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Flashcards in HTN Deck (64)
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1

What is HTN a precursor to

systemic dx like hypertensive retinopathy, cerebrovascular dz, renal failure, and *CVD*

2

What is the #1 attributable risk factor for death world wide

Suboptimal BP

3

What is the epidemiology of HTN

1/3 adults have HTN
1/3 have pre-HTN

4

Why does incidence of HTN increase in women around 55 y/o

Menopause! estrogens not there to protect anymore

5

What races have a higher prevalence of HTN

African American
White
Mexican American

6

What happens when BP hits 115/75

CVD risk DOUBLES for each 20/10 mmHg increase

7

What is the MOA of primary essential HTN

Overactive SNS
Renal Na+ retention
Inflammation, oxidative stress, vascular remodeling
RAAS damaging vascular health

8

What controls BP

SNS, RAAS, plasma volume mediated by kidneys

9

What are the types of HTN

Primary essential HTN (90-95% of cases)
Secondary HTN (younger onset)

10

What are risk factors for Primary HTN

*Smoking
*Diet (high Na intake)
*Excess alcohol intake
*Obesity
*Physical inactivity
Age, race, FHx, dyslipidemia, DM

11

What disorders can cause Secondary HTN

Renal disease
Meds (adderall, NSAID, OCP, steroid, decongestant)
Hypo/Hyperthyroid/parathyroid
Obstructive sleep apnea
Pheochromocytoma
Coarctation of aorta
Primary Aldosteronism
Reno vascular dz
Cushing's

12

When should you suspect secondary HTN

Young onset
Diastolic HTN >50 y/o
Target organ damage at presentation (SrCr >1.5, LVH)
Secondary causes
-Hypokalemia, abdominal bruit, Labile pressure w/ tacky diaphoresis or tremor, FHx renal dz
Poor response to generally effective therapy

13

How is HTN and age related

Young patient= DIASTOLIC
Older pt= SYSTOLIC

14

What are positive findings for end organ damage

MI, Angina, coronary revascularization, HF
Ischemic stroke, cerebral hemorrhage, TIA
Retinopathy
Renal dz
PAD (claudication)

15

What symptoms during Hx should make you think of HTN

muscle weakness, tachycardia, sweating, tremor, thinning skin, flank pain
Sleep apnea signs (early morning HA, day time somnolence, loud snoring, erratic sleep)

16

What can increased waist circumference be indicative of

Cushing's disease (Dexamethasone test)
Metabolic syndrome

17

What could you see on HTN HEENT PE

Arterial diameter narrower than 50% of venous (A:V 2:#)
Copper/silver wire appearance
exudates
Cotton wool spots
hemorrhaged (flame hemorrhage)
Papilledema

18

What could you see on remaining HTN PE

Rhonchi, rales
Renal mass/bruit
Visual disturbance, focal weakness, confusion

19

What could you see on CV HTN PE

LVH (displaced PMI, ECG evidence)
S4 (pre systolic) gallop (decreased LV compliance)- A-Stiff---wall
Carotid, abd, femoral bruits
Extremity edema

20

USPSTF guideline for HTN

Screen all 18+
Every 3-5 years in 18-39, normal BP, no RF
Annual if 40+ or increased risk for HTN

21

What is required to diagnose HTN

2+ properly measured, seated BP readings on 2 or more office visits
-legs uncrossed, rested, proper cuff size, arm at heart level
-High caffeine drinker not at risk for HTN dx because HTN comes in waves for them, not steady

22

What is the JNC7 HTN goal

Gen. pop: 140/90
DM or renal Dz: 130/80

23

What is the JNC8 HTN goal

<140/90 for ALL adults (including CKD/DM)
<150/90 in adults 60+
-ACC/AHA said continue with JNC-7

24

What is the ADA target BP (diabetics)

<140/90
risk-based individualization to lower targets 130/80

25

What diagnostic tests are important o order in HTN eval

CBC
Urinalysis
Blood chemistry (glucose, Ca, Cr, GFR, electrolytes)
TSH (new HTN pt)
Lipid profile
ECG
-Maybe: urine albumin, echo, sleep study

26

What patients did the ACC/AHA study say to initiate anti-HTN meds in

All with stage 2 HTN
Pt with Stage 1 and 1+ of following (ASCVD, T2DM, CKD, 10 year ASCVD risk 10%+)

27

What are non-pharm Diet Modification treatment options for HTN

Salt restriction= 5/3 mmHg decrease
DASH diet= 6/4 mmHg decrease
--High fruit/veg, then grain. low fat dairy
Alcohol reduction= 2-4 decrease in SBP

28

What are other non-pharm treatment options

Weight loss (1mmHg per 1 lb lost)
Exercise (4-6/3 mmHg)
Smoking cessation

29

What are pharm treatment options for HTN

Diuretics
CCB
ACE-I
ARB
BB
DRI
Central alpha 2 agonist
Alpha 1 blockers

30

Who do diuretics work better in

Black, elderly, obese, smokers