htn Flashcards
(16 cards)
htn definition
Definition: BP above 140/90, based on 2 readings in separate occasions, unless severe HTN (systolic ≥180 or diastolic ≥110) or evidence of end-organ damage.
what is essential primary htn
o Most patients with hypertension (80–90%) have no known underlying cause.
o It has multifactorial etiologies:
-Genetic component
-Obesity
-High salt intake
-Metabolic syndrome
-Low birth weight vasopressin)
-Excess alcohol intake
what are drugs that may induce or exacerbate htn
NSAIDS
OCP
SNRI
Acetaminophen
steroids
how to take reading of htn
Measure both arms, take highest arm reading ,take 2 readings, write the lowest
• If postural hypotension is suspected (reduction in systolic BP ³ 20 mmHg): BP should be repeated after 1 minute of standing.
• Dx can’t be made from single reading unless it’s very high >180 or >110
howto diagnose htn
If clinical BP is between 140/90 & 180/120 offer either:
o Ambulatory (ABPM): 2 measurements per hour, at least 14 measurements during normal waking hours
o Home BP measurement (HBPM): 2 measurements per day (day & night) : take readings twice 1-minute apart w/ pt seated & record lowest. This is done 4-7
days. Discharge the 1st day & average the other readings
• Confirm Dx if
o ³ 140/90 clinic
o ³ 135/85 ambulatory or home BP measurements
pharma tx for htn
Step 1:
o 1st line for patients < 55 years is an ACE inhibitor (or ARB if can’t tolerate ACEI)
o Patients aged 55 & above, black African or Caribbean: start with CCB (or
thiazide-like diuretic in those with heart failure or those who develop ankle edema)
• Step 2: (A+C)
o ACE + CCB
• Step 3: (A+C+D)
o Compliance and dosage should be reviewed
o If still not controlled on ACEI + CCB : add thiazide-like
• Step 4: (step 3 + more diuretic or alpha or beta blocker)
o If BP remains more than 140/90 on 3 agents à refer pt to a specialist.
o In those w/ preserved renal function & resistant HTN à spironolactone 25 mg
daily can be added if K+ £4.5 mmol/L.
o if K+ > 4.5 mmol/L, an increased dose of thiazide-like diuretic can be used w/
monitoring of electrolytes.
target BP
o <140/90 for patients ≤60 years old
o <150/90 for patients ≥60
o 130/80 if the patient is diabetic or with CKD or cardiovascular disease
diff btwn hypertensive urgency nd emergency
urgency: BP ≥ 180 systolic and/or ≥ 120 diastolic with no end-organ damage
(asymptomatic severely high BP)
emergency: with end organ damage
how tomanage tx of hypertensive emergency
Must be admitted for immediate
initiation of treatment
• Unwise to reduce BP too rapidly, may :cerebral, renal or retinal ischemia
or MI.
• Aim is to lower the mean arterial
pressure by 10-20% in the first hour,
then gradually lower in the next 23
hours to reach 25% lower of baseline
lowering bp in aortic dissection and acute ischemic stroke
dissection: rapidly lower bp, target 100 to 120 systolic
acute ischemic stroke: slower lowering of bp
what does all types of shock have in common
all have low bp and high HR
distributive shock has 3 parts
septic- infection (antibiotics)
anaphylactic- allergy (epinephrine)
neurogenic - steroids (spinal cord injury)
what is distributive
o Peripheral blood vessel vasodilation : low systemic vascular resistance
o Warm extremities, low BP and high HR, low CVP, low PCWP
cardiogenic shock
Heart can’t pump enough blood (e.g., myocardial infarction, heart failure, arrhythmias).
o Low BP, high HR, high CVP, increased SVR : Cold extremities
o ACS, valve failure, dysrhythmias, high PCWP
hypovolemic shock
o decreased circulatory volume or GI bleed
o Low BP, high HR, Low CVP (because less blood), increased SVR: Cold extremities
obstructive shock
A physical obstruction prevents proper blood circulation (e.g., pulmonary embolism, cardiac tamponade, tension pneumothorax).
Low BP, High HR, High CVP or N, increased SVR
