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However, extreme BP elevation alternating with normal readings is unusual and possibly suggests pheochromocytoma Pheochromocytoma A pheochromocytoma is a catecholamine-secreting tumor of chromaffin cells typically located in the adrenals. BP measurements may be sporadically high before hypertension becomes sustained this phenomenon probably accounts for “white coat hypertension,” in which BP is elevated when measured in the physician’s office but normal when measured at home or by ambulatory BP monitoring. If BP is in the stage 1 hypertensive range or is markedly labile, more BP measurements are desirable. Hypertension with no known cause (primary formerly, essential. Mechanical devices should be calibrated periodically automated readers are often inaccurate ( 1 Diagnosis reference Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. The same principles are followed to measure BP in a forearm (radial artery) and thigh (popliteal artery). Total disappearance of the sound marks diastolic BP. The pressure at which the first heartbeat is heard as the pressure falls is systolic BP. The health care practitioner inflates the cuff above the expected systolic pressure and gradually releases the air while listening over the brachial artery. Thus, obese patients require large cuffs. An appropriately sized cuff covers two thirds of the biceps the bladder is long enough to encircle > 80% of the arm, and bladder width equals at least 40% of the arm’s circumference. Aldosterone also enhances potassium excretion low plasma potassium ( 3.5 mEq/L [Ī properly sized BP cuff is applied to the upper arm. Aldosterone and vasopressin cause sodium and water retention, elevating BP. This inactive product is cleaved by angiotensin-converting enzyme (ACE), mainly in the lungs but also in the kidneys and brain, to angiotensin II, a potent vasoconstrictor that also stimulates autonomic centers in the brain to increase sympathetic discharge and stimulates release of aldosterone and vasopressin. Renin, an enzyme formed in the juxtaglomerular apparatus, catalyzes conversion of angiotensinogen to angiotensin I. The renin-angiotensin-aldosterone system helps regulate blood volume and therefore blood pressure.
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Use of sympathomimetics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, cocaine, or licorice commonly contributes to worsening of blood pressure control. Excessive alcohol intake and use of oral contraceptives are common causes of curable hypertension.
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read more, and mineralocorticoid excess syndromes other than primary aldosteronism. read more, coarctation of the aorta Coarctation of the Aorta Coarctation of the aorta is a localized narrowing of the aortic lumen that results in upper-extremity hypertension, left ventricular hypertrophy, and malperfusion of the abdominal organs and. Before closure of the epiphyses, the result. read more, acromegaly Gigantism and Acromegaly Gigantism and acromegaly are syndromes of excessive secretion of growth hormone (hypersomatotropism) that are nearly always due to a pituitary adenoma. read more (myxedema), primary hyperparathyroidism Hyperparathyroidism Hyperparathyroidism occurs when one or more of the parathyroid glands become overactive, causing elevated serum levels of parathyroid hormone and leading to hypercalcemia.
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It is diagnosed by clinical features such as a typical facial appearance, hoarse slow speech, and dry skin and by low levels of thyroid hormones. read more, hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. Symptoms are many and include tachycardia, fatigue, weight loss, nervousness, and tremor.
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read more, hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. In the most common forms, accumulated hormone precursors. read more, congenital adrenal hyperplasia Overview of Congenital Adrenal Hyperplasia Congenital adrenal hyperplasia is a group of genetic disorders, each characterized by inadequate synthesis of cortisol, aldosterone, or both. Cushing disease is Cushing syndrome that results from. read more, Cushing syndrome Cushing Syndrome Cushing syndrome is a constellation of clinical abnormalities caused by chronic high blood levels of cortisol or related corticosteroids. It causes persistent or paroxysmal hypertension. Other, much rarer, causes include pheochromocytoma Pheochromocytoma A pheochromocytoma is a catecholamine-secreting tumor of chromaffin cells typically located in the adrenals.