Interesting Cases in Hypertension: Useful Lessons on Management Gurpreet S Wander
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdomen, computed tomography scan of 140
Acalculia 109
Acute coronary syndrome 55, 160, 168, 169
Acute glomerulonephritis 81, 91
management of 91
Acute myocardial infarction 126, 168, 169
Acute organic brain syndrome 91
Adrenal adenoma 146
Adrenal carcinoma 146
Adrenal hyperplasia, primary 146
Adrenalectomy 144
Agnosia 109
Agranulocytosis 148
Albumin-creatinine ratio 88
Albumin-excretion rate 88
Albuminuria 87
management of 89
Alcohol 27
moderation of 32
Aldosterone antagonists 171
Aldosteronism, primary 27
Alexia 109
Ambulatory blood pressure monitoring 17, 32, 59, 94
role of 61
American College of Cardiology 170
American Heart Association 170
Amlodipine 30, 86, 89
Amphetamine 27
Aneurysm
intracranial 114
treatment options for 120
Angina 157
Angiotensin-converting enzyme inhibitors 3, 12, 13, 33, 72, 76, 80, 89, 91, 131, 155, 160, 164, 165, 167, 171
Angiotensin-receptor
antagonists 91
blockers 3, 12, 13, 33, 72, 89, 91, 136, 156, 161, 164, 165, 169, 171
neprilysin inhibitor 164, 165
Anomia 109
Anosognosia 109
Antecedent hypertension, prevalence of 168
Anticoagulation 112
Anticonvulsant therapy 70
Antihypertensive agent 136, 168, 173
Antihypertensive drugs 34, 74
dialyzability of 96t
downregulation 35
withdrawal, benefits of 34
Antihypertensive medication 133
Antihypertensive therapy 3, 82
Antihypertensive treatment 176
downregulation of 34
Antiplatelet agent 112
Antithrombotic treatment 112
Aorta, atypical coarctation of 66
Aortic aneurysm 32
Aortic arch syndrome 66
Aortic coarctation 27
Aortic dissection 32
Aortic pulse wave velocity 22
Aortitis syndrome 66
Aortoarteritis 65
Arrhythmias 32
Arterial stiffness 21
Arteritis 66
Atenolol 86, 89
Atherosclerosis 6
Atrial fibrillation 172, 173, 175, 176
Automated office blood pressure 28
B
Berry aneurysm 114
Beta-blockers 3, 13, 160, 165, 170
cholesterol-lowering asymptomatic plaque study 7
intravenous 102
Bisoprolol 165t
Bleeding, reoccurrence of 124
Blood flow 116
Blood pressure 30, 49, 57, 71, 83, 89, 116, 125, 135
and hypertension, effect of cigarette smoking on 20
arterial 94
central 21
control 34, 102
diastolic 42, 59, 92, 158
effect of lipid-lowering therapy on 6
goal 87
lower 133
lowering therapy on lipid levels, effect of 7
management 169
measurement 58, 95
severe pre-eclampsia besides 68
systolic 1, 15, 22f, 42, 59, 67, 92, 158
Blood sugar
fasting 57
postprandial 57
Blood vessel disorders 116
Body mass index 15, 70
Brain natriuretic peptide 155
Brainstem 101
Breastfeeding mothers drug for 78t
Breath, severe shortness of 174
Breathlessness 77
Broca's aphasia 37
C
Calcium channel
antagonists 13
blockers 4, 28, 30, 33, 160, 166, 170
Carbimazole 148
Cardiac resynchronization therapy 164fc
Cardiovascular disease 2, 42, 174
Cardiovascular system 25
Carvedilol 165
Caudate nucleus 101
Central nervous system 67, 107
Cerebellum 101
Cerebral
artery 110, 116
anterior 109
atherosclerosis 116
ischemia, delayed 121
vasoconstriction syndrome 76
vasospasm, extent of 124
Cerebrovascular accident 55, 108
Chest pain 174
Chloride 57
Chlorthalidone 30, 86, 89
Chronic hypertension 70, 72, 77, 126
in pregnancy 71, 72
Chronic inflammatory vasculitis 66
Chronic kidney disease 2, 26, 49, 57, 81, 86, 87, 94, 161
classification of 86
pulse pressure and progression of 45
Chronic obstructive pulmonary disease 18
Circle of Willis 116
Clevidipine 130
Cocaine 27
Combination therapy 4
Conn's syndrome 141143
Conn's tumor 143
Consciousness, diminished level of 117
