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CV <3 > Lecture 2: HTN Part 2 > Flashcards

Lecture 2: HTN Part 2 Flashcards

1
Q

How often should follow-up occur after starting antiHTN management?

A
  • 4-6 weeks while titrating.
  • 6-12 months once stable.
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2
Q

How much BP reduction do we expect per agent at an optimal dose?

A

10mm Hg per agent added.

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3
Q

How is stage 2 HTN generally treated?

A

2 agents with complimentary actions.

AKA not ACEI and ARBs together.

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4
Q

What qualifies as HTN urgency?

A

Severe HTN without symptoms.
Generally around 180/120.

No acute organ damage should be present.

Usually caused by poorly controlled chronic HTN.

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5
Q

What is the primary goal of treating HTN urgency?

A

Reducing BP within a few hours.

  • Clonidine
  • Captopril
  • Metoprolol tartrate
  • Hydralazine
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6
Q

What are the main concerns with clonidine administration?

A
  • Sedative SE
  • Rebound HTN
  • Potential hypotension depending on efficacy
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7
Q

Why is nifedipine not as preferred for HTN urgency treatment?

A

Unpredictable response.

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8
Q

What qualifies as HTN emergency?

A

Severe HTN + end organ damage.

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9
Q

What are the primary organs typically affected in HTN emergency?

A
  • Brain
  • Eyes
  • Heart
  • Lungs
  • Kidney
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10
Q

What is the main deciding factor in treating HTN emergency?

A

The organs currently being affected, i.e. ischemic stroke vs acute aortic dissection.

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11
Q

Why is a CT head performed without contrast in initial workup for HTN emergency?

A

If there is a hemorrhagic stroke present, contrast will leak out into the vessels.

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12
Q

How much can BP be lowered within the first 2 hours of HTN emergency?

A

25%, to prevent hypoperfusion.

Afterwards, 160/100.

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13
Q

What are the 4 conditions with specific BP goals in HTN emergency?

A
  • Ischemic CVA: 180-200 with slow reduction.
  • Hemorrhagic CVA: < 140
  • Aortic dissection: < 120
  • MI: AC and O2 + NTG, BP can be variable.
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14
Q

What are the two primary agents in treating HTN emergency?

A

Combination of BBs and CCBs.

First-line CCB: nicardipine (generally)
First-line BB: Labetalol (generally)

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15
Q

What coronary condition should nicardipine be used in caution with?

A

MI

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16
Q

What condition might esmolol be preferred over labetalol in HTN emergency?

A

COPD.

However, both are cautionary in asthma.

Labetalol has beta and alpha properties, and can induce bronchospasm.

Esmolol is a weaker antiHTN.

17
Q

What are the primary CV changes during pregnancy?

A
  • CO increase by 40% (Primarily SV increase)
  • HR increase by 10bpm during 3rd trimester.
  • BP tends to trend down in 2nd trimester as SVR lowers.
18
Q

What BP in pregnancy is considered abnormal?

A

> = 140/90

Increased risk of morbidity and mortality.

19
Q

How is HTN during pregnancy diagnosed?

A

Two elevated readings 4 hrs apart.

20
Q

What is preeclampsia criteria?

A

NEW onset HTN (140/90) + proteinuria after 20 wks of gestation.

21
Q

What is gestational HTN criteria?

A

HTN (140/90) after 20 weeks gestation w/o pre-existing HTN OR proteinuria.

22
Q

What is chronic HTN during pregnancy?

A

HTN (140/90) before 20 wks or 12 weeks postpartum.

Can precede preeclampsia.

23
Q

What antiHTNs are contraindicated specifically in pregnancy?

A

ACEis and ARBs

24
Q

What are the preferred acute antiHTNs in pregnancy?

A
  • IV labetalol
  • IV hydralazine
  • Oral IR nifedipine
25
Q

What are the preferred chronic antiHTNs for HTN in pregnancy?

A
  • Labetalol
  • ER nifedipine
  • Methyldopa
26
Q

What is the target BP for HTN managment in pregnancy?

A

130-150/80-100.

Not recommended to drop more than 25% in 2 hrs.

27
Q

What qualifies as resistant HTN?

A

Fails to reach goal with a 3-drug regimen that includes a diuretic.

Generally due to non-compliance

28
Q

For a patient with resistant HTN, what specialists are recommended?

A
  • Cardio
  • Nephro
29
Q

What medication change should be considered for a patient with resistant HTN?

A

Diuretic change to aldosterone receptor blockers.

Spironolactone, epleronone

30
Q

What are some common causes of resistant HTN?

A
  • Improper pressure measurements
  • Volume overload and pseudotolerance
  • Associated conditions
  • Secondary causes
  • Drugs
31
Q
A

CV <3 (25 decks)

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