Etiology•Primary hypertension•95% of all cases

•Secondary hypertension–5% of all cases–Chronic renal disease – most common

•White coat hypertension–Common?–Caused by vascular resistance–Harmless??

Causes of secondary hypertension:

•Renal: Chronic parenchymal diseases (3-5%).

•Renal artery stenosis (1-2%).

Causes of secondary hypertension:

•Endocrinal:

–Primary hyper aldosteronism< 0.3% .

–Pheochromocytoma <0.3% .

–Hypo or hyperthyroidism .

–Cushing syndrome.

Causes of secondary hypertension:

•Aortic coartication.

•Drug induced.

•Pregnancy .

Aim of evaluation:•Establishment of diagnoses .

•Assessment of CV risk.

•Evaluation of TOD.

•Diagnoses of secondary hypertension .

Patient Evaluation

•Hypertension

•Smoking

•Obesity

•Physical inactivity

•Dyslipidemia

•Diabetes

Assess lifestyle and identify other CV risk Assess lifestyle and identify other CV risk factors or concomitant disordersfactors or concomitant disorders::

Assess lifestyle and identify other CV risk factors or concomitant disorders

•Microalbuminuria or GFR < 60 ml/min

•Age–Males > 55 yrs–Females > 65 yrs

•Family history of CVD–Males < 55 yrs–Females < 65 yrs

Patient Evaluation

•Sleep Apnea

•Drug-induced

•Chronic kidney disease

•Primary aldosteronism

•Renal vascular disease

Reveal identifiable causes of hypertensionReveal identifiable causes of hypertension::

Reveal identifiable causes of hypertension:

•Chronic steroid therapy and Cushing’s syndrome

•Pheochromocytoma

•Coarctation of the aorta

•Thyroid or parathyroid disorders

Patient Evaluation

•Heart–LVH or CHF–Angina or prior MI–Prior coronary revascularization

•Brain–Stroke or transient ischemic attack (TIA)

Assess the presence or absence of target organ damage Assess the presence or absence of target organ damage and CVDand CVD

Assess the presence or absence of target organ damage and CVD

•Chronic kidney disease

•Peripheral arterial disease

•Retinopathy