Coronary artery disease 7, 32, 49, 53, 157, 158
pathogenesis of 159
Corticosteroids 31
Corticotropin-releasing hormone 145, 146
Cranial computed tomography 128
Cushing's disease 27
Cushing's syndrome 142, 144146
etiology of 146b
Cyclooxygenase-2 inhibitors 31
Cyclosporine 27, 31
D
Decongestants 27
Deep tendon reflexes, assessment of 75
Deep venous thrombosis 120
Depression 145
Dextroamphetamine 27
Diabetes mellitus 15, 26, 27, 57, 89, 93, 161
Diet pills 27
Dietary sodium restriction 32
Digital subtraction angiography 118
Dihydropyridine calcium-channel blockers 17, 91
Diuretics 12, 13, 89, 130, 171
Drug therapy goals 95
Dyslipidemia 15
Dyspnea 53, 80
causes of 54
E
Eclampsia 70, 74, 75
management of 74
Ectopic, adrenocorticotropic hormone production 146
Ectopic, corticotropin-releasing hormone production 146, 146b
Ectopic thyroid tissue 148b
Ejection fraction 163
Electrocardiogram 25, 38, 47, 48, 138, 157, 162, 174
Electroencephalogram 129
Electrolyte disturbance 55
Enalapril 93, 165t
Epithelial sodium channels 143
Erythropoietin 27
Esmolol 120, 129
Evidence-based medical therapy 99
Excessive dietary salt ingestion 26
F
False resistant hypertension 141
causes of 142b
Felodipine 166
Fenoldopam 131
Fertility 67
Fetal effects 70
Finger agnosia 109
Fisher scale 119
Furosemide 89
G
Gastrointestinal tract 10
Genetic disorders 116
Glasgow coma
scale 98
score 119
Glomerular filtration rate 80, 83, 87
Glomerulonephritis 92
chronic 81, 92
Glomerulosclerosis, focal segmental 81
Glucose management 103
Graves' disease 147, 148
H
Headache 41
episodic 138, 139
intractable 116
severe 77
Heart
disease, coronary 6, 158
failure 32, 153, 154fc, 156fc, 163, 163f
chronic 168
congestive 162
symptomatic 164fc
outcomes prevention evaluation 3
rate 25, 57, 159, 164
Hematuria
macroscopic 92
microscopic 91
presence of 90
Hemiasomatognosia 109
Hemoglobin 57
Hemorrhage
intracranial 108
intraventricular 105
recurrent intracerebral 104
retinal 117
severity of 124
Hemostatic therapy 104
Hepatorenal syndrome 90
Home blood pressure
measurement 28, 32
monitoring 59
role of 57
Hormone, adrenocorticotropic 146
Hydralazine 73, 130, 166
Hydrocephalus, acute symptomatic 122
Hydrochlorothiazide 12, 73, 141
Hyperaldosteronism 143
Hyperparathyroidism 27
Hypertension 10, 12, 15, 20f, 34, 38, 47, 52, 5557, 61, 68, 69, 76, 80, 81, 83, 90, 9295, 97, 98, 100, 104, 113, 116, 126, 133, 137, 141, 142, 144, 147, 149, 158, 161, 163
and acute myocardial infarction 167
and atrial fibrillation 172
and concomitant risk factors 1
and coronary artery disease 157
and diabetes 1
and dyslipidemia 4
and heart failure 152, 162
and obesity 14
and renal disorders 80
and wide pulse pressure 41
arterial 131
control of 1, 139
cuff-inflation 63
degree of 69
development of 10, 11, 79
diastolic 142
drug-resistant 15
encephalopathy 125
importance of 159
in acute hemorrhagic stroke 98
in acute ischemic stroke 107
in aortoarteritis 65
in diabetics, treatment of 2
in hyperuricemia 9
in hypothyroidism, treatment of 149
in microalbuminuria 85
in postpartum period 76
in pregnancy 65
in smokers 18, 19
interpretation of 92
intracranial 122
intradialytic 9496
isolated ambulatory 63
isolated systolic 3032, 33f, 34, 147
labile 62, 64
left bundle branch block in 50
leptins stimulate 14
malignant 80
management of 91
masked 63
pathogenesis of 80, 81
pregnancy-induced 116
refractory 64
resistant 14, 25, 26, 29, 62, 64
secondary 93, 138, 141
severe 75
staging of 92
symptomatic 93
syndromes 22
T wave in 55
transient 69, 77
treatment of 13, 164
types 25
uncomplicated 134
uncontrolled 26
white coat 61, 63
Hypertensive crisis 126
