ChesterCountyMedicineWinter2018 - 8
Treat or not to treat, that is the question
BY MIAN A JAN, MD, FACC, CHAIRMAN DEPARTMENT OF MEDICINE, PENN MEDICINE
CHESTER COUNTY HOSPITAL AND MIAN KOURESCH JAN, MD
t's 2018 and we are still not sure who to treat, even cardiologists
and nephrologists who are supposed to be experts do not have
consensus on pharmacological therapy. Guidelines in the past
have been confusing with no clear plan of care.
In November of 2017 the American Heart Association came
up with fresh guidelines; although not perfect they are more
methodical, unfortunately there is a lot of information to decipher.
We will try to make it simple, but before we do that we briefly
wanted to talk about hypertension.
Although there may not be a definite cause of hypertension
there are risk factors and some of them are modifiable.
o Age: Hypertension is more common as we age. Over the age
of 65 almost 65% have elevated BP.
o Ethnicity: Some ethnic groups like African Americans are
more prone to hypertension.
o Weight: Obesity and increased weight are also risk factors.
o Sex: Men are prone to hypertension at a younger age but
women catch up later in life.
Only one in twenty patients have known underlying cause for
hypertension. We describe two major groups of hypertension.
o Comorbid conditions: Like kidney and cardiovascular
disease and lipid abnormalities, etc., can be risk factors.
Primary Hypertension: Essentially cause unknown. Blood
plasma volume, vascular compliance activity of regulators of blood
volume and pressure all likely contribute. It is also influenced by
environmental factors such as stress and lack of exercise.
o Alcohol and tobacco use: Contribute towards hypertension.
Secondary Hypertension: Has specific causes, and can be
reversible in some cases.
o Diabetes mellitus
o Kidney disease
o Cushings syndrome
o Congenital adrenal hyperplasia
o Sleep Apnea
SIGNS and SYMPTOMS
Hypertension is called the silent killer because in the early
phase there are neither specific signs or symptoms. It causes
damage to the cardiovascular system and other organs like the
kidney without announcing itself. One may feel anxious, have
headaches, insomnia, blushing or nosebleeds but they occur later
in its course.
Atherosclerosis: Probably this slow process is the most
devastating complication of hypertension and can result in:
o Heart failure
o Myocardial infarction
o Aneurysm formation
o Stroke and TIAs
o Kidney failure
o Peripheral vascular disease and amputations
o Retinopathies and possible blindness
8 CHESTER COUNT Y Medicine | WINTER 2018