Cardiovascular – Hypertension他

勉強ノート

Secondary Hypertension Causes（二次性/続発性高血圧の原因）

  • Primary HTN (95%)
  • Secondary HTN (5%)

 

(1) Kidney, (2) Heart, and (3) Thyroid gland

(1) Kidney

Hyperaldosteronism – too much aldosterone (unprovoked hypokalemia)

Regal artery stenosis (RAS) – 70-80%詰まったら、renin-angiotensin systemが発動する。3歳以下(r/t fibrodysplasia/fibromuscular dysplasia)か、50歳以上(r/t atherosclerosis)。RASがある人は、Primary HTNもある。(Renal arteriography)

Pheochromocytoma – adrenal medulla tumor – produce too much catecholamines – (urinalysis VMA)。 VMA=vanillylmandelic acid=metabolic by-product of epinephrine or norepinephrine

Kidney disease with the kidney parenchyma (urinalysis)

 

(2) Heart

Coarctation of the aorta (stenosis) – congenital defect – 子供の頃は気づかず、大人になってから高血圧の症状で発見されることも多い。

 

(3) Thyroid gland disorders

Hyper/Hypothyroidism

 

 

 

Antithrombotic therapy

Anti-thrombotic therapy include antiplatelet drugs and anticoagulation drugs.

Antiplatelet agents – prevent platelets from crumping  – Angina, A-fib, CAD, AAA

  • Low-dose Aspirin (acetylsalicylic acid/ASA) – NSAID, COX inhibitor
  • Clopidogrel, ticagrelor, ticlopidine, prasugrel – Adenosine diphosphate (ADP) receptor inhibitors

 

Anticoagulant therapy (agents) – prevent blood clotting. – Stroke, MI, A-fib, PE, DVT – NOT for AAA (Cameron et al., 2018)

  • Unfractionated heparin (UFH)
  • Low-molecular-weight heparin (LMWH) – enoxaparin
  • Warfarin (oral)

AAAと診断されたら、処方されるのは「low-dose (81mg) Aspirin」

 

Reference

Cameron, S. J., Russell, H. M., & Phillip-Owens, A. (2018). Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental?. Blood, 132 (25), 2619–2628. doi: https://doi.org/10.1182/blood-2017-08-743237. https://ashpublications.org/blood/article/132/25/2619/39564/Antithrombotic-therapy-in-abdominal-aortic

 

A-fibrillation (A-fib)

  • Irregular R-R interval and no distinct P wave
  • “Irregularly-irregular” 

Check underlying causes first. Underlying causes include:

  • Rheumatic heart disease
  • Mitral valve disease
  • Cardiomyopathy
  • Myocarditis
  • Acute alcohol intoxication
  • Alcohol withdrawal
  • Hyperthyroidism
  • Pneumonia
  • Pulmonary embolism
  • Others..

 

Orthostasis 

Normal human physiologic response of the autonomic nervous system. Orthostatic hypotension is the second most common cause of syncope that often affects older adults. 

4 compensatory mechanisms are involved in the blood pressure redistribution system of the body, and autonomic reflex is the most important mechanism (Munoz et al., 2023). 

Orthostatic hypotension occurs most frequently in people with the peripheral autonomic nervous system dysfunction or neurodegenerative disorders. (diabetes or Parkinson disease) 

Also, in people who are taking vasoactive (affects blood vessels) medications.

 

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Image: (Rivasi et al., 2020)

Reference

Munoz, A. C., Vohra, S., & Gupta, M. (2023). Orthostasis. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/30422533/

Rivasi, G., Rafanelli, M., Mossello, E., Brignole, M., & Ungar, A. (2020). Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications. Drugs & aging, 37(10), 725–738. https://doi.org/10.1007/s40266-020-00796-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524811/