Difference between revisions of "Systemic Hypertension"

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'''Description:'''
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== Introduction ==
 
  
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Hypertension is defined as the pathological elevation of arterial [[Blood Pressure|blood pressure]]. There are two main types of hypertension, systemic hypertension (affects the systemic circulation) and [[Pulmonary Hypertension|pulmonary hypertension]] (affects the pulmonary circulation). This article will cover systemic hypertension. Blood pressure in veterinary patients is not measured routinely; therefore hypertension is usually only diagnosed after clinical signs become apparent.  
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*Hypertension is defined as the pathological elevation of arterial blood pressure.
  
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Primary systemic hypertension is an idiopathic increase in arterial blood pressure. Secondary systemic hypertension is an increase in arterial blood pressure secondary to a pathological process.
 
  
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The ocular system, cardiovascular system, and nervous system are the most vulnerable to elevated arterial blood pressures. However, some endocrine disturbances have also been found to predispose animals to hypertension.  
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*There are two main types of hypertension, systemic hypertension (affects the systemic circulation) and pulmonary hypertension (affects the pulmonary circulation).
  
  
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== Signalment ==
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*Blood pressure in veterinary patients is not measured routinely; therefore hypertension is usually only diagnosed after clinical signs become apparent.
  
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'''Dogs''': male > female; obese animals; middle to old age
 
  
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'''Cats''': middle to old age.
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===Systemic Hypertension===
  
  
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== Clinical Signs ==
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*Primary systemic hypertension= idiopathic increase in arterial blood pressure
  
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Signs are the result of ischemia, oedema, and/or haemorrhage of the affected areas, so are specific to the affected area.
 
  
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Neurological signs include depression, [[Seizures|seizures]], syncope, paresis, vestibular signs and ataxia. Cardiac signs include left ventricular hypertrophy, [[:Category:Heart Failure|heart failure]], systolic [[Heart Murmurs|murmur]] and gallop rhythms. Ocular signs are common especially in cats, where this is often the first noted clinical sign. Retinal detachment, degeneration or haemorrhage as well as blindness are features of the disease here. Renal signs include proteinuria. Kidney disease can be caused by hypertension, but can also be the cause of hypertension. Chronic renal failure is the most common cause of hypertension showing clinical signs in dogs and cats. Endocrine signs include [[hyperthyroidism]] (cats) and [[hyperadrenocorticism]] and [[Diabetes Mellitus|diabetes mellitus]] is dogs.
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*Secondary systemic hypertension=increase in arterial blood pressure secondary to a pathological process
  
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== Diagnosis ==
 
  
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History and clinical signs may be suggestive of the disease, so upon physical examination a blood pressure measurement should be taken. Systolic pressure > 175mmHg indicates hypertension in a relaxed dog or cat and diastolic pressure > 100mmHg indicates hypertension in a relaxed dog or cat. However, most cats and many dogs are not relaxed when in the veterinary clinic environment so accurate readings can be difficult.  
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*The ocular system, cardiovascular system, and nervous system are the most vulnerable to elevated arterial blood pressures. However, some endocrine disturbances have also been found to predispose animals to hypertension.
  
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Methods of [[Blood Pressure Measurement|measuring blood pressure]] are the direct method, which is invasive. This uses an indwelling catheter to measure systolic, diastolic, and mean arterial pressures. This is usually saved for very ill patients or those undergoing anaesthesia. The indirect and non-invasive methods are Doppler Flow Technique which is good for large dogs, but very inaccurate for cats. Also the Oscillometric Technique which is best for small dogs and is good for cats too.
 
  
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====Signalment====
  
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== Treatment and Control ==
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'''Dogs''': male>female; obese animals; middle to old age
  
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'''Cats:'''
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'''Cats''': middle to old age
  
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Treat the underlying problems first. Pharmacological treatment can be by calcium channel blockers (e.g. amlodipine). Blood pressure should be monitored regularly.
 
