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nefrologia > hypertension > Flashcards

hypertension Flashcards

1
Q

SECONDARY HYPERTENSION
causes

and pervalence of primary hypertension

A

SECONDARY HYPERTENSION (6-8%)

KIDNEY DISORDERS

  • Parenchymal disease
  • Renovascular hypertension

ENDOCRINE DISORDERS

  • Cushing’s Syndrome
  • Primary hyperaldosteronism
  • Congenital hypertrophy of the adrenal cortex
  • Pheochromocytoma
  • Hyperthyroidism
  • Acromegaly

Iatrogenic causes

  • Oral contraceptives or estrogen therapy
  • Glucocorticoids, mineralocorticoid, sympathomimetic
  • Lead poisoning

primary HYPERTENSION (92-94%)

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2
Q

Diseases that correlate with hypertension

A
  • Insufficiency heart
  • Coronary artery disease
  • Blindness
  • Preeclampsia / eclampsia
  • Gangrene of lower extremities
  • Break aneurysm aortic
  • Chronic renal inssuficiency
  • Hemorrhage cerebral
  • Stroke
  • hypertensive Encephalopathy
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3
Q

Complications of hypertension, of different natures

A

of pressure nature
• Accelerated-malignant hypertension
• Encephalopathy
• Cerebral hemorrhage
• Aortic dissection
• Heart failure
• Renal failure
of atherosclerotic nature
• Cerebral thrombosis
• Myocardial infarction
• Angina pectoris
• arteriopathy of the lower limbs

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4
Q

Classificatoin of arterial pressure for adults over 18 years old

A

Optimal
<120
<80
Normal
<130
<85
Control 2 years
Borderline
130-139
85-89
Control to 1 year
Stage 1
140-159
90-99
Confirmation to 2 months
Stage 2
160-179
100-109
Treated within 1 month
Stage 3
> 180
> 110
Treat immediately or
within 1 week

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5
Q

Clinical evaluation of hypertension

A

CLINICAL EVALUATION
1. Clinical History
 (family history, medical history and the next)
2. Physical Examination
 (CNS, heart, abdomen, peripheral vessels)
3. Laboratory Tests
 (biochemistry, blood count)
4. Instrumental Tests
 (ECG, RxTorace, echocardiography

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6
Q

Arterial hypertension. Laboratory investigations. Tests recommended for all hypertensive patients.

A

TEST RECOMMENDED FOR ALL THE HYPERTENSIVE
• Hemoglobin and hematocrit
• Creatinine plasma
• plasma uric acid
• serum sodium and potassium
• Glucose
• Trim fat (triglycerides, cholesterol and HDL)
• Analysis of urine (urinary sediment)
• Electrocardiogram
• Microalbuminuria

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7
Q

Additional tests for arterial hypertension patients

A

ADDITIONAL TEST
• Fundus oculi
• Chest Ro
• Echocardiogram
• Ultrasound renal
• Measurement of the PA in the 24 hours (ABPM)

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8
Q

Factors influencing the choice of antihipertensive drugs

A
  1. The risk profile of the patient’s CV
  2. The presence of concomitant diseases that
    promote or restrict the use of a class
    therapeutics
  3. Different individual response to different
    classes of drugs
  4. The risk of drug interactions
  5. Clinical evidence
  6. Other
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9
Q

Major risk factors. of hypertension

A

Major risk factors
• SMOKE
• DysLIPIDEmIA
• DIABETES
• Chronic renal injury
• old age (> 60 years)
• SEX (Men and Women in menopause)
• HISTORY POSITIVE FOR CARDIOVASCULAR DISEASE EARLY

Or when these organs are damaged:
• HEART
• STROKE
• NEPHROPATHY
• peripheral arterial disease
• RETINOPATHY

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10
Q

Site of action of the main antihipertensive drugs.

