Systemic hypertension

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Systemic hypertension is increasingly recognized within the canine and feline population, particularly in older patients. Blood pressure (BP) is the product of cardiac output and total peripheral resistance, and cardiac output in turn is determined by the heart rate and stroke volume. In health, the baroreceptor reflex interacts with the autonomic nervous system and both local and systemic vasoactive agents to regulate the heart, peripheral vasculature and the renin-angiotensin-aldosterone system (RAAS), keeping BP tightly controlled. Systemic vascular resistance is maintained partly through peripheral vascular compliance and elasticity, particularly of the arteriolar beds. This chapter looks at Target organ damage; Classification of systolic hypertension; Indications for measuring blood pressure; Diagnosis of systemic hypertension; and Treatment and management of systemic hypertension.

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27.4 Ocular lesions secondary to systemic hypertension. Feline fundus with evidence of multifocal intraretinal haemorrhages, large bullous retinal detachment and oedema. Marked variation in vessel calibre, with marked apparent loss/attenuation of retinal arterioles, is present (likely due to detachment/oedema). Feline fundus with central focal bullous retinal detachment; peripherally similar smaller circular lesions can also be identified. There is also generalized oedema. Note how the blood vessel is raised by the bullous detachment (arrowed). Feline fundus with multifocal areas of pigmentary disturbance. These represent old/inactive lesions likely to be secondary to small bullous detachment in the past (for example, that indicated by arrow). This cat did not have any detectable visual problem. Feline eye demonstrating an area of total bullous retinal detachment, with large folds of retina displaced anteriorly within the vitreous and therefore now visible directly via the pupil with a focal light source (optic disc more posterior and obscured by retinal folds in this image). Multifocal intraretinal haemorrhages are present. Note also the marked mydriasis. This cat was clinically blind on presentation with similar changes observed bilaterally. Feline eye with evidence of gross hyphaema (blood in anterior chamber). The blood has formed a solid clot. Also note the mydriasis, which is suggestive of concurrent fundic damage. Canine eye with evidence of gross hyphaema. ((a)–(e) courtesy of R. Elks.)
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27.6 Protocol for the management of systemic hypertension in the cat and dog.
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27.7 Treatment of systemic hypertension in the dog.
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27.8 Treatment of systemic hypertension in the cat.
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