Our Cat, Sweetie Frankmann, lived with Feline Hypertension for years. Sweetie found us. She showed up in our yard many years ago in late Spring of 2007. At this time, we already had a full household and a very sick cat named Maynard, so she remained outside. We also didn’t know if she had a home somewhere nearby. In the meantime, Sweetie grew her trust in us as we fed her and interacted with her outdoors. Eventually, we could pet her and even pick her up. When we had to let Maynard go, Sweetie joined our house full-time indoors. We never did find her original pet parent. We also didn’t know how old she was, but we had guessed around 2 years of age. Sweetie lived up to her name every single day. I’ve met a lot of cats and she was up there with some of the sweetest.
Fast forward to 2018, Sweetie was then about 12. As we do with all cats 8 years and older, we measured her blood pressure (BP) at her routine biannual wellness exam. Her systolic pressure (number on top) at that visit averaged 215 – quite a bit over the desired <150-160. Over 180 is considered severely hypertensive and the risk to target organs is extremely high. These target organs include the eyes (up to 50% of all cats with hypertension), heart, kidneys, and brain. At this same visit, we also noted Sweetie had an elevated heart rate, murmur, and elevated cardiac enzymes – evidence that the hypertension was already affecting other organs. In her case, her heart (and possibly her kidneys as later she did develop Chronic Kidney Disease too) was the main target. Thankfully her vision and neurologic status was not affected.
We immediately began a once a day, inexpensive oral treatment with amlodipine (humans also take this drug for hypertension under the brand names Norvasc and Katerzia). And, as with any medication we initiate, we monitored Sweetie closely until her BP was in a desirable range of <160, and most preferable <150 systolic. We also continued to monitor her heart rate, murmur and cardiac enzymes which did decrease with treatment of the hypertension. And we followed trends in lab work so that we continually monitored for any concerns with her kidneys.
Sweetie continued to receive amlodipine every day of her life until she succumbed to advanced stage chronic kidney failure this past December 2022. She was believed to be 16-17 years old when we let her go. Side note: Chronic Kidney Disease (CKD) is another very common disease in older cats and why repeated, screening lab work is extremely important. CKD will be a topic of discussion for ACOC’s Year of the Cat in the month of July.
Why do I tell you this story?
To emphasize the importance of routine wellness exams, lab work, and BP measurements in otherwise “healthy” cats beginning at 8 years of age and older. Ideally exams are performed twice a year and labs/BP taken and measured once a year unless a problem is detected. Then, we determine frequency based on disease, response to therapy, and other factors. Just like our human doctors do! Still further, Sweetie’s story highlights what earlier diagnosis and treatment can do for us: give us more time with the furry members of our family. In Sweetie’s case, this bought us over four additional years with her!!!
Ideally, we would have caught Sweetie’s hypertension earlier and before target organ damage had occurred. But, as with most cats, she appeared and acted perfectly normal. Cats are masters at hiding illness: even to two veterinarian pet parents!
Hypertension (HT) is a common problem in cats and most frequently diagnosed in cats older than 7 years of age. Most hypertensive cats have an underlying disease with CKD being the most common. These cats have Secondary HT and is why it is very important to monitor BP in cats with known underlying diseases such as CKD, hyperthyroidism, and diabetes mellitus. Idiopathic HT (absent identifiable underlying cause) accounts for approximately 13-20% of hypertensive cats and is only diagnosed after ruling out other conditions first. Situational HT (“white coat syndrome”) is a result of excitement or anxiety in a cat with otherwise normal blood pressure. And is why we confirm hypertension with repeat BP measurements at separate visits prior to starting medications (unless there is clear evidence of ocular or neurological damage).
Save the eyes!! The eyes are the most susceptible organ to HT. Chronic, untreated HT can lead to retinal detachment and sudden blindness. A quick evaluation of the retina with an ophthalmoscope is needed and very important to perform.
Behavioral changes. The brain is also very susceptible to HT. Up to 46% of cats with HT will have neurologic signs such as: nighttime howling, disorientation, balance problems, vision loss, hearing loss, seizures and other relatively sudden behavioral changes.
My aching heart. Like Sweetie, the heart and vasculature can also be affected. If heart disease develops, we may see lethargy, weakness, collapse, lameness (from a blood clot), pain – or even absence of any clinical signs as with Sweetie. Our suspicion of any heart and vascular damage or disease can more readily be ruled out or in with a stethoscope and listening for a murmur or an increased heart rate.
To pee or not to pee. Last, the kidneys. Sustained HT is associated with progression of CKD – but which came first is often difficult to determine. With Sweetie, we suspect the HT led to the progression of her CKD and not the other way around. CKD is easy to diagnose with examination, urinalysis, and screening lab work.
The diagnosis of HT is relatively easy to diagnose and treat. We recently upgraded our BP machine to the latest technology (HDO = High Definition Oscillometric) and we are happy to say it is much more cat friendly and accurate. This will make measuring and interpreting BP faster and easier. In just minutes we can screen your cat’s BP (stay tuned for some videos of cats getting their BP measured). Treating with a once-a-day medication that can and often is compounded into a tasty liquid can be done without too much trouble in most cats (we can teach you how). Follow-up visits to check that the BP is regulated will be needed. Then, once under control, less frequent but chronic measurements of BP will be required for life. Additionally, if there is underlying disease – we must find and treat this too.
For more information on Feline Hypertension I encourage you to go to https://catfriendly.com/feline-diseases/feline-hypertension-high-blood-pressure/
What can you do? The next time you’re in to see us, ask us what your cat’s blood pressure readings are! If you notice anything out of the ordinary with your cat at home, be sure to make an appointment. And, I cannot stress enough, the value of continual preventive care visits for cats of all ages (even if indoor only) with a veterinarian. Have we seen your cat lately?
Written by Dr. Wendy Frankmann and dedicated to Sweetie Frankmann. We miss your head bunting and rubs!
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Dr. Wendy Frankmann