Hypertension and Renal Organ Damage PDF
Preview Hypertension and Renal Organ Damage
Practical Case Studies in Hypertension Management Series Editor: Giuliano Tocci Roberto Pontremoli Hypertension and Renal Organ Damage Practical Case Studies in Hypertension Management Series Editor Giuliano Tocci Rome, Italy The aim of the book series “Practical Case Studies in Hypertension Management” is to provide physicians who treat hypertensive patients having different cardiovascular risk profiles with an easy- to- access tool that will enhance their clinical practice, improve average blood pressure control, and reduce the incidence of major hypertension-related complications. To achieve these ambitious goals, each volume presents and discusses a set of paradigmatic clinical cases relating to different scenarios in hypertension. These cases will serve as a basis for analyzing best practice and highlight problems in implementing the recommendations contained in international guidelines regarding diagnosis and treatment.While the available guidelines have contributed significantly in improv- ing the diagnostic process, cardiovascular risk stratification, and therapeutic management in patients with essential hypertension, they are of limited help to physicians in daily clinical practice when approaching individual patients with hypertension, and this is particularly true when choosing among different drug classes and molecules. By discussing exemplary clinical cases that may better represent clinical practice in a “real world” setting, this series will assist physicians in selecting the best diagnostic and therapeutic options. More information about this series at http://www.springer.com/ series/13624 Roberto Pontremoli Hypertension and Renal Organ Damage Roberto Pontremoli University of Genoa IRCCS Policlinico San Martino Genoa Italy ISSN 2364-6632 ISSN 2364-6640 (electronic) Practical Case Studies in Hypertension Management ISBN 978-3-319-56407-4 ISBN 978-3-319-56408-1 (eBook) https://doi.org/10.1007/978-3-319-56408-1 Library of Congress Control Number: 2017950499 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Anna and Mattecatte, who had the grace and patience to endure my many absences Foreword Sustained high blood pressure is a major risk factor for developing early renal impairment and for promoting development and pro- gression from microalbuminuria towards proteinuria and end- stage renal disease or dialysis, with or without concomitant presence of diabetes. For many years, in fact, renal disease has been viewed only as a clinical consequence of diabetic nephropa- thy. Although diabetic patients have higher risk of new-onset microalbuminuria and creatinuria compared to non-diabetic indi- viduals, several studies have consistently demonstrated that high blood pressure represents a powerful and independent risk factor for development and progression of renal damage. Concomitant presence of hypertension and renal disease not only affects physicians’ ability to achieve the recommended blood pressure targets under pharmacological therapy but also leads to high individual risk of having major cardiovascular events, includ- ing myocardial infarction, stroke and renal failure. For these reasons, prompt assessment and early diagnostic esti- mation of renal parameters represent a crucial aspect for the clini- cal management of patients with hypertension, not only in view of their influence on individual global cardiovascular risk stratifica- tion but also in view of their potential implications for therapeutic choice among different classes and combination therapies of anti- hypertensive drugs. Compelling indications are, indeed, available to help physicians in choosing the proper blood pressure-lowering strategy to be applied in hypertensive patients with renal disease. However, in a setting of real practice, the choice of the proper pharmacological therapy in these high-risk patients may be often more difficult than expected, due to the frequent concomitant pres- ence of comorbidities and other non-cardiovascular therapies, viii Foreword which may at least, in part, interfere with the efficacy, safety and tolerability profile of a given antihypertensive regimen. In this volume of Practical Case Studies in Hypertension Management, the clinical management of paradigmatic cases of patients with hypertension and different stages of renal disease will be discussed, focusing on the different diagnostic criteria cur- rently available for identifying early or advanced renal impairment or dysfunction, as well as on the different therapeutic options cur- rently recommended for achieving effective and sustained blood pressure control and reducing hypertension- related morbidity and mortality in this high-risk population. Giuliano Tocci Contents Clinical Case 1 Patient with Hypertension and Reduced Glomerular Filtration Rate .............. 1 1.1 Clinical Case Presentation ....................... 1 Family History ................................ 1 Clinical History ............................... 2 Physical Examination ........................... 2 Haematological Profile .......................... 2 Blood Pressure Profile .......................... 3 12 -Lead Electrocardiogram ...................... 3 Current Treatment ............................. 3 Diagnosis .................................... 3 Global Cardiovascular Risk Stratification ........... 5 Treatment Evaluation ........................... 5 Prescriptions .................................. 6 1.2 Follow-Up (Visit 1) at 6 Weeks ................... 6 Physical Examination ........................... 6 Current Treatment ............................. 6 Diagnostic Tests for Organ Damage or Associated Clinical Conditions ............................ 6 Diagnosis (Updated) ........................... 7 Treatment Evaluation and Prescriptions ............ 8 1.3 Follow-Up (Visit 2) at 3 Months .................. 8 Blood Pressure Profile .......................... 9 Current Treatment ............................. 9 1.4 F ollow-Up (Visit 3) at 1 Year ..................... 9 Physical Examination ........................... 9 Blood Pressure Profile .......................... 9 Diagnostic Tests for Organ Damage or Associated Clinical Conditions ................... 10 x Contents Current Treatment ............................. 10 Prescriptions .................................. 11 1.5 Discussion ................................... 11 References ................................... 13 Clinical Case 2 Patient with Hypertension and Microalbuminuria ............................. 15 2.1 Clinical Case Presentation ....................... 15 Family History ................................ 15 Clinical History ............................... 15 Physical Examination ........................... 16 Haematological Profile .......................... 16 Blood Pressure Profile .......................... 17 12 -Lead Electrocardiogram ...................... 17 US Scan of the Abdomen ........................ 17 Current Treatment ............................. 17 Diagnosis .................................... 19 Global Cardiovascular Risk Stratification ........... 19 Treatment Evaluation ........................... 20 Additional Tests Prescribed to Optimize Management .................................. 21 Therapeutic Prescriptions ........................ 21 2.2 Follow-Up (Visit 1) at 3 Months .................. 22 Physical Examination ........................... 22 Results of Further Diagnostic Tests ................ 22 Biochemical Profile ............................ 22 2.3 F ollow-Up (Visit 2) at 1 Year ..................... 23 Biochemical Profile ............................ 23 Blood Pressure Profile .......................... 23 ABPM ...................................... 24 Current Treatment ............................. 24 2.4 Discussion ................................... 25 References ................................... 28 Clinical Case 3 Patient with Hypertension and Mild Proteinuria .............................. 29 3.1 C linical Case Presentation ....................... 29 Family History ................................ 29 Clinical History ............................... 29 Physical Examination ........................... 30 Haematological Profile .......................... 30
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