HTN Flashcards
What is the most common diagnosis in primary care?
HTN
How does HTN effect Heart conditions?
HTN doubles the risk of CV diseases
It also effects: CHD, CHF, ischemic and hemorrhagic strokes, renal failure and peripheral artery disease (PAD)
Renal Artery Stenosis should be suspected if ?
Onset of HTN before age 20 or after age 50
HTN is resistant to 3 or more drugs
If there are epigastric or renal artery bruits
If there is atherosclerotic dz of the aorta or peripheral arteries
If there is an abrupt increase in the level of serum creatinine after administration of ACE inhibitors
If episodes of pulmonary edema are associated w/ abrupt surges in BP
What Does JNC 8 say about Diastolic BP?
Diastolic BP is a more important cardiovascular risk factor than is elevated SBP in younger patients w/o major comorbidities
Why is there such a low rate of control of HTN ?
Poor access to health care and medications
Lack of adherence w/ long term therapy
“Silent Disease”
What are Major Complications of HTN ?
- Hypertensive Cardiovascular Disease
- Hypertensive Cerebrovascular Disease and Dementia
- Hypertensive Kidney Disease
- Atherosclerotic Complications
Hypertensive Cardiovascular Disease?
Most common cause of death in HTN patients
Major cause of morbidity and mortality in primary HTN
Result of LVH->CHF->Ventricular
->arrhythmias->myocardial ischemiasudden death
Occurrence of heart failure can be reduced by 50% w/ antihypertensive therapy
LVH regresses w/ therapy
Hypertensive Cerebrovascular Disease and Dementia?
Stroke is the 2nd most frequent cause of death in the world
HTN is the most common and most important risk factor for ischemic stroke
More closely correlates to systolic vs diastolic BP
Incidence of both ischemic and hemorrhagic strokes decreases w/ therapy
HTN is the most important risk factor for the development of a HEMORRHAGIC STROKE
HTN is associated w/ a higher incidence of both VASCULAR and ALZHEIMER types dementia
Hypertensive Kidney disease?
Primary renal disease is the most common etiology of secondary HTN
More common in blacks than whites
Proteinuria is a reliable marker of the severity of chronic kidney disease and is a predictor of it’s progression.
The kidney is both a target and a cause of HTN
Related to systolic BP as opposed to diastolic.
HTN is a risk factor for renal injury and end stage renal disease.
Aggressive BP control to 140/90 (JNC 8) or less slows the progression
Atherosclerotic Complications?
Hypertensive therapy has a lesser impact on these complications
Reduction of atherosclerosis requires control of multiple risk factors including but not limited to HTN alone
Other conditions have to be treated to improve…
Blood vessels may be a target organ for atherosclerotic disease secondary to long standing elevated BP
Most Americans w/ HTN die of complications of atherosclerosis
How do you diagnose a pt w/HTN?
*Need 2 or more readings on 2 separate occasions over one to several weeks to diagnose HTN
> 140mmHg/ >90mmHg
Home monitoring is better correlated w/ target organ damage than clinic-based values
Blood Pressure Classification ?
Normal: 120/80
Pre-HTN: 120-139/80-89
S-1 HTN: 140-159/90-99
S-2 HTN: >160/>100
Isolated Systolic Hypertension
How does systole vs diastole change w/age?
HTN before age 50- majority have combined systolic and diastolic HTN
HTN after age 50- majority have systolic HTN
Types of HTN ?
Primary or Essential Hypertension
“White Coat Syndrome”
Secondary Hypertension
