approach to hypertension

hypertension

Most patients presenting with hypertension are worried by the numbers on their blood pressure machines but don’t require immediate treatment. But we need to be on the lookout for specific causes and complications of hypertension. You can use the expanded ABCs approach to work through the body systems, looking for causes and complications of hypertension

A

B: CHEST

  • Edema from heart failure

C: CARDIOVASCULAR

  • Cardiogram: LVH as chronic complication hypertension
  • Dysfunctional LV: ACS as complication
  • Outflow: coactation as cause, dissection as complication

D: NEURO

  • Neuron: seizure as complication
  • Unregulated pressure as cause
  • RBC bleed as complication
  • Onco mass as cause

E: ENDO

  • Electrolyte: hypercalcemia; hypernatremia/hypokalemia as sign of aldosteronism
  • hOrmones: hyperthyroid, hyperaldosterone, pheo

F: CREATININE

  • renal failure as cause or complication
  • pregnant: pre-eclampsia

G

H: HEME

  • Hgb: hemolysis

I: INTOX

  • Ingest: cocaine, etoh withdrawal
  • N
  • Treat: NSAID, OCP, steroid
  • O: NSAID
  • X poison: lead

J

 

Putting this together, a systems-based approach can assess causes and complications

  • B: assess oxygen, r/o edema
  • C: ECG assess chronic HTN and r/o acute MI, bilateral BP consider congenital coarct or acquired dissection
    • if hypertensive emergency (end-organ damage): IV meds, eg labetalol, NTG, nitroprusside,hydralazine
    • if hypertensive urgency (220/120): po meds, eg clonidine, captopril
  • D: if severe headache or abnomal neuro exam get CT head for causes (ICP, mass) or complications (bleed)
  • E: check electrolytes, consider hormones
  • F: consider pre-eclampsia in pregnant and post-partum; check renal function
  • G
  • H: if anemic consider hemolysis
  • I: assess and stop exposures

hypertension

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