Veterinary care should include diagnostic tests and subsequent treatment recommendations.
Diagnosis In-depthDiagnostic tests are needed to recognize hypertension and exclude other diseases. Tests may include:
Repeated measurements of arterial blood pressure using a Doppler flow device or an oscillometric device
Complete medical history and physical examination
Examination directed to the potential causes of hypertension and to the organs injured by high blood pressure
A neurological examination
Ophthalmoscopic examination
Examination of the heart to include physical diagnosis using a stethoscope, chest X-rays or an echocardiogram (ultrasound of the heart).
Kidney exam, including physical examination, blood tests, urinalysis and diagnostic imaging, X-rays or ultrasound
Additional diagnostic tests may be recommended on an individual pet basis, including:
Identification of the underlying cause of hypertension. This may require a variety of laboratory tests including blood tests of endocrine function, specialized X-rays or ultrasound examination of abdominal organs.
Diagnostic tests for Cushing's disease
Detailed urine analyses for identification of some forms of kidney disease.
Treatment In-depth
The principles of therapy include management of the underlying cause of hypertension and lowering of the arterial blood pressure. Treatment must be individualized for the patient and the associated problems and may include one or more of the following:
Hypertensive crisis (very high blood pressure with severe clinical signs such as stroke, impaired consciousness or blindness) should be treated aggressively in the hospital with drugs that lower blood pressure. The potent intravenous vasodilator drug, sodium nitroprusside, may be used for this purpose. Sodium nitroprusside must be carefully administered and this may require transfer to an emergency hospital. Diuretics, amlodipine or other vasodilator drugs (hydralazine) can also be used in a hypertensive crisis.
Chronic treatment of hypertension in dogs may be accomplished with a number of anti-hypertensive drugs. Most clinicians begin with enalapril or benazepril, especially if there is evidence of underlying kidney disease or concurrent valvular heart disease. Amlodipine and beta-blockers are additional forms of potentially effective therapy. In some dogs, combination therapy is required.
Most people are familiar with treating hypertension initially using weight reduction and exercise programs and decreases in dietary sodium intake. Unfortunately, these measures are rarely, if ever, effective in controlling hypertension in dogs. Certainly, a reduction in dietary sodium (salt) is appropriate for most patients, but diet alone will not be enough.
Management of hypertension may never be completely successful unless the underlying cause can be managed. This can be difficult with certain diseases or tumors of the adrenal gland.
Organs injured by hypertension may recover in some cases once the blood pressure is controlled. In other situations, the prognosis for neurologic function, sight and cardiac function depends on the duration of clinical symptoms.
