HYPERTENSION PROTOCOL- INITIAL VISIT STUDY GUIDE.

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HYPERTENSION PROTOCOL- INITIAL VISIT STUDY
GUIDE


1) RATIONALE
a) This protocol will assist in the differentiation between essential
hypertension and renal artery stenosis to aid in the identification of patients
in need of referral to nephrology to prevent further renal damage from an
unidentified renal artery stenosis. The design of the protocol for UTI
encompasses these principles.

2) SYMPTOMS
a) HYPERTENSION
i) Blood pressure >140/90 mmHg
ii) Other possible subjective symptoms
(1) Headache
(2) Visual changes
(3) Dyspnea
(4) Chest pain
(5) Sensory or motor deficit
b) RENAL ARTERY STENOSIS
i) Onset of hypertension age >55 years or <30 years
ii) History of accelerated, malignant, or resistant hypertension
iii) History of unexplained kidney dysfunction
iv) History of multivessel coronary artery disease
v) History of other peripheral vascular disease
vi) Abdominal bruit
vii) Sudden or unexplained recurrent pulmonary edema
viii) Other possible factors
(1) Absence of family history of hypertension
(2) Other bruits
(3) History of acute kidney injury after administration of ACE
inhibitor or angiotensin II receptor antagonist (ARB)

3) HISTORY
a) Continue with treatment of hypertension but consult supervising physician if
patient has:
i) History of accelerated, malignant, or resistant hypertension

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ii) History of unexplained kidney dysfunction
iii) History of multivessel coronary artery disease
iv) History of other peripheral vascular disease
v) Abdominal bruit
vi) Sudden or unexplained recurrent pulmonary edema

4) PHYSICAL EXAM
a) Perform the following examinations:
i) Vital Signs (blood pressure, pulse)
ii) Auscultation for bruits (carotid, abdominal, and femoral)