HTN & Renal Artery Stenosis

EPIDEMIOLOGY

In K.S.A, more than 25% of the adult population has HTN ( saudi medical journal, 2007)

In the U.S., 29% of the adults have HTN

Incidence is rising throughout the world ( ? Due to lifestyle)

WHY  IS  HTN  HARMFUL ?

STAGES OF HTN

• Elevated B.P. : Systolic between 120-130
• Stage 1 HTN : Systolic between 130-140 and/or diastolic b/w 80 & 90
• Stage 2 : Systolic 140 or more and/or diastolic 90 or more

 Hypertensive Crisis: (Hypertensive urgency // Hypertensive Emergency)  Systolic usually more than 180 and diastolic more than 120

TYPES OF HTN

1. Primary hypertension- (no known cause) also called essential HTN
2. Secondary Hypertension- (Secondary to an underlying disease)

S/S of HTN

Very non-specific

• Asymptomatic
• Headache, dizziness, body pain
• Sec. HTN: features of the underlying disease
• Severe rise in BP can present as angina/MI, CHF, stroke/TIA, altered mental status Hypertensive encephalopathy ⇒ Hypertensive crisis

Physical Exam

Do a detailed examination at the first visit.

1. Check the pulses, cardiac examination
2. Examine for any S/S of stroke
3. Examine the eyes for retinopathy
4. Examine the heart for murmurs, CHF
5. Auscultate the abdomen for renal artery bruit ( occurs in renal artery stenosis)
6. Look for features of Cushing’s, acromegaly etc. if you suspect these.

HYPERTENSIVE RETINOPATHYY

  Divided into 4 grades , based on severity

• Grade 1: Retinal vessels become less clear
• Grade 2:  A-V nipping
• Grade 3: Edema, hemorrhages, Copper wiring
• Grade 4: Optic disc edema, silver wiring

Diagnosis of hypertension

Routine investigations

• CBC, urea, creatinine, electrolytes, lipid profile, ECG, blood sugar, urinalysis
• If secondary HTN is suspected ⇒ order further tests accordingly
• ECG may show left ventricular hypertrophy
• High creatinine ⇒ suspect renal pathology