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Cardiovascular > Intro & HTN Part 1 > Flashcards

Intro & HTN Part 1 Flashcards

1
Q

what part of the bp represents the “stretch” and “Relax?”

A

Systolic BP = stretch
Diastolic BP = relax

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2
Q

Measures the force of blood against the arterial walls

A

Hypertension

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3
Q

when can you diagnose a pt with HTN?

A

average of 2+ accurate, seated BP readings during 2+ outpatient visits
Only exception → hypertensive emergency

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4
Q

what is a normal bp - ACC/AHA

A

<120 AND <80

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5
Q

what is an elevated bp - ACC/AHA

A

120-129 AND <80

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6
Q

what is considered HTN in terms of ACC/AHA

A

Stage 1 - 130-139 OR 80-89
Stage 2 - ≥140 OR ≥90

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7
Q

difference between primary vs secondary HTN

A
  1. primary - no single, reversible cause identified, from complex interactions between multiple factors
    - Accounts for 95% of cases
  2. Secondary → definable cause, makes up other 5%
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8
Q

common causes of secondary HTN (9)

A
  1. CKD
  2. Pheochromocytoma
  3. Renal Artery Stenosis
  4. Hyperaldosteronism
  5. Cushing Disease
  6. OSA
  7. Coarctation of the Aorta
  8. Thyroid Dysfunction
  9. Drug-Induced HTN
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9
Q

difference in BP between younger vs older pts

A
  1. Young Patients (<50)
    - Systolic and diastolic BP rise
    - Predominantly caused by hormonal activation
    - Associated with OSA
    - Tx initiated when BP >140/90 (JNC)
  2. Older Patients (>60)
    - Systolic BP rises, without rise in diastolic pressure
    - Predominantly caused by arterial stiffness
    - Not associated with OSA
    - Tx initiated when SBP >150 (JNC)
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10
Q

Occurs when systolic BP is >140, but diastolic is <90
what type of HTN

A

isolated systolic

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11
Q

isolated systolic HTN MC happens in who? how?

A
  1. older pts
    - Results from arterial stiffness and atherosclerosis
  2. Can occur in younger
    - MC in athletic males
    - Likely due to high stroke volume
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12
Q

what is the best risk predictor of long-term HTN complications? (SBP or DBP)

A
  • DBP - for patients <45 y/o
  • SBP - for patients >60 y/o
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13
Q

Persistently elevated BP > 140/90 in the office, but a lower value outside of the clinic
what type of HTN

A

White Coat

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14
Q

white coat HTN is MC seen in who?

A

older

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15
Q

is tx needed for white coat HTN?

A

as long as numbers are within range at home, tx is not necessary
Long-term monitoring required!
Cuff comparison key!

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16
Q

Normal BP in the office, but elevated values at home
Results in same complications as essential HTN
Often a result of lifestyle → alcohol use, tobacco use, caffeine consumption, etc.
what type of HTN

A

masked

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17
Q

Phenomenon that can occur in elderly patients that results from calcification of peripheral vessels
Results in falsely elevated BP, resulting in symptomatic overtreatment
what type of HTN

A

pseudoHTN

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18
Q

s/s of pt with pseudohypertension

A

hypotensive symptoms with elevated office readings

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19
Q

One of the most common chronic conditions in the US

A

HTN

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20
Q

Average SBP in ___(men/women) is > than in ___(men/women) in early adulthood

A

men > women
Age-related rise in BP higher in women

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21
Q

DBP increases with ___, then decreases
Results in wider pulse pressure after age 60
when does it stablize?

