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Hypertension

HYPERTENSION CLUB JANUARY 21 ST , 2007. Hypertension. Rheumatologic practice. HYPERTENSION IN RHEUMATOLOGIC PRACTICE. Hatem Hamdi Eleishi, MD Consultant Rheumatologist, Dr. S. Fakeeh Hospital, Jeddah Assistant Professor of Rheumatology, Cairo University, Egypt.

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Hypertension

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  1. HYPERTENSION CLUB JANUARY 21ST, 2007 Hypertension Rheumatologic practice

  2. HYPERTENSION IN RHEUMATOLOGIC PRACTICE Hatem Hamdi Eleishi, MD Consultant Rheumatologist, Dr. S. Fakeeh Hospital, Jeddah Assistant Professor of Rheumatology, Cairo University, Egypt

  3. Rheumatologic Disorders That May Cause Hypertension 1 Systemic Disorders That May Cause Rheumatologic Manifestations And Also Hypertension 2 Rheumatologic Treatments That May Cause Hypertension 3 4 Anti-hypertensive Treatments That May Cause Rheumatologic Problems 5 Anti-hypertensive Treatments That May Benefit/Help Solve Rheumatologic Problems 6 Patient Non-compliance With Cardiologist’s Advice That May Benefit/Help Solve Rheumatologic Problems

  4. Rheumatologic Disorders that may cause Hypertension 1 of 6

  5. A 26-year old female with: Hypertension Fatigue, polyarthritis Fever, weight loss Lab: ESR 100 mm/hr Hb 7gm/dL Creatinine 2.3mg/dL WBC 2.700/cc Facial rash

  6. Systemic Lupus Erythematosus Lab (cont.): Hypocomplementemia Albumin: 2.1 g/dL Urinalysis: Proteinuria, hematuria, pyuria, granular casts Positive ANA Positive anti-DNA

  7. Polyarteritis Nodosa A 37-year-old man with: Hypertension Arthralgias, myalgias Fever, weight loss Testicular pain Lab: ESR 100 mm/hr Hb 7gm/dL Creatinine 2.3mg/dL Foot drop SC nodule over the calf HBV positive

  8. Takayasu’s Arteritis A 38-year old woman presents with: Fatigue Increasing pain in both arms • Blood pressure measurements: • Right arm 105/65mmHg • Left arm 140/80mmHg Labs: Hb 10.4g/dL, ESR 68mm/h

  9. Takayasu’s Arteritis Early: Non specific symptoms Variable rate of progression Later: manifestation of large vessel occlusive disease Arms, legs Renal arteries Coronaries TOO LATE

  10. Wegener’s granulomatosis A 27-year old female with: Hypertension Fatigue, polyarthritis Fever, weight loss Purpuric lesions were noted over the elbows Negative ANA Chest X-ray: a well-circumscribed round lesion in the right upper zone approximately 8 cm in diameter. Chronic sinusitis

  11. Diffuse Systemic Sclerosis A 57-year old female with: Hypertension Fatigue, polyarthralgias Creatinine 3.0mg/dL Positive ANA Cold blue hands Skin tightness

  12. Systemic lupus erythematosus Takayasu’s arteritis Polyarteritis Nodosa Wegener’s Granulomatosis Systemic sclerosis

  13. Takayasu Polyarteritis nodosa Wegener’s SLE Systemic sclerosis Anterior Branch 3 lobar branches Interlobar Interlobular Arcuate Afferent Microscopic polyangitis Churg Strauss Renal artery GM

  14. Systemic Disorders that may cause Rheumatologic Manifestations and also Hypertension 2 of 6

  15. Endocrinal Thyrotoxicosis Thyrotoxic Myopathy Proximal, later, generalized muscle weakness Acromegaly Hypertension Proxmial myopathy Osteoporosis Cushing’s disease

  16. Systemic Disorders that may cause Rheumatologic Manifestations and also Hypertension (cont.) Miscellaneous

  17. A 67-year man with: Systolic hypertension Pain in left lower arm with deformity No constitutional symptoms ESR: 10mm/hr

  18. Paget’s Disease Elevated ALP Elevated urinary hydroxyproline Normal s. calcium

  19. Paget’s Disease A focal disorder of bone remodeling that typically begins with excessive bone resorption followed by excessive bone formation Normal bone Pagetic bone

  20. What causes hypertension in Paget’s disease? Pagetic bone Normal bone High cardiac output failure

  21. A 56-year man with: Long-standing Hypertension Has a 3-month history of: Back pain Constitutional symptoms ESR: 85mm/hr

  22. Retroperitoneal Fibrosis (RPF) Back exam: free Anuria, rising creatinine Mid-abdominal bruit CT abdomen confirms the diagnosis

  23. Clue Consider the diagnosis of RPF in: A middle-aged or elderly patient With the triad of: Abdominal and/or back pain Elevated ESR Weight loss

  24. Endocrinal Cushing’s syndrome Thyrotoxicosis Acromegaly Miscellaneous Paget’s Disease RPF

  25. Rheumatologic Treatments That May Cause Hypertension 3 of 6

  26. Corticosteroids Cyclosporine

  27. Anti-hypertensive Treatments That May Cause Rheumatologic Problems 4 of 6

  28. Thiazide diuretics Hydralazine

  29. Anti-hypertensive Treatments That May Benefit Existing Rheumatologic Problems 5 of 6

  30. Captropril We like that sulfhydryl (-SH) group

  31. Hypertensive Patient Non-compliance With Doctor Advice That May Benefit Some Rheumatologic Problems 6 of 6

  32. Smoking is good for……….. Oral ulcers in Behcet’s disease

  33. In conclusion

  34. Thank you

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