Hypertensive encephalopathy 91, 93, 125127
incidence of 125
Hypertensive retinopathy, features of 32
Hypertensive target organ damage 93
Hyperthyroidism 147, 148
causes of 147
iodide-induced 148
Hyperuricemia 9, 10, 12, 13
management of 13
role of 11
Hyponatremia 122
Hypothyroidism 145, 147, 150
I
Indian Hypertension Guidelines 2
Infections 116
Internal carotid artery 109
Interventricular septum 167
Intracerebral hemorrhage 98, 102
score 105t
Intracranial pressure control 103
Intrauterine growth restriction, high incidence of 67
Invasive therapy 104
J
Jargon speech 109
K
Keith-Wagener-Barker retinopathy 127
Kidney
injury, acute 84
vasculature of 83
L
Labetalol 73, 102, 120, 129
Large-vessel stroke within
anterior circulation 109
posterior circulation 110
Left ventricular
ejection fraction 41, 164
hypertrophy 5, 9, 18, 26, 27, 37, 41, 47, 53, 163, 167, 169, 173
Limb leads 49
Lipitension 6, 7
Lisinopril 86, 165
Losartan 13t
M
Magnetic resonance imaging 101, 118, 140
Malaise 77
Martorell syndrome 66
Maternal hypoxia and trauma, prevention of 75
Mean arterial pressure 94
Meningismus 117
Metabolic syndrome 5
components of 5
Methimazole 148
Methyldopa 72
Metoprolol 73
succinate 165
Microalbuminuria 85
Middle aortic syndrome 66
Middle cerebral artery 115
Mineralocorticoid receptor antagonist 165
Modafinil 27
Monocyte chemoattractant protein-1 12
Moxonidine 17
Multiple endocrine neoplasia type 2 139
Muscle sympathetic nervous activity 29
Myalgia, diffuse 80
Myocardial infarction 159, 163, 167, 175
N
National Cholesterol Education Program 5
Natriuretic peptides 162
Natural licorice 27
Nausea 77
Nebivolol 165
Nelson's syndrome, features of 144
Nephritic illness 90
Nephritic syndrome 92
Nephritis, acute 90
Nephrotic syndrome 90
New onset postpartum hypertension, incidence of 76
New York Heart Association 152, 162
Nicardipine 130
Nifedipine 73
Nitrates 161, 166
Nitric oxide 20
Nitroglycerin 130, 169
Noncontrast computed tomography 118
Nonsteroidal anti-inflammatory
agents 27
drugs 25, 31, 80
O
Obesity 26, 34
and hypertension 14
Obesity-related hypertension, treatment of 17
Obstructive sleep apnea 26, 27
Oral contraceptive 27
use 145
P
P wave terminal force 54
Palpitations 139
Panaortitis 66
Peripheral artery disease 175
Petrosal vein, inferior 145
Pharmacological therapy 144
Phentolamine 131
Pheochromocytoma 27, 138140, 142
bilateral 140
treatment for 139
Pituitary adenoma 146
Platelet count 57
Platelet-derived growth factor 11, 12
Polycystic ovarian disease 145
Posterior reversible encephalopathy syndrome 126
Post-myocardial infarction 167
Postpartum hypertension
life-threatening complication of 76
management of 77, 78fc
Potassium 57
Precordial leads 49
Prednisone 86
Pre-eclampsia 68, 70
diagnosis of 69
risk factors for 69
treatment of 68
Pre-existing hypertension, causes of 71
Pregnancy
and Takayasu's arteritis 67
in aortoarteritis 65
Prehypertension 92
Primary hyperaldosteronism 142, 143
causes of 141
Propylthiouracil 148
Prostatic hyperplasia, benign 30
Protein-creatinine ratio 88
Protein-excretion rate 88
Proteinuria 87, 9092
asymptomatic non-nephrotic 91
Pseudohypertension 62, 63
Pulmonary artery systolic pressure 18, 41, 152, 155
Pulse pressure 44
and age 43
and antihypertensive therapy 45
and cardiovascular disease 45
and diabetes 45
Pulseless disease 66
Putamen 101
R
Ramipril 165
Rapidly progressive glomerulonephritis 92
Reactive oxygen species 20
Red cell casts 90
Renal artery stenosis 27
Renal denervation therapy 29
Renal disease, end-stage 58
Renal failure 92
Renal parenchymal disease 27
Renin-angiotensin-aldosterone system 2, 6, 17, 94, 159, 173
