Sekundarna hipertenzija

master's thesis

• Title (english): Secondary hypertension
• Author: Luka Šantek
• Mentor: Ingrid Prkačin (mentor)
• Committee member: Nikolina Bašić Jukić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Ingrid Prkačin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Sekundarna hipertenzija se odnosi na arterijsku hipertenziju kod koje je moguće identificirati uzrok i zahvaća 5-10% opće populacije s nekim oblikom hipertenzije. Zbog toga što su sekundarni oblici hipertenzije rijetki a pretrage dugotrajne i skupe, samo bolesnici sa kliničkom sumnjom trebaju biti podvrgnuti probiru. U posljednjih nekoliko godina neki novi aspekti dobili su na važnosti u vezi ovog probira. To se posebno odnosi na 24-satno ambulatno mjerenje krvnog tlaka (ABPM) za koje postoji sve više dokaza da igra središnju ulogu u dijelu obrade bolesnika sa sumnjom na sekundarnu hipertenziju. Štoviše, opstruktivna apneja u spavanju (OSA) je prepoznata kao jedan od najčešćih uzroka ove bolesti. Konačno, uvođenje postupka renalne denervacije pomoću katetera za liječenje bolesnika sa rezistentnom hipertenzijom (RH) dramatično je povećao interes i broj bolesnika kod kojih se vrši procjena stenoze bubrežnih arterija (RAS).
Predstavljeni su klinički znakovi bolesnika s najčešćim uzrocima sekundarne hipertenzije. Navedene su specifične preporuke za procjenu i liječenje različitih oblika sekundarne hipertenzije. Unatoč primjeni odgovarajuće terapije ili čak uklanjanju sekundarnih uzroka ustanovljeno je da se u dugotrajnom praćenju krvni tlak rijetko vraća na normalne vrijednosti. Takva rezidualna hipertenzija ukazuje da neki bolesnici sa sekundarnom hipertenzijom istodobno imaju esencijalnu hipertenziju (EH) ili da je ireverzibilno remodeliranje vaskulature preuzelo mjesto. U bolesnika s potencijalno reverzibilnim uzrocima hipertenzije rano otkrivanje i liječenje je važno kako bi smanjilo/spriječilo nepovratne promjene u krvnim žilama i ciljnim organima.

Abstract (english)

Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects 5–10% of the general hypertensive population. Because secondary forms are rare and work up is time-consuming and expensive, only patients with clinical suspicion should be screened. In recent years, some new aspects gained importance regarding this screening. In particular, increasing evidence suggests that 24 h ambulatory blood pressure monitoring (ABPM) plays a central role in the work up of patients with suspected secondary hypertension. Moreover, obstructive sleep apnoea (OSA) has been identified as one of the most frequent causes. Finally, the introduction of catheter-based renal denervation for the treatment of patients with resistant hypertension (RH) has dramatically increased the interest and the number of patients evaluated for renal artery stenosis (RAS).
There are presented clinical clues of the most common causes of secondary hypertension. Specific recommendations are given as to evaluation and treatment of various forms of secondary hypertension. Despite appropriate therapy or even removal of the secondary cause, BP rarely ever returns to normal with long-term follow-up. Such residue hypertension indicates either that some patients with secondary hypertension also have concomitant essential hypertension (EH) or that irreversible vascular remodelling has taken place. Thus, in patients with potentially reversible causes of hypertension, early detection and treatment are important to minimize/prevent irreversible changes in the vasculature and target organs.

• Keywords: arterijska hipertenzija; sekundarna hipertenzija; opstruktivna apneja u spavanju; stenoza bubrežnih arterija; primarni aldosteronizam; feokromocitom
• Keywords (english): arterial hypertension; secondary hypertension; obstructive sleep apnoea; renal artery stenosis; primary aldosteronism; pheochromocytoma
• Language: croatian
• URN:NBN: urn:nbn:hr:105:621611
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-09-14 07:39:27