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Test 4 Health Assessment (Mordecai) > Exam 4 Hypertension part I (bri) > Flashcards

Exam 4 Hypertension part I (bri) Flashcards

1
Q

how is HTN defined by the american college of cardiology and AHA?

A
  • sustained SBP > 130 mmHg
  • and/or a DBP > 80 mmHg

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2
Q

HTN
* effects > ____ million people in US
* nearly ____ adults

A
  • 100 million
  • 1/2

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3
Q

HTN effects ____% of African Americans, ____% of Whites, ____% of Asians, ____% of Hispanics

A
  • 40%
  • 30%
  • 29%
  • 27%

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4
Q

HTN Dysproportionately effects ____ income countries, and the lifetime rx of developing HTN in the US is ____%

A
  • low-middle
  • 90%

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5
Q

What are the classifications of BP in adults:

  • elevated
  • stage 1 HTN
  • stage 2 HTN
A

120-129 / <80
130-139 / 80-90
>= 140 / >= 90

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6
Q

In addition to SBP and DBP elevation, a ____ is alsoa risk factor for cardiovascular morbidity as it correlates withvascular remodeling and “stiffness”

A

widened pulse pressure

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7
Q

The cause of primary HTN is unclear, but contributing factors include ?

A
  • SNS activity
  • dysregulation of the RAAS
  • deficiency in endogenous vasodilators

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8
Q

Genetic and lifestyle risk factors assoc w/HTN include

A
  • obesity
  • alcoholism
  • tobacco

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9
Q

A minority of pts w/ HTN havesecondary HTN resulting from a potentially correctable ____ or ____ cause

A

physiologic or pharmacologic

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10
Q

Common causes of secondary HTN inmiddle-aged adults:

A
  • hyperaldosteronism
  • thyroid dysfunction
  • OSA
  • Cushings
  • pheochromocytoma
    (8-12% have underlying cause)

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11
Q

Children w/ HTN generally have secondary HTN from?

A
  • renal parenchymal disease
  • or coarctation of the aorta

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12
Q

Most comon causes of secondary HTN in children (birth -12 yr) and % of pt with thunderlying cause.

A
  • renal parenchymal disease 70-85%
  • coartation of the aorta

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13
Q

Most comon causes of secondary HTN in adolescents (12 -18 yr) and % of pt with underlying cause.

A
  • coratation of aorta 10-15%

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14
Q

Most comon causes of secondary HTN in young adults (19-39 yr) and % of pt with thunderlying cause.

A
  • thyroid dysfunction 5%
  • fibromuscular dysplasia
  • renal parenchymal disease

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15
Q

Most comon causes of secondary HTN in older adults (> 65 yr) and % of pt with underlying cause.

A
  • 17%
  • atheroclerotic renal artery stenosis
  • renal failure
  • hypothyroidism

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16
Q

Disseminated vasculopathy plays a major role in:

A
  • ischemic heart dz
  • LVH
  • CHF
  • CVA
  • PAD
  • aortic aneurysm
  • nephropathy

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17
Q
  • ____ of the common carotid intimal to medial thickness and arterial pulse-wave velocity can provide an early dx of vasculopathy
A
  • Ultrasound measurement

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18
Q

MRI can be used to follow microangiopathic changes indicative of ____

A

cerebrovascular damage

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19
Q

what is the general therauptic goal for HTN?

A

SBP < 130
DBP < 80

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20
Q
  • ____ million people in US have untreated HTN
  • ____ million treated pts are above their BP goal
A
  • 28
  • 29

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21
Q

what is resistant HTN? what is the treatment?

A
  • above-goal BP despite 3+ antihypertensive drugs @ max dose
  • Tx usually includes a LA CCB, an ACI-I or ARB + a diuretic

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22
Q

what is controlled resistant HTN?

A

controlled BP requiring 4+medications

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23
Q

what is refractory HTN?

A
  • uncontrolled BP on 5+ drugs
  • present in 0.5% of pts

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24
Q

____ HTN (intolerance to drugs) can result from BP inaccuracies (including white-coat syndrome) or medication noncompliance

A

Pseudo-resistant

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25
Q

what are lifestyle modifications that decrease BP?

A
  • weight loss
  • ↓ETOH
  • exercise
  • smoking cessation

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26
Q

there is a continous relationship between increased ____ and ____

A

increased BMI and HTN

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27
Q

____ is an effective nonpharmacologic intervention, through direct BP reduction and synergistic enhancement of drug efficacy

A

Weight loss

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28
Q

Overweight adults should aim for ideal body weight, but can expect a 1 mmHg reduction in BP for every ____kg of weight loss

A

1mmhg reduction in BP for every 1 kg of weight loss

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29
Q

Even modest increases in physical activity areassocwith?

A

BP decrease

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30
Q

Excessive alcohol use isassociated with?

A
  • ↑HTN
  • may cause resistance toantihypertensive drugs

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31
Q

Dietary ____ and ____ intake are inversely related to HTN andcerebrovascular disease

A

potassium and calcium

sldie 12

32
Q

____ isassocw/small but consistent BP decreases

A

Salt restriction

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33
Q

Notably absent from 1st line therapy are ____, which are reserved for pts w/ CAD or tachydysrhythmia, or a component of multidrug tx in resistant HTN

A
  • β blockers

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34
Q

Treatment of secondary HTN is often interventional, including

A
  • surgical correction of renal artery stenosis, adrenal adenoma or pheochromocytoma

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35
Q

If renal artery repair not possible, BP control may be accomplished w/ACE-I’s alone or w/ diuretics, although ACE-I’s, ARBs, and direct renin inhibitors are not recommendedin bilateral renal artery stenosis because?

