Hypertension is the elevation of blood pressure. An individual is classified as hypertensive when there is a sustained rise in blood pressure to more than 140/90 mmHg on three or more readings, each at least one week apart. Most patients have essential hypertension and an underlying cause is identified in less than 10%. Renal Figure 35 MRA renal arteries. Patients with uncomplicated essential hypertension are asymptomatic and are identified only in the course of routine physical examination; however, patients with secondary hypertension may complain of symptoms from the underlying disorder. Patients with chronic pyelonephritis may have experienced recurrent urinary tract infections, with loin pain, pyrexia and rigors or have a history of childhood urinary tract infections or prolonged enuresis. Hypertension can also complicate glomerular disease; in particular it is associated with acute nephritic syndrome. Patients with nephritic syndrome may have experienced an acute illness with fatigue, malaise, haematuria, oliguria and oedema. With Conn’s syndrome, patients may complain of muscle weakness and fatigue due to hypokalaemia and polyuria from impaired urine-concentrating ability. Paroxysms of headache, sweating, palpitations with flushing may be experienced by patients with phaeochromocytoma. Classically, these patients have attacks of hypertension; however, in the majority, the hypertension is sustained. Weight gain, hair growth, acne, abdominal striae, muscle weakness, back pain and depression may be some of the symptoms experienced by patients with Cushing’s syndrome. With acromegaly, patients may complain of headaches, galactorrhoea, deepening of the voice, muscle weakness and joint pains. Hats and rings may no longer fit due to increasing size of the cranium and hands. A complete drug history will identify offending drugs that may precipitate hypertension.
Hypertension
Causes
The patient presented with poorly-controlled hypertension. Subsequent examination revealed a bruit inferior to the left costal margin. MRA revealed a tight stenosis close to the origin of the left renal artery (arrow). The stenosis was successfully treated with angioplasty and stenting.
History
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