excessive activity of 81
Respiratory system 25
Rhabdomyolysis 90
S
Seizures 75, 77, 100
management of 103
recurrent 75
Selective cyclooxygenase-2 inhibitors 27
Sensory agraphia 109
Sinus tachycardia 138
Small bowel disease 10
Small vessel disease 110
Smoking on blood pressure
acute effects of 20
chronic effects of 21
Sodium 57
and water retention 81
nitroprusside 130
sensitive hypertension 11
Stress management 33
Stroke 32, 58, 108, 113, 134, 159, 173
acute 107
hemorrhagic 98
ischemic 107, 108
and rehabilitation centers 112
hemorrhagic 99, 106
ischemic 108
positive family history of 116
ST-segment elevation myocardial infarction 170
Subarachnoid hemorrhage 113, 116, 118, 124
complication of 114
diagnosis of 114
management of 114
Sweating 138, 139
Sympathetic nervous system, overactivity of 81
T
Takayasu's arteritis 65, 66
management of 67
Target blood pressure 99
Target organ diseases 49
Thalamus 101
Thiazide 2, 28
diuretics 3
Thromboaortopathy, occlusive 66
Thrombolysis, intravenous 111
Thyroidectomy, bilateral subtotal 149
Thyroiditis
chronic 148
post-partum 148
subacute 148
Thyroid-stimulating hormone secretion 148
Thyrotoxicosis 144, 147, 148
causes of 148b
factitia 148
Tissue plasminogen activator 20
Torsemide 89
Total leukocyte count 57
Toxic adenoma 148
Toxic multinodular goiter 148
Toxicosis, transient 148
Transient ischemic attack 108
Tumor
intracranial 27
metastatic 116
trophoblastic 148
U
Unstable angina 126
Uric acid
metabolism of 10, 11
physiology of 11
role of 12f
Urinary albumin excretion 85
three categories of 88t
Urinary metanephrines 138
V
Vascular ischemia 67
Ventricular premature depolarizations 52
Ventricular septal defects 167
Visual disturbances 77
Vomiting 77, 80
von Hippel-Lindau syndrome 139
W
Weight reduction 32
Windkessel function 31
World Federation of Neurological Surgeons 118
×
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Interesting Cases in Hypertension Useful Lessons on Management
Interesting Cases in Hypertension Useful Lessons on Management
Chief Editor Gurpreet S Wander MD DM Professor and Head Department of Cardiology Hero DMC Heart Institute Dayanand Medical College and Hospital Ludhiana, Punjab, India Editors Siddharth N Shah YP Munjal M Chenniappan Falguni S Parikh Narinder Pal Singh Anupam Prakash Nihar P Mehta Vitull Gupta
Jaypee Brothers Medical Publishers (P) Ltd
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Interesting Cases in Hypertension: Useful Lessons on Management / Gurpreet S Wander
First Edition: 2020
9789389587593
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Contributors
Chief Editor
  • Gurpreet S Wander MD DM
    Professor and Head
    Department of Cardiology
    Hero DMC Heart Institute
    Dayanand Medical College and Hospital
    Ludhiana, Punjab, India
Editors
  • Siddharth N Shah MD FACP (Hon) FRCP (Edin)
    Consultant
    Bhatia, SL Raheja, Saifee, and Sir HN Reliance Hospitals
    Mumbai, Maharashtra, India
  • M Chenniappan MD DM
    Consultant Cardiologist
    Ramakrishna Medical Centre
    Tiruchirappalli, Tamil Nadu, India
  • Narinder Pal Singh MD MBA FRCP FACP FISN FICP
    Senior Director
    Department of Internal Medicine
    Max Super Speciality Hospital
    Ghaziabad, Uttar Pradesh, India
  • Nihar P Mehta MD DNB (Medicine) DNB (Cardiology) FRCP (London)
    Consultant Cardiologist
    Jaslok Hospital, Breach Candy Hospital
    Sir HN Reliance and Bhatia Hospital
    Mumbai, Maharashtra, India
  • YP Munjal MD (Medicine)
    Medical Director and Honorary Senior Consultant
    Diabetes and Life Style Disease Center
