Hypertension Flashcards
What is the definition of resistant hypertension?
- 3 drugs
- 1 of which is a diuretic
- At optimal doses (>50% maximum)
How might renin profiling be used in hypertension?
- PRA >0.65 suggests vasoconstriction, consider ACEi or beta blocker
- PRA <0.65 suggests volume expansion, consider diuretic or CCB
What percentage of patients with drug-resistant hypertension will have OSA?
- 70-90%
What is the value of captopril renography?
- high negative predictive value, therefore a negative result practically excludes RAS
What portion of the renal artery tends to be affected by FMD?
- the distal half to third
What MEN syndrome is associated with hypertension?
- MEN 2
- 2a: medullary thyroid carcinoma, hyperparathyroidism, cutaneous lichen amyloid
- 2b: medullary thyroid carcinoma, multiple neuromas, marfinoid habitus
What is the prevalence of confirmed primary hyperaldosteronism?
4.5-9.5%
What are the confirmatory tests that can be performed in a patient with a positive ARR?
- IV salt loading; give 2L of NaCl over 4 hrs.
- If plasma aldosterone is >10, this confirms diagnosis
- Oral salt loading; 2g NaCl tablets TDS for 3 days with K replacement. If 24hr urinary aldosterone is >14, this is confirmatory
- Fludrocortisone suppression testing
What are features suggest adrenal carcinoma on imaging?
- Size is critically important
- 2% of masses up to 4cm
6% of masses 4-6cm - 25% of masses > 6cm
What test is performed to help with the identification of correct adrenal vein catheterisation in AVS?
- Adrenal vein cortisol is sampled. You are in the adrenal vein if the ratio of cortisol in sampled vein to inferior vena cava cortisol is 5:1
What genetic mutations are associated with aldosterone producing adrenal adenomas?
- KCNJ5
- CACNAID
You diagnose primary hyperaldosteronism in a patient with a hyperfunctioning adenoma. How do you decide who would be a good surgical candidate?
- Younger age
- Non-obese
- No evidence of end-organ damage
