Evaluation and Treatment of HTN Flashcards
(35 cards)
What is primary/essential hypertension?
> 140/90 idiopathic without secondary cause. This is 95% of all cases of HTN. 2x increase in african americans.
Typical age of onset= 25-55.
What is secondary hypertension?
hypertension with secondary cause
What is resistant HTN?
BP >160 despite 3 or more medications, including diuretic in which all drugs are dosed at least 50% or more of max dose, or BP that requires 4 drugs to control.
What is malignant/accelerated hypertension?
HTN with grade 3 or 4 HTN retinopathy, TMA, and evidence of acute tissue injury (brain, kidney or heart).
What are the joint national committee (JNC) reports/guidelines?
committee established in the 70s to provide an overview of recent scientific evidence ad unify positions of member organizations and send a clear message to the practicing community that lowering high BP is very important.
** What does the JNC 8 recommend for treating HTN of the general population OVER 60 years old?
(TEST QUESTION)
lower BP to less than 150/90
** What does the JNC 8 recommend for treating HTN of the general population UNDER 60 years old?
(TEST QUESTION)
lower BP to less than 140/90
** What should initial treatment in the white population, including those with DM include?
initially a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB.
** What should initial treatment in the black population, including those with DM include?
initially a thiazide diuretic or calcium channel blocker
What are some secondary causes of HTN?
- CKD
- renovascular parenchymal disease (atherosclerotic renal artery stenosis)= MOST COMMON CAUSE
- sleep apnea
- drug induced
- primary aldosteronism
What drugs can cause secondary HTN?
- oral contraceptives
- NSAIDs
- antidepressants
- glucocorticoids
- decongestants (pseudoephedrine)
- weight loss medications
- EPO
- cyclosporine
- amphetamines
- cocaine
What are the 3 objectives when evaluating a pt with HTN?
- lifestyle, CV risk factors, concomitant disorders
- reveal identifiable causes of high BP (secondary causes).
- evaluate for evidence of target organ damage and CVD.
What are the big CVD risk factors?
- HTN
- smoking
- obesity
- dyslipidemia
- DM
- all modifiable
What does each increment of 20/10 mm HG do to your risk of developing CVD?
doubles it
What is ambulatory BP monitoring?
monitoring BP at different intervals, indicated for evaluation of “white coat” HTN. May also reveal absence of 10-20% decrease of BP during sleep, which may indicate increased CVD risk.
What is important to have a pt do prior to taking BP?
no caffeine and no smoking 1 hr prior to visit
What are the routine laboratory tests for HTN?
- EKG
- urinalysis
- glucose and hematocrit
- BMP (serum K+, creatinine, and calcium)
- lipid profile
What are the lifestyle modifications suggested for pts with HTN?
- weight reduction
- DASH eating plan= whole grains, poultry, fish, and nuts
- dietary sodium reduction (2.5 g)
- physical activity
- moderation of alcohol consumption
How often do you follow up with a pt once they have reached their goal BP?
3-6 months
What is important to remember about treating with certain medications, especially in the city?
make sure an insurance company will cover the drug you choose.
What drugs should be used to control HTN in women who are pregnant?
methyldopa, BBs, and vasodilators for the safety of the fetus.
*ACE inhibitors and ARBs are contraindicated.
What population has the lowest rates of BP control?
people over age 65
** How should you think about hypertensive EMERGENCY?
TEST QUESTION
SYMPTOPMATIC hypertension. These are pts with marked BP elevations and acute target organ damage (encephalopathy, myocardial infarction, unstable angina, pulmonary edema, eclampsia, stroke…). These pts require hospitalization and parental drug therapy.
** What is hypertensive URGENCY?
TEST QUESTION
ASYMPTOMATIC hypertension. These are pts with markedly elevated BP but WITHOUT acute target organ damage. They do not require hospitalization but should receive immediate combination oral antihypertensive therapy.
