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Flashcards in HTN Deck (68)
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1

When someone has high BP, want to prevent

end organ damage
(stroke, heart attack, blindness, kidney failure, heart failure)

2

HTN is when BP is

140/90 in office multiple times
OR 135/85 at home

3

AOBP is a device that allows ________

you to continuously/regularly check your BP at home

4

Normal BP is

5

PreHTN BP is

120-139 mmHg SBP or DBP 80-89 mmHg

6

Stabe 1 HTN BP is

140 to 159 mmHg SBP or DBP 90 to 99 mmHg

7

Stage 2 HTN BP is

> 160 mmHg SBP or > 100 mmHg DBP

8

Guidelines for measuring BP

long table on slides 7-8

9

Prevalence is highest in

non-hispanic blacks

10

More LV hypertrophy, higher incidence of ____

CV events
-Reversible and treatable

11

Higher BP and HTN left untreated leads to a higher incidence of

ESRD (end stage renal disease)

12

There are cardiovascular benefits to treating

mild HTN (lowers risk of CVA and coronary heart disease)

13

Cause of primary HTN

over activation of SNS and RAAS via:

-NSAIDs
-too much salt intake
-family history
-smoking
-alcohol
**Sleep apnea is a MAJOR cause of CV problems, A-Fib, HTN**

14

Who should be screened for secondary HTN?

1. Severe or resistant HTN
(persistent HTN despite use of adequate doses of three antihypertensives from different classes)
2. Acute rise in BP in a patient with previously stable values
3. Age under 30 in non-obese, non-African American patients with negative family history
4. Malignant or accelerated HTN
5. Severe HTN and evidence of end-organ damage
6. Age of onset before puberty

15

Genetic causes of secondary HTN

1. Liddle syndrome (psueodhyperaldosteronism)
2. hyperaldosteronism
3. HTN in pregnancy

16

FMD (fiber musculodysplasia)

*Cause of secondary HTN
-FMD (fiber musculodysplasia) in young women (young woman with refractory HTN, reversible cause of high BP in young women; “beads on a string” sign; sign is caused by areas of relative stenoses alternating with small aneurysms; seen in renal arteries)

17

95% of HTN is

essential (primary)

18

Refractory HTN

*Cause of secondary HTN
-Refractory hypertension was defined as BP that remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6-month follow-up period

19

Renovascular Disease

*Cause of secondary HTN
-Bruits (diastolic abdominal) -PAD
-->Cr increase with ACE-I (Creat is 1.2, give ACE inhibitor, creat goes up to 2.0; suspect bilateral renal artery stenosis)
-Pulmonary edema (Flash pulmonary edema with HTN (recurrent), think renal artery stenosis)

20

Other factors that can cause secondary HTN

oral contraceptives, NSAIDs, stimulants (cocaine, methylphenidate), calcineurin inhibitors, antidepressants,

21

Pheochromocytoma

*Cause of secondary HTN
-paroxysmal (sudden burst) increase in BP
-Triad of pounding headache, palpitations, sweating

22

Primary aldosteronism

*Cause of secondary HTN
-unexplained HYPOkalemia, urinary protein wasting (even thought about 1/2 of pts are normkalemic)
-Tx: Sprinolactone (aldosterone inhibitor)

23

Cushing Syndrome

*Cause of secondary HTN
-Cushingoid facies, central obesity, proximal mm weakness, ecchymoses
-May have history of glucocorticoid use

24

Sleep apnea syndrome

*Cause of secondary HTN
-Usually in obese men who snore loudly when sleeping
-Daytime somnolence, fatigue, morning confusion

25

Coarctation of the Aorta

*Cause of secondary HTN
-HTN in arms with diminished femoral pulses and low/unreadable BP in legs
-Left brachial pulse is diminished and equal to the femoral pulse (if origin of L subclavian artery is distal to the coarctation)
-Bicuspid Aortic Valve is associated with coarcatiob
-Tx: stenting of the aorta to help alleviate congestion
-Bicuspid and aorta need MRI of brain, could have aneurism

26

Hypothyroidism

*Cause of secondary HTN
-s/s of hypothyroidism
-elevated serum TSH

27

Primary hyperparathyroidism

*Cause of secondary HTN
-elevated serum calcium

28

Chronic complications of HTN

-Hypertensive heart disease
-Hypertensive cerebrovascular disease and dementia
-Hypertensive kidney disease

29

Hypertensive emergencies

-Grade 3-4 HTN retinopathy
-CVA (encephalopathy, brain infarction, intracerebral or subarachnoid hemorrhage)
-Cardiac: aortic dissection, acute left vent failure, MI
-Renal: acute glomerulonephritis, renal crisis, microangiopathic hemolytic anemia
-Excessive circulating catecholamines: Pheo crisis, interactions with MAO inhibitors, cocaine/drug use, rebound HTN after stopping meds
-Eclampsia (seizures in pregnant woman with high BP and protein in urine)
-Surgical (post op)
-Body burns
-Epistaxis (nose bleeds from increased pressure)

30

Most people with HTN are

asymptomatic
-may see headache, if severe can cause encephalopathy, N/V, confusion, vision changes