HTN and Associated Changes Flashcards Preview

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Flashcards in HTN and Associated Changes Deck (23):
1

What is HTN in terms of BP cutoffs?

BP >140/90
UNLESS:
-DM: >130/80
-80y+: >150/90

2

What is accelerated HTN?

Significant recent increase in BP over previous hypertensive levels associated with evidence of vascular damage on fundoscopy but without papilloedema

3

What is malignant hypertension?

High enough BP to cause papilloedema and other manifestations of vascular damage (retinal haemorrhages, bulging discs, mental status changes, increasing Cr).
Often BP >200/140

4

What is the aetiology of HTN?

-Essential /Primary HTN
-Secondary HTN
-White coat HTN

5

Factors predisposing to HTN?

-Male
-30y+
-High salt diet
-Smoking
-Obesity
-Sedentary lifestyle
-Stress
-Dsylipidemia

6

Renal causes of secondary HTN?

-Renovascular HTN
-Renal parenchymal disease / glomerulonephritis / pyelonephritis / polycystic kidney disease

7

Endocrine causes of secondary HTN?

-1" hyperaldosteronism
-Phaeochromocytoma
-Cushing's syndrome
-Hyperthyroidism / hyperparathyroidism
-Hypercalcemia of any cause

8

Vascular causes of HTN?

-Coarctation of the aorta
-Renal artery stenosis

9

Causes of secondary HTN?

ABCDE
Apnea, Aldosteronism
Bruits, Bad Kidneys
Coarctation, Cushings, Catecholamines, Calcemia
Drugs
Endocrine Disease

10

Ix in all pts w/ HTN?

-FBE: anemia CKD
-UEC: esp K+ (high in renal disease, low in aldosteronism)
-LFTs: fatty liver/ drug rxn
-Urine Alb:Cr ratio: evidence renal damage
-Fasting BSL
-Lipids
-ECG: CAD / hypertrophy
-Urinalysis

11

Lifestyle Mx HTN?

-Diet
-Moderate Exercise
-Smoking cessation
-Stress Management
-Low risk alcohol consumption
-Healthy BMI

12

Pharmacological Mx HTN?

-ACEi, ARB
-B blocker
-CCBs
-Diuretics
If partial response to standard monothearpy, add another first line drug in 2-3/52.
Step 1: A / C / D
Step 2: A+C / A+D
Step 3: A+C+D

13

What does HTN predispose to?

-CAD
-Stroke
-Cardiac hypertrophy
-CCF
-Renal failure

14

Is a person's avg BP ass/w CV risk?

Yes- relationship between BP and CV risk is continuous. Above 115/75mmHg, for each 20mmHg SBP increase CV/stroke risk doubles.

15

How is diagnosis of HTN made?

INITIAL
BP >140/90mmHg
After 5 minutes seated rest
2 readings, 2mins apart.
REVIEW
-Additional visit 1-4/52
-24hour ambulatory measures
-Home BP measures

16

Important features to elicit in HTN Hx?

-FHx
-PHx: CV / stroke events
-HF Sx
-Renal disease symptoms
-Smoking
-DM
-High cholesterol

17

Examination features in HTN?

-Pulse rate and rhythm
-BMI
-Full CV exam
-Renal bruits / masses
-Stigmata secondary causes

18

When should BP be treated?

SBP >180
DBP >110
normal pt, no other RFx

19

When should BP + risk be treated?

SBP >140
DBP >90
PLUS DM, CV / renal disease OR high CV risk

20

What are the high CV RFx?

-Age
-SBP
-Total:HDL cholesterol ratio
-Smoking
-DM
-End organ damage

21

What is the end organ damage indicative of high CV risk?

-Microalbuminuria / low eGFR (renal damage)
-LV hypertrophy (cardiac damage)
-High pulse wave velocity (stiff large arteries)
-Increase intimal-media thickness (reflects atherosclerosis).

22

Considerations of ACEi/ARBs as first line choice in Mx HTN?

-Preferred if

23

Evaluation of "resistant HTN"

Usually poor compliance.
-Consider spiro, B-blocker, centrally acting agent, a-blocker or vasodilator
-Question compliance
-Check for NSAIDs, cold remedies, antidepressants etc
-?Secondary HTN causes