    Banarsidas Chandiwala Institute of Medical Sciences
    New Delhi, India
  • Falguni S Parikh MD DNB FICP MNAMS
    Consultant
    Department of Internal Medicine
    Kokilaben Dhirubhai Ambani Hospital
    Mumbai, Maharashtra, India
  • Anupam Prakash MD PGCC (Hosp Mgt) PDCC (Dialysis Med) MAMS FICP FACP FIACM
    Professor
    Department of Medicine
    Lady Hardinge Medical College
    New Delhi, India
  • Vitull Gupta MD
    Consultant
    Department of Medicine
    Kishori Ram Hospital and Diabetes Care Centre
    Bathinda, Punjab, India
Preface
We are happy to present this book which discusses some practical aspects in the management of Hypertension. We have presented case scenarios followed by some questions which the reader can answer for self. This is followed by a discussion on the topic. The answers to the questions are available in the discussion that follows. The contributing authors have all put up interesting cases with some lessons in management of your patients with hypertension. The editors are all experts in their fields with vast experience in management of these patients. Each section has been developed by an expert of the field. I have written the section on hypertension and cardiac effects.
Hypertension is the commonest non-communicable disease and has a prevalence of 28% in our country. It causes multiple target organ damage which changes the approach to management of a given case. The “Indian Guidelines on Management of Hypertension IGH- IV” were released in 2019 and should be used as a reference for management of patients. These are available on the JAPI website and can be read through the link https://japi.org/october_2019_spl/contents.html.
It is important to use the Indian guidelines since these are adapted to our population and are based on lot of data from our own country. There have been some changes in the approach to management of hypertension. The recent ACC/AHA guidelines were released in 2017 and the definition of hypertension was changed to >130/80. The subsequent ESC/ESH guidelines of 2018 and also the Indian guidelines have retained a value of >140/90 for definition of hypertension. There are many such subtle differences in approach of management which depend on the social, economic, cultural, dietary and healthcare delivery system of different countries. In this sense this book will be useful since it incorporates the experience and concepts of some experts who have managed patients with hypertension for a lifetime. It is not intended to be a textbook on hypertension. It only is a practical, useful and easy reading for guidance of clinicians regarding management of individual patients.
I have no words to express my gratitude to Mr Jitendar P Vij, Group Chairman of Jaypee Brothers Medical Publishers (P) Ltd who has taken personal interest in bringing out this book. But for his interest and guidance it would not have been possible to bring out this book. Each of the editors have contributed interesting cases, some questions and meaningful discussions. I am thankful to the staff of Jaypee Publishers specially Dr Richa, Dr Nidhi, and Himani Pandey who have made useful corrections in some of the errors that we missed as an oversight. Muskan Sharma, my secretary worked very hard to knit the whole assembly together so as to present it in the form of this beautiful book.
The ultimate aim of any academic exercise is to benefit our patients. We all will be very satisfied in case it helps to manage your patients in a better form and with evidence based.
Gurpreet S Wander