Hypertension

Rheumatologic practice

HYPERTENSION CLUBJANUARY 21ST, 2007

Hatem Hamdi Eleishi, MDConsultant Rheumatologist, Dr. S. Fakeeh Hospital, Jeddah

Assistant Professor of Rheumatology, Cairo University, Egypt

HYPERTENSION IN RHEUMATOLOGIC PRACTICE

Rheumatologic Disorders That May Cause

Hypertension

Systemic Disorders That May Cause Rheumatologic

Manifestations And Also Hypertension

Rheumatologic Treatments That May Cause

Hypertension Anti-hypertensive Treatments That May Cause Rheumatologic Problems Anti-hypertensive Treatments That May Benefit/Help Solve Rheumatologic ProblemsPatient Non-compliance With Cardiologist’s

Advice That May Benefit/Help Solve Rheumatologic

Problems

1

2

3

4

5

6

Rheumatologic Disorders that may cause Hypertension

1 of 6

Facial rash

A 26-year old female with:

Hypertension Fatigue, polyarthritis

Lab:

ESR 100 mm/hr

Hb 7gm/dL

Creatinine 2.3mg/dLWBC 2.700/cc

Fever, weight loss

Lab (cont.):

Hypocomplementemia

Albumin: 2.1 g/dL

Systemic Lupus Erythematosus

Urinalysis:

Proteinuria, hematuria, pyuria, granular casts

Positive ANA

Positive anti-DNA

Polyarteritis NodosaA 37-year-old man with:

Foot dropSC nodule over the calf

HBV positive

Testicular pain

Hypertension

Arthralgias, myalgias

Fever, weight loss

Lab:

ESR 100 mm/hr

Hb 7gm/dL

Creatinine 2.3mg/dL

Takayasu’s ArteritisA 38-year old woman

presents with:FatigueIncreasing pain in both armsBlood pressure measurements:

Right arm 105/65mmHgLeft arm 140/80mmHgLabs:

Hb 10.4g/dL, ESR 68mm/h

Takayasu’s ArteritisEarly: Non specific symptoms

Variable rate of progression

Later: manifestation of large vessel occlusive diseaseArms, legs

CoronariesRenal arteries

TOO LATE

Wegener’s granulomatosisA 27-year old female

with:

Chronic sinusitis

Purpuric lesions were noted over the elbows

Chest X-ray: a well-circumscribed round lesion in the right upper zone approximately 8 cm in diameter.

Hypertension

Fatigue, polyarthritisFever, weight loss

Negative ANA

Diffuse Systemic SclerosisA 57-year old female with:

Cold blue hands Skin tightness

Hypertension

Fatigue, polyarthralgias

Positive ANA

Creatinine 3.0mg/dL

Systemic lupus erythematosus

Takayasu’s arteritis

Wegener’s Granulomatosis

Polyarteritis Nodosa

Systemic sclerosis

Renal artery

AnteriorBranch 3 lobar

branches Interlobar

Interlobular

ArcuateAfferent

GM

Takayasu Microscopic polyangitisPolyarteritis nodosa

SLEWegener’s

Systemic sclerosis

Churg Strauss

Systemic Disorders that may cause

Rheumatologic Manifestations

and also

Hypertension 2 of 6

Endocrinal

Cushing’s disease

Thyrotoxicosis

Acromegaly

Thyrotoxic Myopathy

Hyp

erte

nsi

on

Proximal, later, generalized

muscle weakness

Proxmial myopathy

Osteoporosis

Miscellaneous

Systemic Disorders that may cause

Rheumatologic Manifestations

and also

Hypertension (cont.)

A 67-year man with:

ESR: 10mm/hr

Systolic hypertensionPain in left lower arm with deformity

No constitutional symptoms

Paget’s Disease

Elevated ALP

Elevated urinary hydroxyprolineNormal s. calcium

Paget’s DiseaseA focal disorder of bone remodeling that typically begins with excessive bone resorption followed by excessive bone formation

Normal bone Pagetic bone

What causes hypertension in Paget’s disease?

Normal bone Pagetic bone

High cardiac output failure

A 56-year man with:

ESR: 85mm/hr

Long-standing Hypertension

Back painConstitutional

symptoms

Has a 3-month history of:

Back exam: freeAnuria, rising creatinineMid-abdominal bruitCT abdomen confirms the diagnosis

Retroperitoneal Fibrosis (RPF)

Consider the diagnosis of RPF in:

A middle-aged or elderly patient

With the triad of:

Clue

Abdominal and/or back pain

Elevated ESR Weight loss

EndocrinalCushing’s syndrome

Thyrotoxicosis

AcromegalyMiscellaneousPaget’s Disease

RPF

Rheumatologic Treatments

That May Cause Hypertension

3 of 6

Corticosteroids

Cyclosporine

Anti-hypertensive Treatments

That May Cause Rheumatologic Problems

4 of 6

Thiazide diuretics

Hydralazine

Anti-hypertensive Treatments That May

Benefit ExistingRheumatologic

Problems

5 of 6

Captropril

We like that sulfhydryl (-SH) group

Hypertensive Patient Non-compliance With

Doctor Advice That May Benefit

Some Rheumatologic Problems

6 of 6

Smoking is good for………..

Oral ulcers in Behcet’s disease

In conclusion

Thank you