Summary
Definition
History and exam
Key diagnostic factors
- pressão arterial (PA) >180/120 mmHg
- presença de fatores de risco
Other diagnostic factors
- sintomas neurológicos
- sintomas cardíacos
- exame cardiopulmonar anormal
- exame abdominal anormal
- oligúria ou poliúria
- exame fundoscópico anormal
- exame neurológico anormal
Risk factors
- hipertensão tratada indevidamente
- doença renal crônica (DRC)
- estenose da artéria renal
- transplante renal
- endocrinopatias com efeitos hipertensivos conhecidos
- gestação
- idade avançada
- etnia negra
- sexo masculino
- uso de drogas simpatomiméticas
- farmacoterapia com efeito hipertensivo conhecido
- apneia obstrutiva do sono
- vasculite e doenças do tecido conjuntivo
Diagnostic tests
1st tests to order
- bioquímica sérica
- hemograma completo com esfregaço
- urinálise com microscopia
- eletrocardiograma (ECG)
- radiografia torácica
Tests to consider
- testes da função tireoidiana
- testes da função hepática
- enzimas cardíacas
- fragmento N-terminal do peptídeo natriurético tipo B (NT-proPNB)
- perfil de coagulação
- teste de gravidez urinário ou sérico
- exame toxicológico da urina
- angiotomografia (ATG)
- ecocardiografia transtorácica (ETT)
- ultrassonografia renal com Doppler
- tomografia computadorizada (TC) de crânio sem contraste
- ressonância nuclear magnética (RNM) do crânio
- atividade de renina plasmática e nível de aldosterona
- amostra de urina ou metanefrina plasmática
- cortisol urinário livre de 24 horas
- estudo do sono
Treatment algorithm
hipertensão acelerada (maligna), encefalopatia hipertensiva ou hemorragia intracraniana
acidente vascular cerebral (AVC) isquêmico agudo
isquemia/infarto do miocárdio
insuficiência ventricular esquerda e/ou edema pulmonar
dissecção da aorta
lesão renal aguda
estado hiperadrenérgico
hipertensão grave na gestação (pré-eclâmpsia e eclâmpsia)
Contributors
Authors
M. Lee Sanders, PhD, MD
Clinical Associate Professor
Division of Nephrology
University of Iowa
Iowa City
IA
Disclosures
MLS is an author of a reference cited in this topic.
Manish Suneja, MD, FASN, FACP
Clinical Professor
Division of Nephrology
University of Iowa
Iowa City
IA
Disclosures
MS receives royalties from McGraw Hill as the editor of DeGowin’s Diagnostic Examination and is an author of a reference cited in this topic.
Acknowledgements
Dr M. Lee Sanders and Dr Manish Suneja would like to gratefully acknowledge Dr Hector Ventura and Dr Madhavi T. Reddy, previous contributors to this topic.
Disclosures
HV declares that he has no competing interests. MTR is employed by Merck and owns stocks in Merck, and Johnson & Johnson.
Peer reviewers
Aparna Sundaram, DO, MBA, MPH
Physician Consultant
Preventive Medicine
Private Practice
Atlanta
GA
Disclosures
AS declares that she has no competing interests.
Ethan Cumbler, MD
Assistant Professor
Department of Internal Medicine
University of Colorado Health Sciences Center
Denver
CO
Disclosures
EC declares that he has no competing interests.
Michael Schachter, MB, BSc, FRCP
Department of Clinical Pharmacology
St Mary’s Hospital
Imperial College
London
UK
Disclosures
MS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.Full text Abstract
American College of Obstetricians and Gynecologists. Practice bulletin no. 222: gestational hypertension and preeclampsia. Jun 2020 [internet publication].Full text Abstract
Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension the Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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