Primary vs. Secondary Hypertension – Nephrology | Lecturio
Primary vs. Secondary Hypertension – Nephrology | Lecturio
This video “Primary vs. Secondary Hypertension ” is part of the Lecturio course “Nephrology: Secondary Hypertension” ► WATCH the complete course on http://lectur.io/secondaryhypertension
► LEARN ABOUT:
- Hypertension
- Pathogenesis of Primary Hypertension
- Clinical Manifestation of Secondary Hypertension
- Causes of Secondary Hypertension
► THE PROF:
Dr. Sussman is an Associate Professor of Medicine at the University of Arizona Health Sciences Center. She completed her medical schooling at the University of Arizona and her Internal Medicine/Chief Residency training at the University of Washington. She subsequently pursued a Nephrology Clinical and Research Fellowship at the University of Washington. Dr. Sussman was recruited back to the University of Arizona in 2009 and has served as a clinician educator with a strong emphasis in medical student education. Dr. Sussman maintains an active interest in Glomerulonephritis and innovative teaching methodologies in medical education. She additionally serves as the Medical Director of Sahaurita DCI Desert Dialysis unit and has developed and is the Clinical Director of the nocturnal in-center dialysis program at DCI South Tucson.
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Content
0.63 -> [Music]
5.359 -> hello
5.92 -> and welcome back to the nephrology
7.44 -> curriculum today we're going to be
8.96 -> talking about
9.76 -> secondary hypertension so interestingly
13.44 -> hypertension is actually the most common
15.92 -> disease specific reason
17.52 -> for office visits of adults to
19.199 -> physicians in the u.s
22.24 -> now when we think about the definition
23.76 -> of hypertension it really depends
25.519 -> on who's defining it so by the joint
27.92 -> national committee
29.119 -> which guidelines were produced in 2014
31.76 -> it's really based upon the average of
33.68 -> two or more properly measured readings
35.76 -> of each
36.399 -> of two or more visits of an initial
38.16 -> screen
39.84 -> normal blood pressure is considered a
41.52 -> systolic of less than
43.28 -> millimeters of mercury a diastolic of
45.12 -> less than 80.
46.68 -> pre-hypertension is considered a
49.039 -> systolic pressure
50.32 -> of between 120 and 139 and a diastolic
53.6 -> between
54.079 -> 80 and 89 millimeters of mercury and
56.879 -> finally hypertension
58.239 -> is staged in two stages stage 1 is
61.28 -> considered a systolic blood pressure
63.28 -> of 140 to 159 with a diastolic between
66.08 -> 90 and 99
67.52 -> and stage 2 is a systolic greater than
69.84 -> 160
70.72 -> and a diastolic greater than or equal to
72.479 -> 100.
75.04 -> now over the last couple of years we've
77.04 -> had some interesting randomized
78.4 -> controlled trials
79.52 -> and therefore the american college of
81.2 -> cardiology and the american heart
82.64 -> association
83.68 -> really have provided newer targets based
86.24 -> on the most recent evidence
88.159 -> a normal blood pressure according to the
90.159 -> acc and aha
91.92 -> is considered again less than 120 over
94.479 -> 80.
95.68 -> but an elevated blood pressure now is
97.759 -> considered a systolic between 120 and
100.36 -> 129
101.759 -> with a diastolic of less than 80. stage
104.56 -> 1 hypertension
105.6 -> is now considered a systolic between 130
108 -> and 139
109.04 -> and a diastolic of 80 to 89. stage 2
112.64 -> by the acc and aha is considered a
115.119 -> systolic greater than or equal to 140
117.36 -> and a diastolic greater than or equal to
119.52 -> 90.
