Related Diagnostic Tests:
Basic lab studies; history and physical; UA; metabolic panel; serum lipids; ECG; 24-creatine clearance, ECHO; liver function; TSH; BP monitoring; sleep studies, and ultrasounds of vessels
HTN is either primary or secondary. Primary (essential or idiopathic) is elevated BP without an identifiable cause, occurring in 90% of all cases. Factors may include increased SNS activity, overproduction of hormones/ vasoconstrictors, high sodium intake, greater than ideal wight, diabetes mellitus and excessive ETOH. Secondary HTN, in 10% of the cases, may be caused by narrowing of the aorta, renal disease, endocrine disorders, neurologic disorders and injury, sleep apnea, medications (esp. SNS stimulants), estrogen and contraceptive pills, NSAIDS, cirrhosis, pregnancy. Treatment is directed at the underlying cause.
Medicines: Diuretics (thiazides, loop diuretics, K+-sparing, aldosterone receptors); ACE inhibitors, Ca+-channel blockers, Beta-blockers, as well as vasodilators (hydralazine, nipride).
Arterial pressure increase due to an increase in cardiac output or stroke volume, along with peripheral resistances due to many factors such as heredity, water and sodium retention, altered renin-angiotension mechanism, stress and increased sympathetic nervous system activity, insulin resistance and hyperinsulemia, and vascular endothelial cell dysfunction.
Blood pressure monitoring, (home use of Holter Monitor). Assist with lifestyle modifications with weight reduction, DASH (dietary Approaches to Stop Hypertension), eating plan, dietary sodium reduction, patient education and support regarding reducing ETOH and stopping smoking. Encouraging exercise. And medical maintenance of BP to under 140/90. Teach about drug therapy and side effects. Teach self regulation of blood pressure checking.