The Hope Center Blog

Case Study – Cardiology

Hypertension: Diagnosis and Treatment Options

Hypertension is primarily seen in geriatric patients and if untreated can cause serious consequences such as blindness, progressive renal damage, cardiac hypertrophy, aneurysm, seizures, or strokes. Accurate diagnosis of hypertension is important so that treatment can be initiated to prevent these problems.

Unfortunately, diagnosis is not always straightforward. Hypertension can be over diagnosed if based on a single blood pressure reading.

However, if the index of suspicion is not high or if patients are not tested, the disease can be missed. Obtaining accurate blood pressure readings can be difficult due to the stress level of some patients, variations in body conformation and size, and technical aspects of blood pressure measurement.

Tips for Improving Accuracy of Blood Pressure Monitoring

  1. Train team members well in blood pressure measurement technique
  2. Minimize stress for the patient by having the owner present, allowing a few minutes to acclimatize, dimming the lights, and minimizing noise.
  3. Ensure the cuff width is 40% of the limb circumference in dogs and 30-40% in cats. Too large, will artificially lower the reading and too small, will increase it.
  4. Cuff placement is on cylindrical appendages. Certain breeds, such as Dachshunds and Basset Hounds, have quickly tapering limbs that do not occlude evenly and tail readings are more accurate for this conformation.
  5. Ultrasonic Doppler is the most accurate method for small dogs and cats.
  6. Readings should be consistent and reproducible. If an abnormal reading is obtained, adjust cuff to make sure similar reading is obtained, and confirm similar reading on another site.
  7. Record where blood pressure taken, position of patient, cuff size, and state of patient for future comparison.

Who’s at Risk for Hypertension?

Hypertension is most common in older patients. We recommend routine screening in all patients over 10 years of age.

CVCA Rockville

If no concurrent disease is present, then the hypertension is considered primary or idiopathic. Since primary hypertension is uncommon, it’s important to make sure that high readings are persistent and reproducible.

Interpreting Blood Pressure Results

A persistently systolic blood pressure above 160 mmHg moderately increases the risk of end organ damage. A reading above 180 mmHg severely increases that risk.

If an elevated blood pressure is detected, a thorough physical exam should be performed evaluating for evidence of endocrinopathy, as well as vascular dilation, petechiae and/or retinal detachments noted on a fundic exam. CBC, chemistry, and urinalysis may elucidate an underlying cause.

Treatment of Hypertension

Amlodipine is the treatment of choice in cats due to efficacy and duration of action. The initial dosage is ¼ of a 2.5 mg tablet once daily. Patients require gradual increases including up to ½ tablet twice daily if needed. The decline expected can be in the 40 mm Hg range but responses vary. With hyperthyroidism, there is excessive sympathetic stimulation and beta-blockers are helpful.

Both ACE inhibitors and Amlodipine (0.1-0.25 mg/kg q 24 h) are useful in the dog. The reduction in blood pressure with enalapril is mild. However, it also has protective effects on the kidneys by decreasing intraglomerular hypertension.

The majority of cases of hypertension can be treated on an outpatient basis with oral medications. Animals with severe neurological manifestations may require aggressive in-hospital treatment, including nitroprusside or hydralazine.

The goal of treatment is to reduce blood pressure and minimize the danger of end organ damage. Blood pressure is checked weekly until controlled, then every 3 months thereafter.

Key Points to Remember

  1. Blood pressure screening is recommended in older patients, patients with diseases that increase risk of hypertension, and patients with symptoms consistent with end organ damage.
  2. The decision to treat is based on reliable, repeatable blood pressure readings.
  3. Treatment is aimed at addressing any underlying diseases and maintaining a systolic blood pressure less than 160 mmHg.

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About Dr. Sidley

Dr. Sidley’s practice is devoted to the most effective and compassionate treatment of dogs and cats with heart disease. She understands that staying current on the latest diagnostic techniques and treatment options is only part of her job and also places a high value on respectful client communication. She strives to understand the financial, emotional, and other factors particular to each case but essential in helping the client develop the best plan for that patient.

Born and raised in northern Virginia, Dr. Sidley returned to the area in 2000 to join Chesapeake Veterinary Cardiology Associates. She is a 1988 graduate of the University of Virginia, received her Doctorate of Veterinary Medicine from the University of Minnesota in 1996, and completed her internship and cardiology residency at North Carolina State University four years later. She has been a Diplomate of the American College of Veterinary Internal Medicine in the College of Cardiology since 2000. Dr. Sidley has designed and led academic research studies and has been published in many research journals, including the Journal of Veterinary Internal Medicine and the Journal of the American Veterinary Medical Association.

About Dr. Jacob

Dr. Jacob joined CVCA in 2005. She received her bachelor’s degree and her Doctorate in Veterinary Medicine at Cornell University. She completed both her small animal internship and her cardiology residency at the Animal Medical Center in New York. She then became part of the faculty of the College of Veterinary Medicine at the University of Minnesota as an assistant clinical professor. While at the University of Minnesota, Dr. Jacob developed a busy clinical cardiology service and stressed the importance of client education and addressing all of the patient’s needs to her students. Dr. Jacob has lectured on a variety of topics to students, veterinary technicians and colleagues.

She has been a Diplomate of the American College of Veterinary Internal Medicine since 1998. Her involvement in numerous research projects has led to the publication of several articles in scientific journals. Her interests include pacemaker therapy, medical therapy of congestive heart failure and feline cardiomyopathies. Dr. Jacob understands the importance of communication and emphasizes education and deciding with the clients what the best treatment options are for their pet and their family. Dr. Jacob loves spending her spare time at home with her husband and two school age sons. She also enjoys exercising, mainly triathlons. Occasionally, they find time to travel as well! Dr. Jacob sees patients primarily in our Towson, MD and Rockville, MD offices.

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Hospital Location: 1 Taft Ct
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