120.799 -> now these are updated targets and i want
122.799 -> you to stay tuned because as new data
124.88 -> comes in
125.68 -> these might be moving targets for you
130.08 -> so when we think about hypertension the
131.84 -> majority of physician visits for
133.44 -> hypertension are due to what we used to
135.68 -> term essential
136.72 -> or primary hypertension but about 10
140 -> percent of those cases
141.2 -> are actually due to secondary
142.8 -> hypertension
145.28 -> when we think about the pathogenesis of
147.2 -> primary hypertension
148.72 -> it's really multifactorial and the
150.4 -> purpose of this slide is not to have you
152.16 -> memorize it
153.04 -> but to really understand that there's so
154.959 -> many different things that go
156.64 -> into primary hypertension we have things
159.76 -> like an increase in sympathetic nervous
161.519 -> tone
162.08 -> we have activation of ras that will
164.72 -> increase cardiac output
166.239 -> we also have local and circulating
169.2 -> regulators
170.319 -> that will ultimately increase peripheral
172.08 -> vascular resistance that
173.68 -> ultimately will manifest into primary
175.84 -> hypertension
177.76 -> this is in contrast to the pathogenesis
179.84 -> of secondary hypertension
181.68 -> where the pathogenesis is related to the
183.599 -> underlying condition
185.36 -> this is due to things like renal
186.72 -> vascular disease a functioning adrenal
189.2 -> adenoma
190.48 -> sleep disorder breathing medications
192.879 -> either iatrogenic or illicit substances
195.36 -> things like black licorice typically
197.12 -> european
198.48 -> and then finally coarctation of the
200 -> aorta
202.8 -> so when you have that patient sitting in
204.4 -> front of you it's very difficult
206.159 -> sometimes to distinguish between primary
208.319 -> and secondary hypertension
210.319 -> but there are a few clinical clues that
212.64 -> can suggest the presence of a secondary
214.48 -> cause
215.68 -> this includes things like young age of
217.84 -> onset typically before the third decade
221.28 -> a sudden onset of hypertension in
223.04 -> somebody who normally
224.319 -> was normotensive or uncontrolled or
227.76 -> refractory
228.64 -> hypertension we can also see things like
232.08 -> hypokalemia in association with
234.319 -> metabolic alkalosis
236.239 -> oftentimes without the use of diuretics
239.92 -> can also see a patient who perhaps has
242.08 -> features of a recognized underlying
244.159 -> cause
244.879 -> for example new onset of hyperglycemia
247.599 -> in the setting of weight gain
248.72 -> characterized by truncal obesity
250.799 -> immune faces very suggestive of
253.599 -> cushing's syndrome
256.959 -> so when we think about the causes of
258.32 -> secondary hypertension it's easiest to
260.56 -> group them into different categories
262.479 -> so we can group them into renal
264.4 -> categories
265.52 -> these are things like renal vascular
267.04 -> hypertension and renal parenchymal
269.12 -> hypertension
271.36 -> endocrine causes or endocrinopathies
274.32 -> these are things like primary
276.04 -> hyperaldosteronism
277.6 -> cushing's syndrome or cushing's disease
280.08 -> via chromocytoma
281.8 -> hyporeninism and hypothyroidism
286.08 -> we can also have cardiovascular causes
288.4 -> like sleep disordered breathing with
289.68 -> obstructive sleep apnea
291.28 -> and coachtation of the aorta now i want
294.16 -> you to notice that i've bolded a couple
296.16 -> of these topics and that's because we're
297.759 -> going to be going through those today
299.52 -> it's also because that's what you're
300.96 -> going to encounter most often in the
302.8 -> clinical scenario
304 -> and that's what you're going to be
305.12 -> responsible for on your boards
308.96 -> there's a couple of other causes to
310.32 -> think about in terms of secondary
311.759 -> hypertension
313.12 -> inherited causes these are a little bit
315.68 -> more obscure
316.639 -> but you should be aware of what they are
318.72 -> there are things like glucocorticoid
320.16 -> remediable aldosteronism
321.919 -> it's quite a mouthful but essentially
323.68 -> what that is is acth dependent
325.919 -> aldosterone production
327.199 -> so people have mineral corticoid excess
330.16 -> there's also something called syndrome
331.759 -> of apparent mineral or corticoid excess
333.84 -> another mouthful
335.039 -> but this is something that actually
337.039 -> causes excess cortisol levels that
338.96 -> activate mineral
340.039 -> mineralocorticoid receptors there's
342.96 -> little syndrome
344 -> which we'll be talking about in our
345.68 -> potassium lecture this is a gain of
347.759 -> function mutation at the epithelial
349.44 -> sodium channel
350.96 -> gordon syndrome which is essentially
352.88 -> like a gain of function
354.08 -> in the sodium chloride co-transporter in
355.919 -> the distal convoluted tubule
358 -> and then congenital adrenal hyperplasia
359.919 -> the 11 beta-hydroxylase variant which
361.759 -> again is going to cause
362.919 -> mineralocorticoid activation
366.4 -> now there's some medications and
367.52 -> supplements that you should be aware of
368.88 -> that can cause hypertension as well
371.199 -> things like glucocorticoids
373.52 -> non-steroidal anti-inflammatory drugs
376.08 -> combined oral contraceptives calcineurin
378.88 -> inhibitors these are medications we give
380.639 -> to our organ transplant recipients
383.28 -> pseudoephedrine caffeine which i think
386.319 -> many of us probably drink
388 -> and licorice and when i talk about
389.36 -> licorice i'm talking about typically
391.039 -> black licorice that
392.16 -> is not the typical kind that we get in
394.4 -> the united states but typically abroad
409.37 -> [Music]
418.4 -> you
Source: https://www.youtube.com/watch?v=0X5qBjNjujs