrochlorothiazidest(HCTZ)st25mgstdailystandstatorvastatinst10mgst
daily.
Familys t History:
Darryl'ss t fathers t hads t HTNs t ands t dieds t ofs t ans t MIs t ats t ages t 54.s t Hiss t mothers t hass t insulin
-de-stpendedstdiabetesstmellitus.
MedicalstHistory:
HCTZst25mgstQD
Atorvastatinst10mgstQD
stLabstResults:
TotalstCholesterol:st238
HDK:st50
st s
t
s-stcular,strenalstdiseasest&ststroke:stTrue
2. Primarys t hypertension:s t -stAlsostcalledstessentialstorstidiopathicsthypertension,stassttherestisstnostknownstcause.
- Possiblystduesttostincreasedstcardiacstoutputst&sttotalstperipheralstresistance,storstboth.
- Untreatedstmaystcausestcomplicationsstorstdeath
- Moststprevalentstformstofsthypertension
3. Secondarys t Hypertensions t causes:s t -stobstructedstrenalstarteries
- kidneystdisease
- endocrinestdisorders.
1) Medicationsst resultingst inst vasoconstrictionst mayst causest temporaryst orst transientst secondaryst hypertension.
2) Chronicstrenalstdiseasest(moststcommonstcause).stFromstchronicstglomerulonephritisstorstrenalstarteryststenosisstinterfere
sstwithstsodiumstexcretion,stthestrenin-angiotensin-aldosteronestsystem,storstrenalstperfusion.
3) Cushing'sstsyndromestcausesstanstincreasestinstcortisolstlevelsstandstraisesstbloodstpressurestbystincreasingstrenalstsodiu
mstretention,stangiotensinstIIstlevels,standstvascularstresponsesttostnorepinephrine.
4) Pheochromocytomastisstastsecretingsttumorstofstchromaflnstcells,stusuallystofstthestadrenalstmedulla,stthatstcausessthypertensio
nstduesttostthestincreasestinstthestcatecholamines,stepinephrine,standstnorepinephrine.stThisstconditionstwillstcausestanstintermit
tentstelevationstinstbloodstpressurestduesttostinconsistentstcatecholaminestrelease.
5) Primarystaldosteronism,stinstwhichstincreasedstintravascularstvolume,stalteredstsodiumstconcentrationsstinstvesselstwalls,st
orstverysthighstaldosteronestlevelsstcausestvasoconstrictionstwithstastresultantstincreasestinstperipheralstresistance.
6) Pregnancy-inducedsthypertension.
7) Congenitalstcardiacstdisorders,stsuchstasstcoarctationstofstthestaorta.
4. Isolateds t systolics t hypertension:s t mostlystseenstinstolderstadultsstthestsystolicstpressurestisstgreaterstthanst1
40stmmstHgstandstthestdiastolicstpressurestisstwithinstnormalstlimitsst(lessstthanst90stmmstHg)
5. Pseudohypertension:s t falsestHTNstduesttostsclerosisstofstlargestarteries
6. ResistantstHypertension:s t AstformstofstHBPstthatstisstdiflcultsttostcontrolstandstmaystrequirestthreestorstmorestdittere
ntstclassesstofstantihypertensivestdrugssttostbeginsttostcontrolstbloodstpressure
7. ModifiablestRiskstfactorsstforstHypertension:stA.)stObesityst(BMIst>30)
B.) Smoking
C.) Physicalstactivity
D.) Dietst(saltst&stfats)
E.) Alcoholstconsumption
st s
t
, F)stStress
Hyperlipidemiast(maystorstnotstmaystmodify)
8. Non-ModifiablestRiskstFactorsstforstHypertension:stA)stFamilysthistory
B) Genderst(morestcommonstinstyoungst&stmiddle-agedstmenst&stinstwomenst65styrsstorstolder)
C) Age
D) Ethnicityst(2xstmorestcommonstinstblacksstvsstwhites)
E) InsulinstResistance
F) Hyperinsulinemia
G) DIABETESst(bookstsaysstnon-
modifiable**)stHyperlipidemiast(maystorstnotst
maystmodify)
9. CasestStudy:stPartst1:stInitialstPresentation.
Darryls t Eastons t iss t as t 45-year-olds t unmarrieds t African-
Americans t man,s t whos t reportss t tos t hiss t MDs t fors t hiss t annuals t physicals t examinatio
n.s t Hes t iss t as t computers t programmer,stsmokesst1stpackstofstcigarettesstperstday,st"eat
sstoutstastlot",standsthasst"4sttost5stbeersstastdaystoverstthestweekend".
Atsthisstlaststexam,sthisstBPstwasst136/78standsthisstcholesterolstpanelstwasstslightlystabn
ormal.
Hestisstgivenstastdiagnosisstofstprimarysthypertension.
Hestisstadvisedstaboutstmodifyingsthisstdietsttostlosestweightstandsttostbringsthisstcholes-
stterolstandstglucosestlevels stunder stcontrolstandstinstructed sttostreturnstinst1stmonth.
Hestisststartedstonsthydrochlorothiazidest(HCTZ)st25mgstdailystandstatorvastatinst10mgst
daily.
Familys t History:
Darryl'ss t fathers t hads t HTNs t ands t dieds t ofs t ans t MIs t ats t ages t 54.s t Hiss t mothers t hass t insulin
-de-stpendedstdiabetesstmellitus.
MedicalstHistory:
HCTZst25mgstQD
Atorvastatinst10mgstQD
stLabstResults:
TotalstCholesterol:st238
HDK:st50
st s
t
