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Flashcards in HTN Deck (25):
0

Patient with hypertension. Next steps?

1. Assess renal and cardiac function
2. Start two drug antihypertensive regimen that includes thiazide
3. Stop smoking

1

Stages of hypertension?

Pre-hypertension: 120-139/80-89

Stage one hypertension: 140 – 159/90 – 99

Stage two hypertension: greater than 160/100

2

A secondary cause of hypertension should be suspected if?

1. Age of onset before 25 or after 55
2. Presenting with malignant hypertension
3. Requiring three or more antihypertensives
4. Suddenly uncontrolled hypertension
5. Rising creatinine with use of ACE inhibitors

3

Renal causes of hypertension?

Renovascular

Parenchymal (glomerulonephritis , polycystic renal disease, diabetic nephropathy)

4

Endocrine causes of hypertension?

Primary aldosteronism, Cushing's, pheochromocytoma, hyperthyroidism, growth hormone excess, OCP

5

Non-renal and non-endocrine causes of hypertension?

Coarctation of the aorta, posttransfusion, hypercalcemia, medications (sympathomimetics, glucocorticoids)

6

Major risk factors for cardiovascular disease?

Age, smoking, dyslipidemia, diabetes, obesity, kidney disease, family history

7

Target organ damage of hypertension?

Cardiomyopathy, nephropathy, retinopathy

8

Clues to renovascular HTN?

Flank bruits, malignant hypertension, hypertension refractory to three drug treatment, sudden worsening hypertension,

9

HTN tx?

Pre-hypertension: Lifestyle modifications unless pt has hypertension or diabetes (start Antihypertensive)

Stage one hypertension: Single hypertensive agent

Stage two hypertension: At least two hypertensive agents

10

Target blood pressure?

135/85

If patient has diabetes or renal disease 130/80

11

Consider what drug in all patients? Why?

Thiazide diuretics. Associated with a decrease in mortality in all types of patients (OLD -now can start in anything)

12

In patients with uncomplicated hypertension, use which drugs first?

Thiazide diuretics and beta blockers

13

First-line antihypertensives in diabetics and heart failure pts?

Problem with thiazides?

Ace inhibitors.

Thiazides can exacerbate hypoglycemia. Add thiazides if blood pressure remains uncontrolled

14

Potassium levels in patients with renal artery stenosis?

Low due to secondary hyperaldosteronism

15

Diagnostic tool for renal artery stenosis?

Captopril enhanced radio nuclide renal scan

MRI angiography, spiral CT

16

Patient with bilateral flank masses, flank pain, elevated blood pressure, and hematuria?

Polycystic kidney disease

17

Patient with hypertension hypokalemia?

Primary hyperaldosteronism

18

Obesity-related cause of hypertension? MoA?

Obstructive sleep apnea. Hypoxemia and hypercarbia leads to Vasoconstriction, systolic hypertension and pulmonary hypertension

19

Patients with HTN, widened pulse pressure and hyperdynamic precordium?

Hyperthyroidism

20

Patient with hypertension, truncal obesity, moon face, purple striae. Test to confirm?

Cushing's syndrome. Dexamethasone suppression test

21

Patient with upper limb hypertension, cold extremities and decreased femoral pulses?

Coarctation of the aorta

22

Patient with hypertension, cutaneous flushing, headache, diarrhea, wheezing? Mech?

Carcinoid syndrome. Production serotonin from the chromaffin cells of the G.I. tract and the lungs

23

Patients with episodic hypertension, headaches, palpitations, chest pain, anxiety, nervousness?

Pheochromocytoma

24

Prognosis in hypertension depends on?

Cardiovascular RFs and observed and end-organ effects of the HTN

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