Live Blog: Hypertensive Patient Case

Today’s talk was given by Dr. Lindsey Hintz, 3rd year primary care resident here at Healthcare Associates. She discussed one of her former patients, a 28 year old African American male who comes in for routine checkups. Dr. Hintz noticed that his blood pressure was 148/95 both times it was checked. He also has sleep apnea, snores, and goes to bed at 6PM.

When to work up for Secondary HTN: 

• Young age (under 30 with risk factors)
• Has no risk factors (including family history)
• African American less likely to look for secondary HTN
• Drug use 
• Illicit 
• OTC stimulants
• NSAIDs
• Oral contraceptive pills
• SSRIs
• EtOH use
• People with resistant HTN (uncontrolled with 3 meds with adequate doses)
• People who have severe HTN
• Stable blood pressures with abrupt change
• Renal artery stenosis
• Pheochromocytoma
  

  • Headache
  • Palpitations
  • Sweats
  • HTN
• Endocrine
• Hypothyroidism
• Cushing’s Disease
• Hyperparathyroidism
• Hypertensive before puberty

• Sleep apnea
• Kidney disease
• Coarctation of aorta with decreased femoral pulses and hypotensive legs
• Primary hypoaldo (low K+ with HTN)

Questions to Ask:

• What’s causing the 2° HTN? 
• How do we change the treatment?

First Line Treatment:

• Chlorthaladone
• Diuretic
• ACE inhibitor
• Ca2+ channel blockers (Lodipine)

Take Home Points: 
Check for secondary HTN when

• Person under 30 has no risk factors
• HTN before puberty
• People with good doses and HTN still not controlled