A

age
until about 55 y/o

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22
Q

HTN is a major risk factor for ___ and ___, which are the 1st and 5th leading causes of death in the US

A

heart disease
stroke

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23
Q

prevalence of HTN

A
  1. ~119 million adults had HTN
    - 57.8% non-Hispanic blacks
    — HTN manifests earlier, is more severe, higher rates of morbidity and mortality d/t stroke, LVH, CHF, ESRD than white Americans
    - 48.9% in non-Hispanic whites
    - 45.2% in non-Hispanic Asians
    - 38.6% in Hispanic Americans
  2. Prevalence is increased in older adults
    - 77.1% in adults ≥65 y/o
24
Q

pathogenesis of HTN

A

BP = CO * systemic vascular resistance
- Maintenance of arterial BP is necessary for organ perfusion
- BP must react to environmental changes to maintain this perfusion over a wide variety of conditions

25
Q

what factors can cause primary HTN (5)

A
  1. Sympathetic nervous system hyperactivity
  2. RAAS
  3. Defect in natriuresis
  4. Abnormal CV or kidney development
  5. Elevated intracellular Ca and Na
26
Q

how does Sympathetic Nervous System Hyperactivity cause primary HTN? MC in who?

A
  1. “Fight or Flight”
    - Acetylcholine and norepinephrine release
    — Autonomic neurons that secrete acetylcholine are cholinergic
    — Autonomic neurons that secrete norepinephrine are adrenergic
  2. Younger pts
    - presents with tachycardia and elevated CO
27
Q

how does the RAAS system cause primary HTN?

A

sodium retention + water retention = BP rises
Renin = AT = AT I = AT II = vasoconstriction = BP rises

28
Q

how does Natriuresis Defect cause HTN

A
  1. ↑ salt intake triggers ↑ BP = ↑ natriuresis to bring BP values back into normal range
  2. Defects in this process result in HTN
29
Q

how does CV or Renal Defect cause HTN

A
  1. elasticity of arteries matches resistance of peripheral arteries to optimize large vessel pressure waves
    - Serves to minimize oxygen consumption and maximize coronary flow
  2. If the aortic elasticity or microvasculature is abnormal it increases the risk of HTN later in life
30
Q

how does Calcium & Sodium ↑ cause HTN

A
  1. Intracellular sodium is elevated in primary HTN
  2. This can lead to increase intracellular calcium as well
    - Theoretically leads to increased vascular smooth muscle tone that is seen in HTN
31
Q

risk factors of HTN (7)

A
  1. OSA
  2. Excessive Alcohol Use
  3. Cigarette Smoking
  4. NSAID use
  5. Obesity
  6. Low potassium or high sodium intake
  7. Metabolic syndrome
32
Q

Goals of HTN Evaluation (3)

A
  1. Assess presence of target-organ damage related to HTN
  2. Determine the presence of other CV risk factors and disease
  3. Evaluate for possible underlying secondary causes of HTN
33
Q

how to measure BP

A
  1. Can be taken at home, in clinic, at a pharmacy, or by ambulatory monitoring
    - Should be taken in both arms, two times, spaced 1-2 minutes apart at first office visit
    - If value varies between extremities, use higher value obtained
34
Q

automated devices may be inaccurate d/t beat-to-beat variability from this condition

A

a-fib

35
Q

home BP monitoring vs ambulatory BP monitoring

A
  1. home
    - Allows for continued monitoring
    - Helps dx white coat HTN
    - Patient must be educated on how to use their device
    - Ensure home device is accurate
  2. ambulatory
    - BP machine automatically obtains multiple readings over an extended period of time (typically 24 hours)
    - Able to assess masked HTN and medication efficacy
    - Helps assess nighttime risk of elevated BP or non-dipping BP
36
Q

what to ask HTN pt when obtaining hx

A
  1. Assess duration, age of onset, previous levels of high BP
  2. Previous antihypertensive therapy and its effect on BP
  3. sx and possible secondary causes of HTN
  4. Med hx
    - Contraceptives, NSAIDs, amphetamines, licorice
  5. Social history
    - Alcohol/tobacco use, activity level, diet
  6. Presence of other CV risk factors
  7. sx that suggest target-organ damage
    Neuro dysfunction, HF, CAD, PAD
37
Q

labs for HTN pts

A
  1. UA (protein)
  2. BMP
  3. EKG
  4. fasting-lipid panel
  5. TSH
  6. other tests for secondary causes
38
Q

complications of untreated HTN (4)

