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hiperteny esenc

hiperteny esenc

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Published by Micija Cucu
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Published by: Micija Cucu on Jul 29, 2013
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07/29/2013

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Other diagnostic factors
headache
visual changes
dyspnoea
chest pain
sensory or motor deficit
1st tests to order 
ECG
fasting metabolic panel with estimated GFR
fasting lipid panel
Hb
urinalysis with microalbumin
Tests to consider 
echocardiogram
carotid Dopplers
plasma renin activity (PRA)
plasma aldosterone
renal duplex ultrasound/MRA renal arteries
24-hour urine phaeochromocytoma screen
24-hour urine free cortisol
TSH
ambulatory BP monitor 
Ongoing
no comorbidity (other than osteoporosis): non-pregnant
stage 1 HTN (BP 140 to 159/90 to 99 mmHg)
o
diuretic monotherapy + lifestyle modification
o
 ACE inhibitor/angiotensin-II receptor blocker monotherapy + lifestyle modification
o
beta-blocker monotherapy + lifestyle modification
o
dihydropyridine CCB monotherapy + lifestyle modification
stage 1 not at goal with monotherapy or stage 2 (BP ≥160/100 mmHg)
 
o
thiazide + ACE inhibitor/angiotensin-II receptor blocker + lifestyle modification
o
 ACE inhibitor/angiotensin-II receptor blocker + dihydropyridine CCB + lifestyle modification
o
 ACE inhibitor/angiotensin-II receptor blocker + beta-blocker + lifestyle modification
o
thiazide + beta-blocker + lifestyle modification
o
beta-blocker + dihydropyridine CCB + lifestyle modification
concomitant CAD without CHF: non-pregnant
stage 1 HTN (BP 140 to 159/90 to 99 mmHg)
o
beta-blocker monotherapy + lifestyle modification
o
dihydropyridine CCB monotherapy + lifestyle modification
stage 1 not at goal with monotherapy or stage 2 (BP ≥160/100 mmHg)
o
beta-blocker + dihydropyridine CCB + lifestyle modification
o
beta-blocker + ACE inhibitor/angiotensin-II receptor blocker + lifestyle modification
o
thiazide + beta-blocker + lifestyle modification
o
 ACE inhibitor/angiotensin-II receptor blocker + thiazide + lifestyle modification
concomitant CHF with ejection fraction less than 55%: non-pregnant
NYHA class I or II
o
 ACE inhibitor/angiotensin-II receptor blocker + beta-blocker + lifestyle modification
o
non-aldosterone-blocking diuretics
NYHA class III or IV
o
 ACE inhibitor/angiotensin-II receptor blocker + beta-blocker + aldosterone antagonist + lifestylemodification
o
non-aldosterone-blocking diuretics
o
substitution or addition of isosorbide dinitrate/hydralazine
concomitant LVH without CAD: non-pregnant
angiotensin-II receptor blocker/ACE inhibitor monotherapy + lifestyle modification
concomitant diabetes or chronic renal disease without cardiovascular disease: non-pregnant
stage 1 HTN (BP 140 to 159/90 to 99 mmHg)
o
 ACE inhibitor/angiotensin-II receptor blocker monotherapy + lifestyle modification
o
dihydropyridine CCB monotherapy + lifestyle modification
o
thiazide monotherapy + lifestyle modification
o
beta-blocker monotherapy + lifestyle modification
stage 1 not at goal with monotherapy or stage 2 (BP ≥160/100 mmHg)
o
 ACE inhibitor/angiotensin-II receptor blocker + thiazide + lifestyle modification

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