|
|
Line 7: |
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| {{CMG}}; {{AE}} {{USAMA}} | | {{CMG}}; {{AE}} {{USAMA}} |
| ==Overview== | | ==Overview== |
| [[Hypertension]] is a major risk factor for [[cardiovascular disease]] and is a major public health problem. The prevalence of [[hypertension]] increased among the united states patients according to the 2017 ACC/AHA Guideline. The previous cut-off 140/90 mmHg has been changed. | | [[Hypertension]] is a major risk factor for [[cardiovascular disease]] and is a major public health problem. The prevalence of [[hypertension]] increased among the united states patients due to changing The previous cut-off 140/90 mmHg. |
|
| |
|
| ==Historical Perspective== | | ==Historical Perspective== |
Line 538: |
Line 538: |
| *[[Hypokalemia]] ( [[diuretic-induced]]), | | *[[Hypokalemia]] ( [[diuretic-induced]]), |
| * Incidentally discovered [[adrenal mass]] | | * Incidentally discovered [[adrenal mass]] |
| *[[ Family history]] of [[early-onset hypertension]] or [[stroke]] at a young age (<40 years) | | *[ |
| |}
| |
| | |
| === History and Symptoms ===
| |
| *[Disease name] is usually asymptomatic.
| |
| *Symptoms of [disease name] may include the following:
| |
| :*[symptom 1]
| |
| :*[symptom 2]
| |
| :*[symptom 3]
| |
| :*[symptom 4]
| |
| :*[symptom 5]
| |
| :*[symptom 6]
| |
|
| |
| === Physical Examination ===
| |
| *Patients with [disease name] usually appear [general appearance].
| |
| *Physical examination may be remarkable for:
| |
| :*[finding 1]
| |
| :*[finding 2]
| |
| :*[finding 3]
| |
| :*[finding 4]
| |
| :*[finding 5]
| |
| :*[finding 6]
| |
| {| style="border: 2px solid #4479BA; align="left"
| |
| ! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Conditions}}
| |
| ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF| Physical examination}}
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Renal parenchymal disease]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| *[[Abdominal mass]] ([[polycystic kidney disease]])
| |
| *[[Skin pallor]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Renovascular disease]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Abdominal systolic or diastolic bruit]]
| |
| * [[Femoral]] or [[carotid]] arteried bruits
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Primary aldosteronism]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Arrhythmias]] with [[hypokalemia]]
| |
| * [[ Atrial fibrillation]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Obstructive sleep apnea]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Overweight]]
| |
| * [[ Short, thick neck]]
| |
| * loss of normal [[nocturnal blood pressure]] fall
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Drug]] or [[alcohol]] induced
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Fine tremor]], [[Tachycardia]], [[Sweating]] ([[cocaine]], [[ephedrine]], [[MAO inhibitors]])
| |
| * [[Acute abdominal pain]] ([[cocaine]])
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Pheochromocytoma]]/[[paraganglioma]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Skin stigmata]] of [[neurofibromatosis]] ([[cafe-au-lait spots]], [[neurofibromas]])
| |
| * [[Orthostatic hypotension]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cushing syndrome]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Central obesity]]
| |
| * [[Moon face]]
| |
| * [[Dorsal and supraclavicular fat pads]],
| |
| * [[Violaceous striae]]
| |
