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Cardio History




    • Ask About

    • Diagnosis - when hypertension was diagnosed
    • Severity - blood pressure measurements
    • Management - nonpharmacologic / pharmacologic
    • Complications - cardiovascular, cerebrovascular, ocular, renal
    • Classification

      Hypertension is defined as persistently elevated blood pressure, based on at least two readings over at least two visits.
    • Normal <120 / 80
    • Pre-hypertension 120 / 80 - 139 / 89
    • Stage I hypertension 140 / 90 - 159 / 99
    • Stage II hypertension >160 / 100
    • Causes of Hypertension

    • Primary

    • Primary (essential) hypertension: chronically elevated blood pressure of unknown aetiology (the most common cause of hypertension in the community)
    • Secondary

    • Chronic kidney disease
    • Renovascular - fibromuscular dysplasia, atherosclerosis
    • Endocrine - hyperthyroidism, hypothyroidism, Cushing’s syndrome, primary aldosteronism, phaeochromocytoma, hyperparathyroidism
    • Drugs - NSAIDs, amphetamines, glucocorticoids, fludrocortisone, erythropoietin, VEGF inhibitors, calcineurin inhibitors
    • Aortic coarctation
    • Obstructive sleep apnoea
    • Factitious

    • White coat hypertension: falsely elevated blood pressure may occur due to by anxiety in a healthcare setting, recent exercise or recent caffeine intake.
    • Recent exercise or caffeine intake


    • Complications of Hypertension

    • Cardiovascular - left ventricular hypertrophy, heart failure, ischaemic heart disease, peripheral vascular disease, arrhythmia
    • Cerebrovascular - ischaemic stroke, haemorrhagic stroke, posterior reversible encephalopathy syndrome
    • Hypertensive retinopathy
    • Hypertensive nephropathy
    • Erectile dysfunction


    • Pearls

    • Set realistic targets
    • Use non-pharmacologic and pharmacologic strategies
    • Titrate medications to the patient’s blood pressure and side effects, e.g. electrolytes / renal function (ACEi / ARBs), cough (ACEi), oedema (CCBs)
    • Titrate up to the maximum dose of an antihypertensive before adding an additional medication
    • If the patient’s blood pressure is not responding: consider white coat hypertension, non-adherence or secondary causes
    • Common Blood Pressure Targets

    • Most patients: ≤140/90
    • Diabetics: ≤130/80
    Cardiovascular Drugs
    • Management Options

    • Non-Pharmacologic

    • Diet - low in salt
    • Exercise - increase incidental exercise and reduce sedentary time
    • Smoking cessation
    • Alcohol reduction
    • Pharmacologic

    • ACE inhibitors (ACEi) - captopril, ramipril, perindopril
    • Angiotensin II receptor blockers (ARBs) - candesartan, irbesartan
    • Calcium channel blockers (CCBs) - amlodipine
    • Thiazides - hydrochlorothiazide
    • Aldosterone antagonists - spironolactone
    • Alpha blockers - prazosin
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 Abbott AV. Diagnostic approach to palpitations. Am Fam Physician. 2005 Feb 15;71(4):743-50. Arthur W, Kaye GC. The pathophysiology of common causes of syncope. Postgraduate medical journal. 2000 Dec 1;76(902):750-3. Benditt DG. Neurally mediated syncopal syndromes: pathophysiological concepts and clinical evaluation. Pacing and clinical electrophysiology. 1997 Feb 1;20(2):572-84. Cayley J,William E. Chest pain--tools to improve your in-office evaluation. J Fam Pract. 2014;63:246.
Constant J. The diagnosis of nonanginal chest pain.  Keio J Med. 1990;39:187-192.
 Cotter L. History and Examination of the Cardiovascular System. Medicine. 2010; 38(7): 344-347. Eriksson B, Vuorisalo D, Sylven C. Diagnostic potential of chest pain characteristics in coronary care.  J Intern Med. 1994;235:473-478 Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. International journal of hypertension. 2011 Mar 2;2011.
Kass S. Pleurisy. Am Fam Physician. 2007;75:1357.
 Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. Jama. 2003 Aug 20;290(7):898-904. Kim EJ, Kim BH, Seo HS, Lee YJ, Kim HH, Son HH, Choi MH. Cholesterol-induced non-alcoholic fatty liver disease and atherosclerosis aggravated by systemic inflammation. PloS one. 2014 Jun 5;9(6):e97841. Mak SM, Strickland N, Gopalan D. Complications of pulmonary hypertension: a pictorial review. The British journal of radiology. 2017 Feb;90(1070):20160745.
Miller TH, Kruse JE. Evaluation of syncope. Am Fam Physician. 2005 Oct 15;72(8):1492-500.
Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007 Sep 1;93(9):1137-46.
 National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012.
Onusko E. Diagnosing secondary hypertension. American family physician. 2003 Jan;67(1):67-74.
 Payne RA. Cardiovascular Risk. British Journal of Clinical Pharmacology. 2012; 74(3): 396-410. Petersen P. Thromboembolic complications in atrial fibrillation. Stroke. 1990 Jan;21(1):4-13.
Schoenkerman A, Goldschlager N. Chest Pain: Does This Patient Have Cardiac Ischaemia? Consultant. 2013; 53(8): 556-560.
 Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Sanchez MA, Kumar RK, Landzberg M, Machado RF, Olschewski H. Updated clinical classification of pulmonary hypertension. Journal of the American College of Cardiology. 2013 Dec 24;62(25 Supplement):D34-41. Susanto M. Dizziness: if not vertigo could it be cardiac disease?. Australian family physician. 2014 May;43(5):264. Swap CJ, Nagurney JT. Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes. JAMA. 2005;294:2623-2629. Vodnala D, Rubenfire M, Brook RD. Secondary causes of dyslipidemia. The American journal of cardiology. 2012 Sep 15;110(6):823-5. Wahls SA. Causes and evaluation of chronic dyspnea. American family physician. 2012 Jul 15;86(2). Watson RD, Gibbs CR, Lip GY. ABC of heart failure: clinical features and complications. BMJ: British Medical Journal. 2000 Jan 22;320(7229):236. Weber BE, Kapoor WN. Evaluation and outcomes of patients with palpitations. The American journal of medicine. 1996 Feb 29;100(2):138-48.
Wexler RK, Pleister A, Raman S. Outpatient approach to palpitations. heart disease. 2011 Jul 1;100:6.
 Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. Cmaj. 2007 Apr 10;176(8):1113-20. Zimetbaum P, Josephson ME. Evaluation of patients with palpitations. New England Journal of Medicine. 1998 May 7;338(19):1369-73.