Question

A 55 year old African American female is back in the ER four hours after you sent her home with the same complaint of chest pain and abdominal pain, nausea, and palpitations.Her EKG and CK's and troponin levels are still negative. However, her blood pressure is dangerously elevated, despite medications given earlier in the day to treat it. What conditions/diseases can cause hypertension? How can you best differentiate the different causes of hypertension what tests would you run and what results would you expect? Are certain races/ethnicities are more risk for hypertension? What do you think is the cause of the patien's hypertension that would be indicated by treatment failure- continued elevated blood pressure despite being on blood pressure medication? What hormone/s would you expect to be elevated and why? What is your next step with regard to treatment? Answer in at least 10 complete sentences for full credit.

Answer 1

Conditions causing Hypertension

• Smokers
• African-Americans
• Pregnant women
• Women who take birth control pills
• People over the age of 35
• People who are overweight or obese
• People who are not active
• People who drink alcohol excessively
• People who eat too many fatty foods or foods with too much salt
• People who have sleep apnea
• People with kidney and adrenal gland disorders.

Differentiating the causes of Hypertension:

Primary Hypertension may be due to

* Calcium, sodium or potassium abnormalities.

* Vascular contractions

* Harmonal elevation

* Central Nervous System stimulations.

Secondary Hypertension may be due to

* Renal disorders

* Endocrinal disorders

* Drugs elevating BP

you have to evaluate whether there was a change in dietary intake, such as increased salt consumption or weight changes. If those can be ruled out, then look immediately at secondary causes such as alternative health issues.

Tests for Hypertension

1. 24 hour BP monitoring with spyghmomanometer.

2. History of lifestyle and genetic predisposition.

3. Blood cholesterol levels.

4. Increased blood electrolytes, blood urea nitrogen, fasting lipids and creatinine levels.

5. Increased blood sugar level.

6. Albumin excretion in urine ( Urinalysis).

Races and ethnicity predispositioned to Hypertension:

* African American

* Indians

* Black women after 50 yes of age.

Reasons for treatment failure: may include

* Non identified underlying cause.

Here we can suspect any renal or adrenal disorders because Hypertension is resistant.

Hyperaldosteronism

Increased aldosterone from adrenal gland leading to high sodium level resulting in Hypertension.

The next step should be the diagnostic confirmation and treatment for Hyperaldosteronism.

Confirmation tests

* Oral salt loading test

* Saline infusion test

* Fludrocortisone suppression test

Additional tests

* CT scan

* Adrenal vein sampling

Treatment

1. Mineralocorticoid receptor antagonists block the action of aldosterone in your body.

2. Lifestyle changes reduce the sodium in your diet and maintain a healthy body weight.