| * [[Hirsutism]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hypothyroidism]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| *[[Delayed ankle reflex]]
| |
| *[[Periorbital puffiness]]
| |
| *[[Coarse skin]]
| |
| *[[Cold skin]]
| |
| *[[Slow movement]]
| |
| *[[Goiter]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[ Hyperthyroidism]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * [[Lid lag]]
| |
| * [[Fine tremor]]
| |
| * [[ Warm]], [[moist skin]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Coarctation of aorta]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| *[[Blood pressure]] higher in upper extremities than in lower extremities
| |
| *[[Absent femoral pulses]]
| |
| *[[continuous murmur]] over patient’s back, [[chest]]
| |
| *[[Abdominal bruit]]
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Congenital adrenal hyperplasia]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| *[[Signs]] of [[virilization]] (11-beta-OH) or incomplete [[masculinization]] (17-alpha-OH)
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |[[Acromegaly]]
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| *[[Acral features]]
| |
| *[[Large hands and feet]]
| |
| *[[Frontal bossing]]
| |
| |}
| |
| | |
| === Laboratory Findings ===
| |
| :*Basic laboratory test should be taken in patients with the diagnosis of [[hypertension]] include:
| |
| *[[Fasting blood sugar]]
| |
| *[[Complete blood count]]
| |
| *[[Lipid profile]]
| |
| *[[Serum creatinine]] with [[eGFR]]
| |
| *[[Serum]] [[sodium]], [[potassium]], [[calcium]]
| |
| *[[Thyroid-stimulating hormone]]
| |
| *[[Urinalysis]]
| |
| :*Optional laboratory test in [[hypertensive]] patients include:
| |
| *[[Uric acid]]
| |
| *[[Urinary albumin]] to [[creatinine]] ratio
| |
| | |
| ===Electrocardiogram===
| |
| There are no ECG findings associated with [disease name].
| |
| | |
| OR
| |
| | |
| An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| ===X-ray===
| |
| There are no x-ray findings associated with [disease name].
| |
| | |
| OR
| |
| | |
| An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| OR
| |
| | |
| There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
| |
| | |
| ===Echocardiography or Ultrasound===
| |
| There are no echocardiography/ultrasound findings associated with [disease name].
| |
| | |
| OR
| |
| | |
| Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| OR
| |
| | |
| There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
| |
| | |
| ===CT scan===
| |
| There are no CT scan findings associated with [disease name].
| |
| | |
| OR
| |
| | |
| [Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| OR
| |
| | |
| There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
| |
| | |
| ===MRI===
| |
| There are no MRI findings associated with [disease name].
| |
| | |
| OR
| |
| | |
| [Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| OR
| |
| | |
| There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
| |
| | |
| ===Other Imaging Findings===
| |
| There are no other imaging findings associated with [disease name].
| |
| | |
| OR
| |
| | |
| [Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| ===Other Diagnostic Studies===
| |
| There are no other diagnostic studies associated with [disease name].
| |
| | |
| OR
| |
| | |
| [Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
| |
| | |
| OR
| |
| | |
| Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
| |
| | |
| == Treatment ==
| |
| === Medical Therapy ===
| |
