Professional Documents
Culture Documents
OF HYPERTENSION
Stella Palar
Aim for evaluation
Diagnose Hypertension
Detect the risk & contributing factors
Baseline for laboratory value that can be
affected by anti hypertensive medicine
Detect any organ damage
Evaluate the cause of secondary
hypertension
DIAGNOSIS
Diagnosis of Hypertension
Anamnesis
Family History
Age
Others:
Related to risk factor of hypertension
High sodium intake
Data of current medicine
In women: history of hypertension on
pregnancy, contraceptive pills
Other previous medical history
Symptoms
Headache
Dizziness
Fatigue
Pounding of the heart
Symptoms are not specific and no more
frequent than in patients with normotension.
Symptoms of complications : heart failure,
chest pain, claudication, vision
The physical examination
An appropriate measurement of BP, with verification in the
contralateral arm
Examination of the optic fundi
Calculation of body mass index (BMI)
Auscultation for carotid, abdominal, and femoral bruits
Palpation of the thyroid gland
Examination of the heart and lungs
Examination of the abdomen for enlarged kidneys, masses,
and abnormal aortic pulsation
Palpation of the lower extremities for edema and pulses
Neurological assessment.
Laboratory Tests and
Other Diagnostic Procedures
Routine tests
Electrocardiogram
Urinalysis
blood glucose and hematocrit
serum potassium, creatinine (or the corresponding estimated
glomerular filtration rate [GFR]), Calcium
lipid profile, after 9- to 12-hour fast, that includes high
density lipoprotein cholesterol and low-density lipoprotein
cholesterol, and triglycerides.
Optional tests
measurement of urinary albumin excretion or
albumin/creatinine ratio.
More extensive testing for identifiable causes is not indicated
generally unless BP control is not achieved.
CLINICAL ASSESSMENT
Assessment of Hypertensive
Patients
Cardiovascular risk
Assessment of Hypertension
CONTRIBUTING FACTORS :
Dislipidemia
Disglycemia (e.g. impaired fasting glucose, diabetes)
Obesity
Unhealthy eating
Physical inactivity
Other:
Licorice root
Stimulants including cocaine
Salt
Excessive alcohol use
Sleep apnea
Hypertension
Peripheral
Vascular
Disease Renal Failure,
Retinopathy
Proteinuria
CHD = coronary heart disease
CHF = congestive heart failure
LVH = left ventricular hypertrophy Slide Source
Hypertension Online
Chobanian AV, et al. JAMA. 2003;289:2560-2572. www.hypertensiononline.org
Hypertension complication
Cerebrovascular disease
- transient ischemic attacks
- ischemic or hemorrhagic stroke
- vascular dementia
Hypertensive retinopathy
Left ventricular dysfunction
Left ventricular hypertrophy
Coronary artery disease
- myocardial infarction
- angina pectoris
- congestive heart failure
Chronic kidney disease
- hypertensive nephropathy (GFR < 60
ml/min/1.73 m2)
- albuminuria
Peripheral artery disease
- intermittent claudication
- ankle brachial index < 0.9
LVH>2cm
2. Aortic Sclerosis
1. Serum creatinine
2. Dipstick for proteinuria evaluation