  
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'''Dogs: '''
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====Diagnosis====
  
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Again, treat the underlying cause and monitor blood pressure. Dogs with renal disease have a range of pharmacological options that can be used in controlling the disease. These include ACE-inhibitor e.g. enalopril, given alone or in combination with some of the other treatments listed next. Calcium channel blocker e.g. amlodipine, sodium restricted diet, beta blockers (e.g. atenolol), diuretics e.g. furosemide and vasodilators e.g. enalopril.
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=====History & Clinical Signs=====
  
 +
*Signs are the result of ischemia, edema, and/or haemorrhage of the affected areas
  
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== Prognosis ==
 
  
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Cats with hypertension are more successfully treated than dogs.
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=====Neurological Signs=====
  
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-Depression
  
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== References ==
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-Seizures
  
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Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat '''Volume 2 (Fifth Edition) ''W.B. Saunders Company''
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-Syncope
  
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Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine '''(6th edition, volume 2) ''W.B. Saunders Company ''
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-Paresis
  
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Merck & Co (2008) '''The Merck Veterinary Manual '''(Eighth Edition) ''Merial''
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-Vestibular Signs
  
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Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine '''(Fourth Edition)'' Mosby Elsevier''
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-Ataxia
  
  
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=====Cardiac Signs=====
  
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{{review}}
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-Left Ventricular Hypertrophy
  
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{{OpenPages}}
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-Heart Failure
  
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[[Category:Arterial_Pathology]] [[Category:Expert_Review]] [[Category:Vascular_Diseases_-_Dog]] [[Category:Vascular_Diseases_-_Cat]]
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-Systolic Murmur
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[[Category:Cardiology Section]]
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-Gallop rhythm
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 +
 
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=====Ocular Signs=====
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 +
*In cats, ocular abnormalities from hypertension are usually the first thing detected.
 +
 
 +
-Blindness
 +
 
 +
 
 +
=====Fundic Examination=====
 +
 
 +
-Hyphemia (Blood in the anterior chamber)
 +
 
 +
-Retinal Haemorrhage
 +
 
 +
-Retinal Detachment
 +
 
 +
-Retinal Degeneration
 +
 
 +
 
 +
=====Renal Signs=====
 +
 
 +
*Renal disease can both be caused by hypertension and cause hypertension.
 +
 
 +
*Chronic renal failure is the most common cause of hypertension showing clinical signs in dogs and cats.
 +
 +
-Renal Disease (especially glomerular damage)
 +
 
 +
*Glomerular damage allows protein leakage, therefore animals with hypertension are more proteinuric than unaffected animals
 +
 
 +
 
 +
=====Endocrine Signs=====
 +
 
 +
-Hyperthyroidism (cats)
 +
 
 +
-Hyperadrenocorticism, Diabetes Mellitus (dogs)
 +
 
 +
 
 +
=====Physical Exam=====
 +
 
 +
 
 +
'''Blood Pressure Measurement'''
 +
 
 +
*Systolic Pressure> 175 indicates hypertension in a relaxed dog or cat
 +
 
 +
*Diastolic Pressure> 100 indicates hypertension in a relaxed dog or cat
 +
 
 +
 
 +
'''1. Direct Blood Pressure Measurement (Invasive)
 +
'''
 +
 
 +
*Uses an indwelling arterial catheter
 +
 
 +
-Measures systolic, diastolic, and mean arterial pressures
 +
 
 +
-Used on very ill patients or those undergoing anaesthesia
 +
 
 +
 
 +
'''2. Indirect Blood Pressure Measurement (Non-invasive)
 +
'''
 +
 
 +
*Two types that measure systolic arterial pressure
 +
 
 +
-Doppler Flow Technique: good for large dogs, poor for cats
 +
 
 +
-Oscillometric Technique: good for small dogs, good for cats
 +
 
 +
 
 +
=====Treatment=====
 +
 
 +
'''Cats'''
 +
 
 +
*Treat the underlying problems
 +
 
 +
*Calcium Channel Blocker (e.g. amlodipine)
 +
 
 +
*Monitor Blood Pressure
 +
 
 +
 
 +
'''Dogs'''
 +
 
 +
*Treat the underlying problems
 +
 
 +
*Monitor Blood Pressure
 +
 
 +
 
 +
'''Dogs with Renal Disease:'''
 +
 
 +
*ACE-inhibitor (e.g. enalopril): Given alone or in combination with some of the other treatments listed below.
 +
 