| *There is no treatment for [disease name]; the mainstay of therapy is supportive care.
| |
|
| |
| *The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
| |
| *[Medical therapy 1] acts by [mechanism of action 1].
| |
| *Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
| |
| | |
| {{familytree/start}}
| |
| {{familytree | | | | | | | | | A01 | | | | | | | | | |A01= Treatment strategy}}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | |}}
| |
| {{familytree | |,|-|-|-|-|v|-|-|^|-|-|-|v|-|-|-|-|.| |}}
| |
| {{familytree | |!| | | | |!| | | | | | |!| | | | |!| | |}}
| |
| {{familytree | B01 | | | B02 | | | | | B03 | | | |B04| |B01=Nomal [[BP]] ([[BP]]<120/80 mmHg)|B02=Elevated [[BP]]([[BP]]120-129/<80mmHg|B03=Stage1 [[hypertension]](BP 130-139/80-89mmHg|B04=Stage 2 [[hypertension]] ([[BP]]≥ 140/90}}
| |
| {{familytree | |!| | | | |!| | | | | | |!| | | | |!| }}
| |
| {{familytree | C01 | | | C02 | | | | | C03 | | | |C04| |C01=Life style modifications|C02=Nonpharmocological therapy(class1)|C03= 10 years [[CVD]] risk≥ 10%|C04=Non pharmacological therapy and [[BP]]lowering medication}}
| |
| {{familytree | |!| | | | |!| | | | |,|-|^|-|.| | |!| | | | | | | | |}}
| |
| {{familytree | |D01| | | D02 | | | D03 | | D04 | |!| | | | | | D01=Reevaulation in 1 year (class 2a)|D02=Reevaulation in 3-6 months(class 1)|D03=Nonpharmocological therapy(class1)|D04=Non pharmacological therapy and [[BP]]lowering medication}}
| |
| {{familytree | | | | | | | | | | | |!| | | |!| | |!| | | | |}}
| |
| {{familytree | | | | | | | | | | | E01 | | E02 |-|'| | | E01=Reevaulation in 3-6 months(class 1)|E02=Reevaulation in 1 months(class 1)}}
| |
| {{familytree | | | | | | | | | | | | | | | |!| | | | |}}
| |
| {{familytree | | | | | | | | | | | | | | | F01 | | | | F01= [[BP]]goal reached|}}
| |
| {{familytree | | | | | | | | | | | | | |,|-|^|-|.| | | | | | | | |}}
| |
| {{familytree | | | | | | | | | | | | |G01| | |G02| |G01=NO, Evaluation and optimization the adherence to medical therapy|G02=Yes,Reevaulation in 3-6 months(class 1)}}
| |
| {{familytree | | | | | | | | | | | | |!| | | | | | |}}
| |
| {{familytree | | | | | | | | | | | | |H01| | | | | | |H01=Intensification of medical therapy}}
| |
| {{familytree/end}}
| |
| | |
| | |
| | |
| | |
| | |
| {| border="1"
| |
| ! style="background:#efefef;" | First line of treatment
| |
| ! style="background:#efefef;" | Drug_ Dosage(mg/day)_ Frequency
| |
| ! style="background:#efefef;" | Comments
| |
| |-
| |
| | [[Thiazide]] or [[thiazidetype]] [[diuretics]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Chlorthalidone]]||12.5–25||1
| |
| |-
| |
| | [[Hydrochlorothiazide]]||25–50||1
| |
| |-
| |
| | [[Indapamide]]||1.25–2.5||1
| |
| |-
| |
| |[[Metolazone]]||2.5–5||1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| *[[Chlorthalidone]] is a prolonged half-life drug and reduces cardiovascular risk
| |
| *[[Hyponatremia]], [[ hypokalemia]], [[uric acid]] and [[calcium]] levels should be monitored
| |
| |-
| |
| | [[ACE inhibitors]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Benazepril]]||10–40||1-2
| |
| |-
| |
| | [[Captopril]]||12.2-150||2-3
| |
| |-
| |
| | [[Enalapril]]||5-40||1-2
| |
| |-
| |
| |[[Fosinopril]]||10–40||1
| |
| |-
| |
| |[[Lisinopril]]||10-40||1
| |
| |-
| |
| |[[Moexipril]]||7.5–30||1-2
| |
| |-
| |
| |[[Perindopril]]||4-16||1
| |
| |-
| |
| |[[Quinapril]]||10-80||1-2
| |
| |-
| |
| |[[Ramipril]]||2.5-20||1-2
| |
| |-
| |
