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Flashcards in 5: Hypertension Deck (18):
0

Hypertension- definition

systolic >140 or diastolic >90
on two or more occasions

1

Essential HTN

*regardless of underlying predominant pathophysiology, pts without identified secondary causes are classified having essential HTN

2

Drugs causing 2ary HTN

Chronic alcohol use in high doses
Cocaine
NSAIDs
Adrenergic meds
Decongestant containing ephedrine
Nicotine
Exogenous estrogens

3

Pointers for BP measurement

-pt should not smoke or drink caffeine 30mins prior
-let the pt rest for 5mins in a quiet setting

4

Cardiac damage

Left ventricular heave
S4
Pulmonary or peripheral edema

5

Cerebrovascular damage

Carotid bruit
Neurologic deficits

6

Peripheral vascular damage

Diminished pulses
Aneurysms

7

Ocular damage

Arteriovenous nicking
Hemorrhages, exudates
Papilledema

8

Renal damage

Peripheral edema
Renal bruits

9

Hypertensive retinopathy- grades

0: no change
1: Barely detectable arteriolar narrowing
2: Obvious arteriolar narrowing with focal irregularities
3: 2+retinal hemorrhages or exudates
4: 3+papilledema

10

Ocular damage by Arteriolar sclerosis- grades

0: normal
1: Barely detectable light reflex changes
2: Obvious increased light reflex changes
3: Copper wire arterioles
4: Silver wire arterioles

11

Secondary HTN- suspect it when...

-abrupt onset of HTN
-BP>180/110mmHg at the time of diagnosis
-extreme age group on diagnosis: below 25 or above 65yrs
-episodes of hypertensive crisis- malignant HTN
-BP not responding to antihypertensive drugs
-sudden worsening of HTN in spite of good compliance

12

Initial lab tests

-12 LEAD EKG
-Urinalysis
-Hematocrit
-Fasting blood glucose or A1c
-serum Na, K, Creatinine, Ca
-lipid profile after a 9-12hr fast

13

HTN- management

All ages
-CKD w/ or w/o diabetes: goal of 60: goal of 20 above the systolic goal-> initiation with 2 anti-HTN agents

14

Ambulatory BP monitoring

in UK, HTN is confirmed with 24hr BP monitoring
mean 24hr BP of >130/80 is regarded as elevated BP

15

Hypertensive urgency

HTN crisis (BP>180/120)
-no end organ damage
-BP can be brought down safely within a few hours

16

Hypertensive emergency

HTN crisis
-target organ dysfunction and damage
-BP must be reduced immediately in an intensive care unit of a hospital
->Immediate BP lowering by 25%-> gradually to 160/110 over next 2 to 6hrs
*rapid lowering of BP to near normal levels is avoided

17

Metabolic syndrome X

dx by 3 out of 5
-Fasting glucose of >100mg/dL or drug for it
-BP >130/85mmHg or drug for it
-Triglyceride >150mg/dL or drug for it
-HDL 102cm (40in) in men, >88cm (35in) in women
if Asian American: >90cm (35in) in men, >80cm (32in) in women