Hypertension

Allan B. Schwartz, M.D., F.A.C.P.
Disclosures		Relationship: Yes Grants/Research Support: Astella, Sanofi Biomed Honorarium: Speaker's Bureau (Sanofi, Novartis, and OrthoBioTech)

The Planners of this activity have no relationships to disclose.

Allan B. Schwartz, MD, is professor of medicine at Drexel University College of Medicine where he is also director of continuing medical education. Here, he discusses the risk factors, diagnosis and management of hypertension.

This lecture and the post-test is worth 2.0 credit hours.

Dr. Schwartz opens his lecture with the recommendations of the Seventh Report of the Joint National Committee for Hypertension for systolic and diastolic levels that are considered normal, prehypertension, and stages 1 and 2 hypertension. He discusses the risk factors for hypertension, the importance of lifestyle modification in hypertension ... and the use of thiazide-type diuretics and ACE inhibitors and other drugs – alone or in combination as therapy. Dihydropyridine calcium channel blockers are useful in Raynaud's syndrome and in hypertension associated with cyclosporine and erythropoietin.

Using seven case presentations, the author traces the causes and treatment of systolic hypertension, endocrine hypertension, hypertension in pregnancy and hypertension in different ethnic groups. Essential hypertension without known etiology, he says, accounts for 90-95% of hypertensive patients. Renal hypertension is the largest category of secondary hypertension. He devotes considerable attention to primary hyperaldosteronism, and pheochromocytoma, as well as Cushing syndrome and hyperthyroidism and hypothyroidism as endocrine causes of hypertension. He contrasts pheochromocytoma with essential hypertension and describes its various tumor locations as well as the diagnosis and treatment of pheochromocytoma.

The diagnosis of renovascular hypertension is by isotopic renogram or aortogram, and one of the treatment options might include percutaneous transluminal angioplasty.

The lecture concludes with a discussion of hypertension in the elderly – more than two-thirds of people over 65 have some form of the disorder; hypertension in women and adolescents, hypertension in pregnancy, and hypertension in minority populations, noting that its incidence is significantly higher in African Americans than in white Americans.