| |[[Trandolapril]]||1-4||1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| *Avoidance of using in combination with [[ARB]] and direct renin inhibitor
| |
| * Using with caution in [[CKD]] or in patients are on [[K ]] sparing agents due to the risk of [[hyperkalemia]]
| |
| * Avoidance in [[pregnancy]]
| |
| * Avoidance in patients with a history of [[angioedema]] with [[ACEI]]
| |
| *Avoidance in severe bilateral [[renal artery stenosis]]
| |
| |-
| |
| | [[ARB]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Azilsartan]]||40-80||1
| |
| |-
| |
| | [[Candesartan]]||8–32||1
| |
| |-
| |
| | [[Eprosartan]]||600-800||1-2
| |
| |-
| |
| |[[Irbesartan]]||150-300||1
| |
| |-
| |
| |[[Losartan]]||50-100||1-2
| |
| |-
| |
| |[[Olmesartan]]||20-40||1
| |
| |-
| |
| |[[Telmisartan]]||20-80||1
| |
| |-
| |
| |[[Valsartan]]||80-320||1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Avoidance of using in combination with [[ACEI]] or [[direct renin inhibitor]]
| |
| * Using with caution in [[CKD]] or in patients are on [[K]] sparing drugs due to the risk of [[hyperkalemia]]
| |
| * Avoidance in [[pregnancy]]
| |
| * Avoidance in patients with a history of [[angioedema]] with [[ARB]]
| |
| * It can be used in patients with a history of [[angioedema]] with [[ACEI]] after 6 weeks of discontinuation of [[ACEI]]
| |
| *Avoidance in severe bilateral [[renal artery stenosis]]
| |
| | |
| | |
| |-
| |
| |[[CCB]]—[[dihydropyridines]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Amlodipine]]|| 2.5–10 ||1
| |
| |-
| |
| | [[Felodipine]]|| 2.5–10 ||1
| |
| |-
| |
| | [[Isradipine]]|| 5–10 ||2
| |
| |-
| |
| |[[Nicardipine SR]] ||60–120|| 2
| |
| |-
| |
| |[[Nifedipine LA]]|| 30–90 ||1
| |
| |-
| |
| |[[Nisoldipine]]|| 17–34 ||1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Avoidance of using in [[heart failure reduced EF]] except [[amlodipine]],[[felodipine]]
| |
| * Pedal edema is dose associated, more common in [[women]]
| |
| |-
| |
| | [[CCB—nondihydropyridines]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Diltiazem ER ]]||120–360 ||1
| |
| |-
| |
| | [[Verapamil IR]] ||120–360 ||3
| |
| |-
| |
| | [[Verapamil SR]]|| 120–360 ||1-2
| |
| |-
| |
| |[[Verapamil]]-delayed onset ER ||100–300 ||1 (in the evening)
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| *Avoidance of using in combination with [[betablocker]] due to the risk of [[bradycardia]]
| |
| * Avoidance of using in [[heart failure reduced EF]]
| |
| * Avoidance of using [[diltiazem ]]with [[verapamil]] due to drug interaction via [[CYP3A4]]
| |
| |-
| |
| ! style="background:#efefef;" | Second line of treatment
| |
| ! style="background:#efefef;" | Drug_ Dosage(mg/day)_ Frequency
| |
| ! style="background:#efefef;" | Comments
| |
| |-
| |
| | [[Diuretics—loop]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Bumetanide]] ||0.5–2|| 2
| |
| |-
| |
| | [[Furosemide]] ||20–80 ||2
| |
| |-
| |
| | [[Torsemide]] ||5–10|| 1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Preferred [[diuretic]] in symptomatic [[heart failure]]
| |
| * Preffered [[diuretic]] in moderate to severe CKD (GFR<30 cc/min)
| |
| |-
| |
| | [[Diuretics—potassium sparing]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Amiloride]]|| 5–10|| 1-2
| |
| |-
| |
| | [[Triamterene]]|| 50–100 ||1-2
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| *Mild [[antihypertensive]] effect
| |
| * Useful for treatment of [[hypokalemia]] due to [[thiazide]] monotherapy
| |
| *Avoidance of using in patients with significant [[CKD]] (GFR <45 mL/min).
