HT special case in afya

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do echo (depending on ECG), urine, eyes (show if emergency prob), ECG (LVF), eGFR, albumin:creatinine ratio, glc, lipids, U/E

''Diabetes''
Tighter control is questioned (Cochrane 2013) - probably small dec in stroke with 130/80
ACEi renoprotective in diabetes - 1st line
In afro-caribbeans - use ACEi + thiazide or CCB
Autonomic neuropathy postural Sx made worse with antiHT
Avoid BB (esp with thiazides) in uncomplicated HT as cause insulin resistance, impair insulin secretion and alter autonomic response to hypoglycaemia

''Endocrine''
Even in young essential HT is most common cause (or white coat HT) but .....
10% have secondary cause esp primary hyperaldosteronism (low K, otherwise well)
esp look for secondary if <40, rapid onset, >180/110, little response to Rx
refer same day if accelerated or ?phaeo
//Primary Hyperaldosteronism
Phaeochromocytoma
Atherosclerotic renovascular disease (2% of all HT)
Cushings
Acromegaly//

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