A
  1. structural and functional changes in the heart and vasculature
    - LVH, increased atrial size, CHF, atherosclerosis, microvascular disease, and cardiac arrhythmias
  2. Increased risk of thrombosis
  3. Increase in morbidity and mortality related to HTN doubles for each 6 mmHg increase in DBP
  4. Target-organ damage my vary between individuals, even if their BP readings are similar
39
Q

LVH can lead to what 3 conditions that can lead to death

A
  1. diastolic HF = systolic HF
  2. MI
  3. ventricular arrhythmias
40
Q

s/s of HTN CV disease

A
  1. Dyspnea, edema
  2. Palpitations, chest pain
  3. LV heave or S4 gallop
  4. LVH criteria on EKG
41
Q

what disease is a major predisposing factor for both ischemic and hemorrhagic stroke
also increases risk for dementia
more related to SBP

A

Hypertensive Cerebrovascular Disease

42
Q

what can actually make sx worse for dementia pts with HTN?

A

once microvascular disease is noted, lowering BP can actually make symptoms worse

43
Q

Chronic untreated HTN results in nephrosclerosis
MC in black pts
what is this disease

A

HTN renal disease
difficult to reverse damage that has already occurred

44
Q

Narrowing of the retinal arteries
what is this condition

A

hypertensive retinopathy

45
Q

hypertensive retinopathy can develop what in the eyes

A

exudates, cotton-wool spots, and retinal hemorrhages
The degree and duration of HTN are primary determinants of retinopathy
Worse when combined with DM

46
Q

vascular complications with HTN

A
  1. Atherosclerosis
    - Condition that causes narrowing and/or hardening of arteries
    - Cause by and contributes to increased BP
  2. Aortic Aneurysm / Dissection
    - HTN is a major contributing factor for development of aneurysm and/or aortic dissection
47
Q

non-pharm tx for HTN

A
  1. Weight reduction (best)
  2. Adopt DASH eating plan
  3. Dietary sodium reduction
  4. Physical activity
  5. Moderation of alcohol consumption
48
Q

ACC/AHA 2017 Management Guidelines for HTN

A
  1. normal - promote healthy lifestyle
  2. elevated - Initiate non-pharmacologic therapy and reassess BP in 3-6 months
  3. stage 1 - Assess 10 year ASCVD Risk
    - If ≥ 10% or clinical ASCVD begin pharm and non-pharm treatment
    - If not, begin non-pharm treatment only
  4. stage 2 - Begin pharm and non-pharm treatment
49
Q

ACC/AHA Antihypertensive medication recommendations

A
  1. Goal BP for ALL patients with HTN is <130/80
  2. Non-African American patients:
    - Thiazide, ACEI/ARB, or CCB
  3. African American patients:
    - Thiazide or CCB
50
Q

pt with HF can take what meds?

A
  1. diuretic
  2. BB
  3. ACEi
  4. ARB
  5. aldosterone antagonist
51
Q

pt with post-MI can take what meds?

A
  1. BB
  2. ACEi
  3. aldosterone antagonist
52
Q

pt with risk coronary disease risk could take what meds

A
  1. diuretic
  2. BB
  3. ACEi
  4. CCB
53
Q

pt with DM could take what meds

A
  1. Diuretic
  2. BB
  3. ACE Inhibitors
  4. ARB
  5. CCB
54
Q

CKD could take what meds for HTN

A
  1. ACEi
  2. ARB
55
Q

pt with recurrent stroke prevention could take what meds

A
  1. diuretic
  2. ACEi
56
Q

f/u and monitoring for HTN pts

A
  1. Once BP is well controlled and meds proven safe / tolerated, f/up can be as infrequent as every 6 to 12 months
  2. Lab monitoring is NOT needed if BP is controlled, unless other disease processes are present
  3. EKG could be obtained every 2-4 years depending on baseline EKG and any symptoms that present

Cardiovascular (24 decks)

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