| |
| |-
| |
| | [[Diuretics—aldosterone antagonists]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Eplerenone]]|| 50–100|| 1-2
| |
| |-
| |
| | [[Spironolactone]] ||25–100|| 1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Preferred for primary [[aldostronism]] and [[resistant hypertension]]
| |
| * Add-on therapy in [[resistant hypertension]]
| |
| * Lesser risk of [[gyncomasty]] and [[impotence]] with [[eplerenone]]
| |
| * Avoidance of combination therapy with [[K sparing agents]]
| |
| |-
| |
| | [[Betablocker]]-[[cardioselective]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Atenolol]] ||25–100|| 2
| |
| |-
| |
| | [[Betaxolol]] ||5–20|| 1
| |
| |-
| |
| |[[Bisoprolol]] ||2.5–10 ||1
| |
| |-
| |
| |[[Metoprolol tartrate]]|| 100–200 ||2
| |
| |-
| |
| |[[Metoprolol succinate]]|| 50–200|| 1
| |
| |}
| |
| | valign="bottom" |
| |
| * [[Beta-blocker]]s are not first-line therapy of hypertension unless in the presence of [[IHD]] or[[heart failure]]
| |
| * Preferred[[ beta-blocker]]s in [[bronchospastic airway disease]]
| |
| * preferred [[Bisoprolol]], [[metoprolol succinate]] in [[heart failure reduced EF]]
| |
| |-
| |
| | [[Betablocker-cardioselective and vasodilatory]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Nebivolol]] ||5–40 ||1
| |
| |}
| |
| | valign="bottom" |
| |
| * Induction of [[nitric oxide]]
| |
| * [[Vasodilarory effect]]
| |
| |-
| |
| | [[Beta blockers—noncardioselective]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Nadolol]]|| 40–120 ||1
| |
| |-
| |
| | [[Propranolol]] IR ||80–160|| 2
| |
| |-
| |
| | [[Propranolol]] LA ||80–160|| 1
| |
| |-
| |
| |}
| |
| | valign="bottom" | Not recommended, especially in [[IHD]] or [[heart failure]]
| |
| |-
| |
| | [[Beta blockers—intrinsic sympathomimetic activity]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Acebutolol]]|| 200–800|| 2
| |
| |-
| |
| |[[Penbutolol]] ||10–40|| 1
| |
| |-
| |
| | [[Pindolol]]|| 10–60|| 2
| |
| |-
| |
| |}
| |
| | valign="bottom" |Not recommended , especially in [[IHD]] or [[heart failure]]
| |
| |-
| |
| | [[Beta blockers—combined alpha-beta receptor]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Carvedilol]] ||12.5–50|| 2
| |
| |-
| |
| |[[Carvedilol phosphate]]|| 20–80|| 1
| |
| |-
| |
| | [[Labetalol]]|| 200–800|| 2
| |
| |-
| |
| |}
| |
| | valign="bottom" | [[Carvedilol]] is preferred in [[heart failure reduced EF]]
| |
| |-
| |
| | [[Direct renin inhibitor]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Aliskiren]]|| 150–300|| 1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| *Avoidance of using in combination with [[ARB]] or [[ACEI]]
| |
| * Using with caution in [[CKD]] or patients are on [[ K]] sparing agents due to the risk of [[hyperkalemia]]
| |
| * Avoidance in [[pregnancy]]
| |
| *Avoidance in severe bilateral [[renal artery stenosis]]
| |
| |-
| |
| | [[Alpha-1 blockers]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Doxazosin]]|| 1–16 || 1
| |
| |-
| |
| |[[Prazosin]]|| 2–20 || 2-3
| |
| |-
| |
| |[[Terazosin]]|| 1–20 || 1-2
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Side-effect is [[orthostasis hypotension]], especially in old patients
| |
| * Seconde line of treatment, preferred in [[BPH]] and [[hypertension]]
| |
| |-
| |
| | [[Central alpha2-agonist and other centrally acting drugs]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Clonidine]] oral ||0.1–0.8|| 2
| |
| |-
| |
| |[[Clonidine]] patch ||0.1–0.3|| 1 weekly
| |
| |-
| |
| |[[Methyldopa]]|| 250–1000|| 2
| |
| |-
| |
| |[[Guanfacine]] || 0.5–2|| 1
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Last line of treatment due to [[CNS]] adverse effect on elderly patients
| |
