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Guideline for hypertension

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Guideline for hypertension

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    1. Guideline for hypertension

    3. Etiology Essential (90%) Renal : renal artery stenosis ; parenchymal disease Endocrine : Pheochromocytoma ; Hyperaldosteronism ; Cushing syndrome ; hyperthyroidism Exogenous agent Coarctation of aorta : Toxemia of pregnancy

    4. Standard work-up Conformation of real hypertension Identify Etiology of H/T Access of End-organ damage Identify cardiovascular risk

    5. How to record BP Measure BP several times on several occasions with the patient in sitting position . including Self Measurement Use a mercury sphygmomanometer or other non-invasive device .including Ambulatory BP monitorings

    7. History Onset of hypertension; Drug history; Family History; Other major cardiovascular risk factors; major target organ complications; Exogenous agents (e.g. oral pills, Licorice)

    8. History Hisory of flank pain, hematuria, history of renal trauma -> Renovascular hyprertension; Histoy of proteinuria, pyelitis of pregnancy, renal stones, dysuria, fever, or chill -> Parenchymal renal disease as a cause of hypertension; History of headache, sweating, palpitations, tachycardia, thoracic and epigastric distress, and weight loss …. Pheochromocytoma; Heat intolence and loss of weight …… Hyperthyroidism, History of weakness, paralysis, tetany, paresthesia, polyuria… primary aldosteronism.

    9. Physical Examination General apperance : eg .Cushing syndrome Serial blood pressure determinations Blood pressure in both arms Funduscopic examination :arteriovenous nicking , hemorrhage, Exudates Palpation of thyroid Auscultation Lungs for wheezing and rales Cardiac: heart beat; S3 ,S4 murmur , PMI , thrill …. Abdominal and cervical ( check bruit ) Palpation of pulses, especially femoral artery :delayed pulse and decrease pressure -> coarctation

    10. Laboratory test Routine screen ,including CBC/DC ,biochemistry and admission panel Urinalysis : including specific gravity , albumin , microanalysis Serum potassium , Calcium ,Creatinine Thyroid function , Cortisol level Chlesterol , TG EKG Chest X-Ray Catecholamines only in presence of diastolic pressure >110 mmHg in patient younger than 30 Echocardiography

    11. Risk factor for Cardiovascular disease Levels of systolic and diastolic blood pressure (Grades 1-3) Men > 55 years Women > 65 years Smoking Total cholesterol > 6.5 mmol / L ( 250 mg / dl) Diabetes Family history of premature cardiovascular disease Homocystine

    12. End –Organ damage Left ventricular hypertrophy ( electrocardiogram, echocardiogram or radiogram ) Proteinuria and/or slight elevation of Left ventricular hypertrophy plasma creatinine concentration (1.2-2.0 mg/dl) Ultrasound or radiological evidence of atherosclerotic plaque (carotid, iliac and femoral arteries, aorta) Generalized or focal narrowing of the retinal arteries

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