 +
*Calcium Channel Blocker (e.g. amlodipine)
 +
 
 +
*Sodium Restricted Diet
 +
 
 +
*Beta Blockers (e.g. atenolol)
 +
 
 +
*Diuretics (e.g furosemide)
 +
 
 +
*Vasodilators (e.g. enalopril)
 +
 
 +
 
 +
=====Prognosis=====
 +
 
 +
-Cats with hypertension are more successfully treated than dogs.
 +
 
 +
[[Category:Arterial_Pathology]][[Category:To_Do_-_Cardiovascular]]
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[[Category:Cardiovascular Pathology - Dog]]

Revision as of 16:13, 15 December 2010

Description:

  • Hypertension is defined as the pathological elevation of arterial blood pressure.


  • There are two main types of hypertension, systemic hypertension (affects the systemic circulation) and pulmonary hypertension (affects the pulmonary circulation).


  • Blood pressure in veterinary patients is not measured routinely; therefore hypertension is usually only diagnosed after clinical signs become apparent.


Systemic Hypertension

  • Primary systemic hypertension= idiopathic increase in arterial blood pressure


  • Secondary systemic hypertension=increase in arterial blood pressure secondary to a pathological process


  • The ocular system, cardiovascular system, and nervous system are the most vulnerable to elevated arterial blood pressures. However, some endocrine disturbances have also been found to predispose animals to hypertension.


Signalment

Dogs: male>female; obese animals; middle to old age

Cats: middle to old age


Diagnosis

History & Clinical Signs
  • Signs are the result of ischemia, edema, and/or haemorrhage of the affected areas


Neurological Signs

-Depression

-Seizures

-Syncope

-Paresis

-Vestibular Signs

-Ataxia


Cardiac Signs

-Left Ventricular Hypertrophy

-Heart Failure

-Systolic Murmur

-Gallop rhythm


Ocular Signs
  • In cats, ocular abnormalities from hypertension are usually the first thing detected.

-Blindness


Fundic Examination

-Hyphemia (Blood in the anterior chamber)

-Retinal Haemorrhage

-Retinal Detachment

-Retinal Degeneration


Renal Signs
  • Renal disease can both be caused by hypertension and cause hypertension.
  • Chronic renal failure is the most common cause of hypertension showing clinical signs in dogs and cats.

-Renal Disease (especially glomerular damage)

  • Glomerular damage allows protein leakage, therefore animals with hypertension are more proteinuric than unaffected animals


Endocrine Signs

-Hyperthyroidism (cats)

-Hyperadrenocorticism, Diabetes Mellitus (dogs)


Physical Exam

Blood Pressure Measurement

  • Systolic Pressure> 175 indicates hypertension in a relaxed dog or cat
  • Diastolic Pressure> 100 indicates hypertension in a relaxed dog or cat


1. Direct Blood Pressure Measurement (Invasive)

  • Uses an indwelling arterial catheter

-Measures systolic, diastolic, and mean arterial pressures

-Used on very ill patients or those undergoing anaesthesia


2. Indirect Blood Pressure Measurement (Non-invasive)

  • Two types that measure systolic arterial pressure

-Doppler Flow Technique: good for large dogs, poor for cats

-Oscillometric Technique: good for small dogs, good for cats


Treatment

Cats

  • Treat the underlying problems
  • Calcium Channel Blocker (e.g. amlodipine)
  • Monitor Blood Pressure


Dogs

  • Treat the underlying problems
  • Monitor Blood Pressure


Dogs with Renal Disease:

  • ACE-inhibitor (e.g. enalopril): Given alone or in combination with some of the other treatments listed below.
  • Calcium Channel Blocker (e.g. amlodipine)
  • Sodium Restricted Diet
  • Beta Blockers (e.g. atenolol)
  • Diuretics (e.g furosemide)
  • Vasodilators (e.g. enalopril)


Prognosis

-Cats with hypertension are more successfully treated than dogs.

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