| * Avoidance of abrupt discontinuation of [[clonidine]] because of [[rebound hypertension]]
| |
| |-
| |
| | [[Direct vasodilators]]
| |
| | align="center" |
| |
| {| border="2"
| |
| |-
| |
| |[[Hydralazine]] ||100–200 ||2-3
| |
| |-
| |
| |[[Minoxidil]] ||5–100|| 1-3
| |
| |-
| |
| |}
| |
| | valign="bottom" |
| |
| * Recommended to use with [[betablocker]] and [[diuretic]] due to [[sodium]] and [[water]] retention and [[reflex tachycardia]]
| |
| * Side effect of [[hydralazine]] is [[drug]]-induced [[lupus]]-like syndrome at higher doses
| |
| * Side effect of [[minoxidil] is [[hirsotism]],[[pericardial effusion]]
| |
| |}
| |
| | |
| | |
| | |
| {|class="wikitable"
| |
| |-
| |
| | colspan="1" style="text-align:center; background:LemonChiffon"|[[AHA guidelines classification scheme#Classification of Recommendations|Class I, Level of evidence:A]]
| |
| |-
| |
| |bgcolor="LemonChiffon"|In patients with [[atherosclerotic]] [[renal artery stenosis]], [[medical therapy]] is recommended
| |
| |-
| |
| | colspan="1" style="text-align:center; background:LemonChiffon"|[[AHA guidelines classification scheme#Classification of Recommendations|Class IIb, Level of evidence:C]]
| |
| |-
| |
| |bgcolor="LemonChiffon"|Revascularization ([[percutaneous renal artery angioplasty]] and/ or stent placement) indicates in patients with refractory [[hypertension]], worsening
| |
| [[renal function]], intractable [[heart failure]], nonatherosclerotic disease ([[fibromuscular dysplasia]])
| |
| |-
| |
| |}
| |
| | |
| {|class="wikitable"
| |
| |-
| |
| | colspan="1" style="text-align:center; background:PaleGreen"|[[AHA guidelines classification scheme#Classification of Recommendations|Class IIb, Level of evidence:B]]
| |
| |-
| |
| |bgcolor="PaleGreen"| The effectiveness of [[continuous positive airway pressure]] ([[CPAP]]) to decrease [[blood pressure]] in patients with [[obstructive sleep apnea]] and [[hypertension]] is not verified
| |
| |-
| |
| |}
| |
| | |
| === Surgery ===
| |
| *Surgery is the mainstay of therapy for [disease name].
| |
| *[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
| |
| *[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
| |
|
| |
| === Prevention ===
| |
| *There are no primary preventive measures available for [disease name].
| |
|
| |
| *Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
| |
| | |
| *Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
| |
| {| style="cellpadding=0; cellspacing= 0; width: 600px;"
| |
| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' [[Recommendations for masked hypertension and white coated hypertension]] : ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]])'''
| |
| |-
| |
| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
| |
| ❑ Screening [[white coated hypertension]] in patients with [[ systolic blood pressure]] 130-160 mmHg and [[diastolic blood pressure]] 80=-110 mmHg by using ABPM or HBPM before diagnosis of [[hypertension]]<br>
| |
| |-
| |
| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence C]])'''
| |
| |-
| |
| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
| |
| ❑ Periodic monitoring [[blood pressure]] with ABPM or HBPM for detection of transient or sustained [[hypertension]] in [[ white coated hypertension]]
| |
| |-
| |
| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence C]])'''
| |
| |-
| |
| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
| |
| ❑ Finding [[ white coated hypertension]] by HBPM and ABPM in high office [[blood pressure]] inspite of receiving treatment,is recommended<br>
| |
| |-
| |
| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]])'''
| |
| |-
| |
| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
| |
| ❑ Finding [[mask hypertension ]] by HBPM or ABPM in office [[blood pressure]] 120-129 /75-79 mmHg <br>
