HYPERTENSION

1. ESSENTIAL: no known/multifactorial etiology *Genetic factors *Fetal factors *Environmental factors ( obesity, alcohol, sodium, stress) *Humoral factors Insulin resistance

2. COMPLICATIONS Cerebrovascular disease Coronary artery disease Heart failure Aneurysms Renal disease Peripheral vascular disease

3. TREATMENT 1. Non-pharmacological 2. Pharmacological

3.1. N/P weight reduction exercise low sodium, low fat decrease alcohol stop smoking increase fruits, veggies and oily fish

3.2. P diuretics: thiazide, loop, k+ sparing beta blockers ace inhibitors angiotensin receptorblockers calciumchannel blockers alpha blockers centrally acting drugs

4. SECONDARY: d/t specific and potentially treatable cause 1. Renal diseases 2. Endocrine diseases 3. Congenital cardiovascular causes 4. Drugs 5. Pregnancy

4.1. diabetic nepropathy chronic glomerulonephritis adult polycystic disease chronic tubulointerstitial nephritis renovascular disease conn's syndrome adrenal hyperplasia phaeochromocytoma cushing's syndrome acromegaly coarctation of the aorta NSAIDs oral contraceptives sympathomimetics MOI

5. MALIGNANT HTN: htn + end organ damage

6. HYPERTENSIVE URGENCY: severe htn, symptomatic and no evidence of end organ damage

7. RESISTANT HTN: continued htn despite 3 or > BP meds at high doses (one diuretic)

8. HISTORY: age at onset PMH drug hx FH SocH PHYSICAL: signs of 2dry cause, signs of LVH INVESTIGATIONS: U-dipstix, fasting lipids and glucose, u & e, ecg