Hypertension

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Special risks (e.g. anesthetic), Pathogenesis, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Prevention, Control, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Serena Brownlie BVM&S PhD CertSAC MRCVS
Mr Mark Rishniw BVSc MS DipACVIM

Introduction

  • Consistent increase in arterial blood pressure above the species normal.
  • Cause : usually secondary, eg chronic renal failure. Primary (idiopathic) cases have been reported.
  • Dogs are relatively resistant to hypertension.
  • Probably underdiagnosed in veterinary medicine.
  • Signs : PUPD, blindness, seizures, behavioral changes.
  • Diagnosis : early screening and identification important to prevent organ damage (particularly eyes, central nervous system, heart and kidney).
  • Treatment : address underlying cause.
  • Prognosis : good if hypertension controlled.
    Print off the owner factsheet on Hypertension (high blood pressure) Hypertension (high blood pressure) to give to your client.

Diagnosis

Clinical signs

  • Anemia, pallor, dehydration.
  • Ophthalmoscopic examination.
    • Hypertensive retinopathy - tortuous, dilated retinal vessels → retinal hemorrhages Retinal hemorrhage: Labrador 12 years → retinal detachment Retinal detachment: Crossbred 9 years , hyphema, papilledema Papilledema: Miniature Poodle 8 years , glaucoma.
  • Neurological deficits, depression, seizures.

Diagnosis

Differential diagnosis

  • Other causes of neurological/hyperviscosity/blindness syndromes:
    • Brain tumor Brain: neoplasia.
    • Inflammatory brain disorder - GME.
    • Coagulopathies Hemostatic disorder: acquired.
    • CEA.
    • PRA Retina: central progressive retinal atrophy (CPRA).
    • Chorioretinitis Chorioretinitis.
    • Encephalitis Encephalitis.
    • Vasculitis.
    • Hepatic encephalopathy Hepatic encephalopathy.

Sequelae

Prognosis

  • Guarded: if renal failure → will progress, but can control short term.
  • Good: if hormonal disease, eg hyperadrenocorticism → should respond to definitive treatment.
  • Poor: if primary hypertension.

Expected response to treatment

  • Signs.
  • Sustained reduction in blood pressure measurement.
  • Resolution/lack of progression of target organ damage.

Reasons for treatment failure

  • Too severe.
  • Late diagnosis: target organ damage severe.
  • Late decompensated primary disease, eg renal failure.
  • Inappropriate/insufficient therapy, lack of response to medications.
  • Standard reasons Standard reasons for failure in a treatment.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Brown S et al(2007) Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats. J Vet Intern Med 21 , 542-558PubMed.
  • Acierno M J & Labato M A (2005) Hypertension in renal disease: diagnosis and treatment. Clin Tech Small Anim Pract 20 (1), 23-30 PubMed.
  • Bodey A R & Rampling M W (1999) Comparison of hemorrheological parameters and blood pressure in various breeds of dog. JSAP 40 (1), 3.
  • Henik R A (1997) Systemic hypertension and its management. Vet. Clinic. NA. 27 , 1355-1372.
  • Bodey A R, Michell A R, Bovee K C et al(1996) Comparison of direct and indirect measurements of arterial blood pressure in conscious dogs. Res Vet Sci 61 , 17-21.
  • Michell A R (1993) Hypertension in companion animals. Vet Annual. 33 , 11-23. (Interesting, rather philosophical, overview.)
  • Dukes J (1992) Hypertension - a review of the mechanisms, manifestations and management. JSAP 33 , 119-129 (Very good, readable overview, especially of pathophysiology.)

Other sources of information

  • Brown S A (2004) Canine hypertension: risk and management. Proceedings of the North American Veterinary Conference.
  • Littman M P & Drobatz K J (1995) Hypertensive and hypotensive disorders. In: Textbook of Veterinary Internal Medicine.4th edn. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders pp 93-97.
  • Michell A R & Bodey A R (1994) Canine hypertension. Proceedings 12th American College of Veterinary Internal Medicine ConferenceACVIM, pp 502-505. (Results of a survey of blood pressure in normal dogs.)

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