| |
| |-
| |
| |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' ([[ACC AHA guidelines classification scheme|Class IIb, Level of Evidence C]])'''
| |
| |-
| |
| |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
| |
| ❑ Finding [[white coated hypertension]] by HBPM or ABPM if office [[blood pressure]] 10 mmHg higher than normal in spite of receiving multiple medications<br>
| |
| ❑ Finding [[masked hypertension]] by HBPM in patients with end organ damage or high cardiovascular risk but office reading [[blood pressure]] at goal <br>
| |
| ❑ Finding [[masked hypertension]] by ABPM in patients with high HBPM inspite of receiving medications<br>
| |
| |}
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
|
| |
| [[Category:Pick One of 28 Approved]]
| |
| | |
| {{WS}}
| |
| {{WH}}
| |
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| | |
| | |
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| | |
| | |
| ==Overview==
| |
| Hypertension is generally defined as an elevated systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. Hypertension can be chronic or acute. While 95% of the cases of chronic hypertension are primary, 5% of [[chronic hypertension]] is secondary to other underlying causes. Hypertensive crisis is the acute elevation of [[blood pressure]] and it can be classified into [[hypertensive emergency]] or [[hypertensive urgency]] when end organ damage is present or absent respectively.
| |
| | |
| ==Causes==
| |
| When a full evaluation yields no clear etiology for the elevated blood pressure:
| |
| * [[chronic hypertension|Primary hypertension]], also called essential hypertension.
| |
| | |
| Secondary hypertension can be caused by:
| |
| *[[Apnea]]
| |
| *[[Hyperaldosteronism]]
| |
| *[[Renal failure]]
| |
| *[[Coarctation of aorta]]
| |
| *[[Cushing's syndrome]]
| |
| *[[Drugs]]
| |
| *[[Diet]]
| |
| *[[Pheochromocytoma]]
| |
| *[[Obesity]]
| |
| *[[Hyperparathyroidism]]
| |
| | |
| For detailed causes of secondary hypertension, click ''' [[Chronic hypertension causes#Causes in Alphabetical Order|here]]'''.
| |
| | |
| ==Classification==
| |
| For more details about each specific type of hypertension, click on the links in blue in the algorithm below.<br>
| |
| In order to distinguish primary hypertension from secondary hypertension, click [[chronic hypertension causes|here]].
| |
| | |
| {{Familytree/start}}
| |
| {{Familytree | | | | | | | A01 | | | | | | A01= '''Hypertension'''}}
| |
| {{Familytree | | | |,|-|-|-|^|-|-|-|.| | | }}
| |
| {{Familytree | | | B01 | | | | | | B02 | | | B01= '''[[Chronic hypertension]]'''
| |
| |B02= '''[[Hypertensive crisis]]''' <br> ''Acute elevation of blood pressure''<br> - Systolic blood pressure >180 mm Hg<br> OR <br> - Diastolic blood pressure >120 mm Hg}}
| |
| {{Familytree | |,|-|^|-|.| | | |,|-|^|-|.| }}
| |
| {{Familytree | C01 | | C02 | | C03 | | C04 | |C01= '''[[Primary hypertension]]''' <br>(also known as [[essential hypertension]]) <br> (95% of the cases)| C02= '''[[Secondary hypertension]]'''<br> <br> (5% of the cases)
| |
| | C03= '''[[Hypertensive emergency]]''' <br>
| |
| Evidence of end organ damage
| |
| | C04= '''[[Hypertensive urgency]]'''<br>
| |
| No evidence of end organ damage }}
| |
| {{Familytree/end}}
| |
| | |
| ==Screening==
| |
| The age to begin screening for hypertension varies between 13-20 years of age, according to different authorities. Generally, hypertension is defined as SBP > 140 mmHg and/or DBP > 90 mmHg. In specific populations, however, routine follow-up target BP may be different; and initiation of treatment may be considered at even lower BP values than those considered for the normal population.
| |