18 Pseudopheochromocytoma is a paroxysmal hypertension syndrome that often presents with panic at the onset and abrupt elevation of BP. This is due to anxiety and panic disorders as underlying conditions associated with the disease. Chronic poor sleep quality can produce similar symptoms and be a result of restless leg syndrome, insomnia and obstructive sleep apnea (OSA).5-Sleep Disorders and Pseudophoechromocytoma Cushing syndrome is an uncommon endocrine disorder caused by chronic excessive glucocorticoid exposure from endogenous or exogenous sources. Chronic exposure leads to a collection of symptoms, including mood disorders, menstrual irregularities, muscle weakness, weight gain, abdominal striae, hirsutism, dorsal and supraclavicular fat and fragile skin. Glucose disorders and hypertension are also common, mimicking severe metabolic syndrome. Cushing syndrome does not appear to be a common cause of RH.5-Cushing Syndrome Obstructive sleep apnea (OSA) is common in patients with RH and is possibly linked to increased fluid retention and accompanying upper airway edema. Clinicians should refer patients with OSA symptoms, such as loud snoring, frequent nocturnal arousal, witnessed apnea or excessive daytime sleepiness, for polysomnography at a sleep laboratory or athome sleep apnea monitoring.5-Obstructive Sleep Apnea Coarctation of the aorta surgery can increase a patient’s risk of hypertension or premature CVD, including MI, aortic aneurysm, stroke and HF. All patients with a history of coarctation repair and hypertension should be evaluated for residual aortic arch obstruction with computed tomography angiography. If hypertension is resistant to treatment, consider surgical or catheter-based intervention depending on the risk/benefit ratio.5-Coarctation of the Aorta Less common causes of secondary hypertension include acromegaly and hyperthyroid/parathyroidism, among others.5-Table 3 Evaluate Target Organ Damage Elevated BP can damage multiple organs, including eyes and kidneys, as well as the cardiovascular system and circulation. Health care professionals should evaluate possible organ damage by administering the following tests: physical exam, basic labs, fundoscopic eye exam of retina and eye grounds, cardiac exam and listening for carotid bruits. The risk of target organ damage increases with duration and severity of hypertension. Reducing BP to target goal is highly recommended to prevent or limit further damage. Elevated BP can lead to hypertensive retinopathy and worsening visual acuity. Changes to the retina may be better assessed with funduscopic examination and retinal imaging using multiple forms of optical coherence tomography than with funduscopic examination.10-Background, Diagnostics of Hypertensive Retinopathy Kidney disease is common in people with hypertension and prevalence increases as kidney function declines. Hypertension can be both a cause and an effect of CKD. Hypertension masked by CKD predicts elevated risk of CKD progression. Clinicians should screen for proteinuria and reduced glomerular filtration rate (GRF) to assess the extent of kidney disease.1-9.3 Chronic Kidney Disease Common cardiovascular damage includes LVH and coronary artery disease. LVH is commonly assessed using electrocardiography, echocardiography or MRI. Atherosclerosis and other coronary artery diseases can be assessed using pulse-wave velocity, carotid intimamedia thickness and coronary artery calcium score. 1-7.2 Cardiovascular Target Organ Damage Hypertension is a major risk factor for peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis. PAD, in turn, is a risk factor for cardiovascular and ischemic limb events. Adequate BP control is critical in PAD; no data show significant differences in clinical outcome by antihypertensive drug class.1-9.5, Peripheral Artery Disease
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