Unusual causes of HTN- Acromegaly
- NSAIDs
- Pheochromocytoma (cf MEN IIa)
- => HTN, flushing, sweating
- May cause hypercalcaemia (but may be due to concurrent hyperparathyroidism in MEN IIa)
- Risk of death! Must exclude
Liddle's syndrome
- Autosomal dominant disorder characterized by early, and frequently severe, hypertension
- Looks like hyperadosteronism
- Low plasma renin activity
- Metabolic alkalosis due to hypokalemia
- But normal to low levels of aldosterone
- Involves abnormal kidney function
- Caused by dysregulation of an epithelial sodium channel (ENaC)
- Treatment
- Low sodium diet
- Potassium-sparing diuretic that directly blocks the sodium channel
- Spironolactone is not effective because it acts by regulating aldosterone and Liddle syndrome does not respond to this regulation
CCB cardiac selectivity order- Varapamil
- Diltiazem
- Amlodipine
- Nifedipine
- Felodipine
- Nicardipine
- Lercanidipine
Side effects - CCBs
- Ankle swelling
- Gingival hyperplasia
- Diuretics
- ACEi
- Impotence
- Cough
- Renal impairment if renal artery stenosis
Contraindications
- CCBs
- ACEi
- Pregnancy
- Renal artery stenosis
- Diuretics
- Beta blockers
- Alpha blockers
Notes- Carcinoid
- => Tachycardia but NOT HTN
- Test 5-HIAA
- Bilateral adrenal hyperplasia is more common than adrenal adenoma as a cause of hyperaldosteronism
- Beading of renal arteries
- Sign of fibromuscular dysplasia
- Can cause HTN
- Lifestyle measures are at least as good as one drug
- Aged, black => CCB
- Aliskiren = Direct renin inhibitor
- Losartan is now off-patant
- => First choice, as there's no cough
- However half-life is only 2 hours (but can still take OD)
- ACEi/ARB help protect kidneys in HTN if there's concurrent diabetes or nephropathy
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