A

heart range

beta - Blockers
Calcium - Antagonists *
Diuretics

peripheral resistance
ACE Inibitori
AT1 Bloccanti
alfa- Bloccanti
alfa2-Agonisti
Calcio-Antagonisti
Simpaticolitici
Vasodilatatori periferici

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11
Q

Antihypertensive therapy results IN
ELDERLY PATIENT

A

There is clear evidence of the effectiveness of
therapy in reducing mortality / morbidity CV

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12
Q

Hypertension and Renal Disease:
Implications for Treatment

A

Hypertension and proteinuria are independent variables predicting reduction of renal function in the long term

  • Chronic renal injury is both a cause and consequence of hypertension
  • The reduction of BP and proteinuria decreases renal and probably cardiovascular risk
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13
Q

Drugs used for hipertension treatment

A

primary choice

Hydrochlorothiazide / chlorthalidone
Furosemide/Torasemide

then

Aggiungere beta- bloccanti and/or alfa-beta bloccanti

Ca-antagonista

or

**(alfa-blocators, antiadrenergici centrali) **

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14
Q

Secondary hypertension
causes 3

A
  1. renovascular hypertension
    (Stenosis, occlusion)
  2. primary aldosteronism
    (adenoma, hyperplasia
    bilateral)
  3. pheochromocytoma
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15
Q

Renovascular hypertension diagnosis. Clinic, laboratory

A

Renovascular hypertension: diagnosis

  1. CLINIC
    - Age of onset <35 or> 60 years
    - Sudden onset
    - Poor control drug
    - Presence of signs of diffuse atherosclerosis
    - Breath paraumbilical
  2. LABORATORY
    - increased creatinine
    - Hypokalemia
    - Increased PRA
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16
Q

Renovascular hipertension diagnosis. imaging

A
  1. ## IMAGINGUltrasound (lateralization)
    -
    Ecocolor doppler (specific, operator dependent, IR)
    -
    Sequential renal scintigraphy with captopril test
    -
    MR angiography, CT angiography (dye)
    -
    Arteriography (diagnostic / intreventistica)
17
Q

Medical therapy vs surgical therapy in renovascular hipertension

A

Medical therapy vs Surgical therapy
1. Medical Therapy
- Antihypertensive drugs, Statins and Antiaggregatings
2. Surgical therapy
- Percutaneous transluminal angioplasty (with or
without stent)
- Bypass aorto-renal
3. Factors influencing the choice:
age, site of stenosis, the number of stenosis,
unilateral ischemia, duration of hypertension,
severity of hypertension

18
Q

Aldosteronism: diagnosis
clinic, laboratory

A

Aldosteronism: diagnosis
1. CLINIC
- Hypertension marked
- Absence of edema
2. LABORATORY
- Hypokalemia
- Suppression of the PRA
- Increase dell’ALDO
- Report PRA / ALDO <20
- Metabolic alkalosis
3. IMAGING
-Echography
TC
-RM

19
Q

Aldosteronism: therapy

A

ADENOMA ADRENAL

SURGICAL THERAPY

  • Adrenalectomy
    Laparoscopic

MEDICAL THERAPY
- Antagonist dell’ALDO
(Spironolactone)

Adrenal hyperplasia
-idiopatica
-aldosteronismo
glucocorticoid-remediable
(Rare)

20
Q

Pheochromocytoma. definition, localization.

A

Pheochromocytoma
• Tumor tissue chromaffin
• Incidence 0.1%
• High production of catecholamines
• Localization prevailing adrenal (90%)
• Form sporadic (75%) or family (MEN, VHL)

21
Q

Pheochromocytoma: diagnosis

  1. CLINIC
A

Pheochromocytoma: diagnosis

  1. CLINIC
    - Hypertension paroxysmal
    - Palpitations
    - Headache
    - Hyperhidrosis
    - Anxiety
    - Tremors
    - Nausea
    - Dyspnea
    - Dizziness
    - Normotension (20% of cases)
22
Q

Pheochromocytoma. laboratory, imaging

A

Pheochromocytoma: diagnosis
2. LABORATORY
- Plasma and urinary catecholamines
- Metanephrine plasma and urinary
- Acid VANILLYMANDELIC urinary
3. IMAGING
- MIBG scintigraphy * (95-100% specificity)
- TC (sensitivity 93-100%)
- RM (sensitivity 93-100%)
- PET
* Metiliodiobenzilguanidina

23
Q

Pheochromacytoma. surgical therapy

A

Pheochromacytoma. surgical therapy
1. SURGICAL
- Laparoscopy
- Preparation preoperative with alpha-
blocker (doxazosin) to prevent
hypotension postoperative

24
Q
A

nefrologia (6 decks)

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