A

they can accelerate renal failure

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36
Q

Primary hyperaldosteronism can be treated w/ an aldosterone antagonist such as ____

A

spironolactone

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37
Q

Certain disease processes, such as ____, require a combined pharmacologic and surgical approach

A

pheochromocytoma

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38
Q

Preop considerations for Secondary HTN

  • Preop BP assessment is often complicated by ____
  • Pts are often instructed to pause BP meds, such as ____ on the day of surgery
A
  • anxiety (white-coat HTN)
  • ACE-I’s & diuretics

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39
Q

what should you do if a BP reading is elevated?

A

a pressure on the contralateral arm should be obtained

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40
Q
  • A careful review of clinic data, homeBP’s, and a thorough history are necessaryto gain an overall picture of ____
  • ____ is not a direct prompt to delay surgery in asymptomatic pts w/oother risk factors
A
  • cardiovascular health
  • Elevated BP

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41
Q

surgery should NOT be delayed d/t transient elveated BP unless…?

A
  • patient is experiencing extreme HTN (SBP >180 or DBP >110)
  • or end-organ injury that could bereversed w/BP control

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42
Q

The cause of secondary HTN may be indicated by the symptoms:

A
  • flushing, sweating & palpitations suggestive of pheochromocytoma
  • renal bruit suggestive of renal artery stenosis
  • hypokalemia suggestive of hyperaldosteronism

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43
Q

what antihypertensive meds should you stop before surgery and which ones do you continue?

A
  • possibly stop ARBs and ACE-I’s
  • dont stop BB, clonidine or CCB’s

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44
Q

Hypertensive pts are prone to ____ d/t physiologic factors along with the BP meds on-board

A

intraop hemodynamic volatility

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45
Q

When superimposed on the organ damage from chronic HTN, even brief periods of hypotension are assoc with?

A
  • acute kidney injury
  • myocardial injury
  • and death

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46
Q

Clinicians need to consider acute intraoperative BP changes in the context of ____?

A

end-organ functional reserve

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47
Q

what can LVH lead to?

A
  • reduced coronary reserve [microangiopathy]
  • impaired contractility
  • reduced LV filling
  • Afib or ventricular dystrhymias

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48
Q

what does reduced cornary rserve (microangiopathy) lead to?

A

myocardial infarction [macroangiopathy]

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49
Q

what does impaired contractility [systolic] and reduced LV filling [diastolic] cause?

A

heart failure

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50
Q

what does afib or ventricular dysrhytmias lead to?

A
  • sudden death
  • cardiac emboli

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51
Q

HTN pt are hemodynamically vulnerable to induction of ?

A

general anesthesia

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52
Q
  • Induction drugs produce ____
  • DL & intubation elicit ____ & ____
A
  • HoTN
  • HTN & tachycardia

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53
Q

A pre-induction A-line, followed by a multimodal induction that includes ____ may be beneficial

A

short acting beta blocker (Esmolol)

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54
Q

Poorly controlled HTN is often accompanied by ____, especially if the pt ison a diuretic

A

volume depletion

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55
Q

In some pts, modest volume loading prior to induction may provide better____

A
  • hemodynamic stability
  • this approach may be counterproductive in pts with LVH and diastolic dysfunction

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56
Q

vasoactive drug considerations should take into account:

A
  • pt’s age
  • functional reserve
  • medications
  • planned operation

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57
Q

____ is categorized as either urgent or emergent, b/o the presence of progressive organ damage

A

hypertensive crisiis

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58
Q

Pts w/chronic HTN tend to tolerate a higher ____ than normotensive pts

A

SBP

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59
Q

Perioperative emergencies in HTN crisis may include:

A
  • CNS injury
  • kidney injury
  • cardiovascular insult

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60
Q

Women w/ PIH may show evidence of end-organ dysfunction (in particular encephalopathy) with a DBP ____.

A

> 100

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61
Q

Current guidelines for peripartum HTN recommends immediate intervention for what BP parameters?

A

SBP >160 / DBP>110

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62
Q

In hypertension:
* BP must be titrated down slowly to avoid ____.
* ____ monitoring can facilitate this process
* ____ is a 1st line drug for peripartum HTN

A
  • overshooting
  • Aline
  • Labetalol

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63
Q

For rapid arterial dilation and BP reduction, ____ infusion isthe gold standard, as it has a fast onset and titratable

A

SNP [sodium nitropresside]

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64
Q

if SNP is not available what is a newer medication that can be used?

A

Clevidipine, a 3rd-generation dihydropyridine CCB with an ultrashort DoA (≈1-min half-life) and selective arteriolar vasodilating properties

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65
Q

in HTN crisis if SNP and clevidipine is not available what else can be used?

A

Nicardipine, a second-generation dihydropyridine CCB, but has a longer half-life (≈30 min), making it less titratable than clevidipine

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Test 4 Health Assessment (Mordecai) (13 decks)

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