Saturday, September 29, 2018
Renal insufficiency
Renal insufficiency is poor function of the kidneys that may be due to a
reduction in blood-flow to the kidneys caused by renal artery disease. Normally, the kidneys regulate
body fluid and blood pressure, as well as regulate blood chemistry and remove
organic waste. Proper kidney function may be disrupted, however, when the
arteries that provide the kidneys with blood become narrowed, a condition
called renal artery stenosis. Some patients with renal insufficiency experience
no symptoms or only mild symptoms. Others develop dangerously high blood
pressure, poor kidney function, or kidney failure that requires dialysis.
Risk factors
The risk factors for renal insufficiency due to renal artery disease are
those associated with atherosclerosis:
- Older
age
- Gender
- Family
history
- Race
or ethnicity
- Genetic
factors
- Hyperlipidemia
(elevated fats in the blood)
- Hypertension
(high blood pressure)
- Smoking
- Diabetes
- Obesity
Patients known to have atherosclerosis and diagnosed with coronary artery disease or peripheral artery disease are at greater risk for renal insufficiency.
Diagnosis
Renal artery disease can usually be diagnosed via duplex ultrasound
scanning and other non-invasive tests. These include CT angiography and MR
angiography. However, the definitive test is contrast angiography, a test that
involves the injection of dye. If a severely blocked renal artery is discovered
during an angiogram, treatment to open the artery may be performed during the
same procedure.
Treatment
Patients with renal insufficiency who have mild or moderate symptoms can
be treated with medication and monitored regularly through blood pressure
measurements and blood tests to monitor kidney function. Those with severe
renal insufficiency or symptoms, including renovascular hypertension.
Friday, September 28, 2018
HYPERTENSION
Hypertension
Blood pressure is the force exerted
by the blood against the walls of the blood vessels. The pressure depends on
the work being done by the heart and the resistance of the blood vessels.
Medical guidelines define
hypertension as a blood pressure higher than 120 over 80 millimeters of mercury
(mmHg), according to guidelines issued by the American Heart Association (AHA)
in November 2017.
Hypertension and heart disease are
global health concerns. The World Health Organization (WHO) suggests that the
growth of the processed food industry has impacted the amount of salt in diets
worldwide, and that this plays a role in hypertension.
This Hypertension Highlights
publication summarizes key changes and information from the 2017 Guideline for
the Prevention, Detection, Evaluation and Management of High Blood Pressure in
Adults. It focuses on recommendations and changes that are most significant for
the treatment of patients with hypertension. For more detailed information and
references, see the full 2017 Hypertension Guideline publication.
Important Statistics The 2017
Hypertension Guideline includes some important new statistics. Under the
updated guideline, more people will be diagnosed with hypertension—nearly half
of American adults (46%), up from 32% under the previous definition. But nearly
all of these new patients can treat their hypertension with lifestyle changes
instead of medications, and overall only a small percentage more adults will
also require antihypertensive medications. Specifically, the updated guideline
means that most black adults have hypertension—56% of women and 59% of men—and
black men now have the highest rate of hypertension; previously, black women
did. Hypertension rates will also nearly triple among all men 20 to 44 years of
age, increasing to 30% from 11%. In addition, rates of hypertension will double
among women younger than age 45, from 10% to 19%. Hypertension is also present
in more than 80% of patients with atrial fibrillation, by far the most common comorbid
condition regardless of age,18 and 80% of adults with diabetes mellitus have hypertension.19
Other statistics in the updated
guideline show that only about 20% of patients with hypertension followed their
treatment plan well enough to improve, and up to 25% of patients fail to even
fill their initial prescription. Left untreated, systolic BP higher than 180 mm
Hg or diastolic BP higher than 120 mm Hg can lead to a nearly 80% chance of the
patient dying within a year. Average survival for this group is about 10
months.
Diagnosing Hypertension
Recommendation: BP categories are
normal, elevated, or stage 1 or 2 hypertension.
The new Hypertension Guideline
changes the definition of hypertension, which is now considered to be any
systolic BP measurement of 130 mm Hg or higher or any diastolic BP measurement
of 80 mm Hg or higher. Hypertension was previously defined as a systolic BP of
140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher. With the updated
guideline, measurements of 140/90 mm Hg or higher are considered stage 2
hypertension. Individuals with stage 1 or stage 2 hypertension should consult a
healthcare provider for further treatment.
Extremely high BP (systolic higher tan
180 mm Hg or diastolic higher than 120 mm Hg) with target organ damage is still
considered an emergency.
A continuous association exists
between higher BP and increased CVD risk, so it is useful to categorize BP
levels for clinical and public health decision-making: normal BP, elevated BP,
stage 1 hypertension, and stage 2 hypertension.
Measurement of BP
Although measuring BP in office
settings is relatively easy, errors commonly occur, which can obscure a
patient’s true BP level. Growing evidence supports the use of automated office BP
measurements.
Patient Evaluation and History
When evaluating patients, note that
primary hypertension likely requires treatment and is not due to a modifiable
factor while secondary hypertension causes need to be explored and corrected
before you diagnose hypertension.
Certain historical features favor
specific causes of hypertension. Features of primary hypertension include
• Gradual increase with slow rate
of rise in BP
• Lifestyle factors that favor
higher BP
• Family history of hypertension Features
of secondary hypertension include
• BP lability, episodic pallor, and
dizziness (pheochromocytoma)
• Snoring, hypersomnolence
(obstructive sleep apnea)
• Prostatism (chronic kidney
disease)
• Muscle cramps, weakness
(hypokalemia from primary or secondary aldosteronism)
• Weight loss, palpitations, heat
intolerance (hyperthyroidism)
• Edema, fatigue, frequent
urination (kidney disease or failure)
• History of coarctation repair
• Central obesity, facial rounding,
easy bruisability (Cushing syndrome)
• Medication or substance use (eg,
alcohol, nonsteroidal anti-inflammatory drugs, cocaine)
• Absence of family history of
hypertension.
Blibliography
- Burt, Vicki L., et al. "Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991." Hypertension 25.3 (1995): 305-313.
- Ong, Kwok Leung, et al. "Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004." Hypertension 49.1 (2007): 69-75.
Wednesday, September 26, 2018
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