Pathology THERA
Important causes include:
- Renal: GN, renal artery stenosis, Renin tumors
- Endocrine: pheochromocytoma, hyperthyroidism, hyperaldosteronism, hypercortisolism, OCP
- Vascular: Coarctation of aorta, PAN, Aortic insufficiency.
- Neurogenic: Psychogenic, raised intracranial pressure, polyneuritis, Obstructive sleep apnea,
- certain drugs (e.g., sympathomimetics).
- Pregnancy-induced hypertension
- C.V Cause
- miscellaneous causes: Oral contraceptives, corticosteroids,, cyclosporine, clonidine withdrawal , carbenoxolone, cocaine , sympathomimetic agents, NSAIDs, liquorice,, erythropoietin
THERA HTN RENAL ARTERY STENOSIS
- Secondary to some other disease
- Accounts for less than 10% of HTN cases
- Renal etiologies: Commonest etiology of secondary HTN is renal disease :
- Chronic renal failure ( due to any cause)
- Renal artery stenosis
- DM nephropathy
- Polycystic kidney disease
- Endocrine Causes :
- Excess cortisol (Cushing’s disease)
- Excess aldosterone (Conn’s syndrome)
- Excess noradrenaline ( Pheochromocytoma) ( all above are adrenal diseases)
- Drugs & Meds. :
- NSAIDs, * Steroids, * Estrogens, * Flu & cold meds ( will worsen HTN), * Cocaine
WHEN TO SUSPECT SEC. HTN?
- Young age ( less than 30 yrs)
- HTN not responding to max. therapy
- Clinical features of the secondary causes ( acromegaly, Cushing’s etc)
CL Med (cc)
1) Renal Etiologies
Disease; DM, Renal Artery Stenosis Chronic Renal failure/ Kidney diseases; due aldosterone and angiotensin stressors due reduced GFR e.g. known stressors
2) Endocrine Causes
- increase Cortisol (Cushing’s Syndrome); “Disease if origin from pituitary ”
- increase Aldosterone (Conn’s Disease); water/salt retention
- increase Noradrenaline; (Pheochromocytoma);
3) Drugs/Medications
- Nsaids
- Steroids
- Estrogens
- flu & Cold medications
- Cocaine
Suspecting HTn
- Usually Young person,
- with no positive effect of lower hypertension whilst using therapy of HTN
- Prior diseases such as; acromegaly, Cushing’s
S/S
Pallor, Angina,
Physical Examination (CC)
- Check Pulse, S/S of stroke
- Retinopathy
- Murmurs, CHF
- Renal Artery Bruits
- …
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