HTN and HTN urgency/emergency Flashcards
(77 cards)
1
Q
what are the modifiable risk factors of HTN?
A
current cigarette smoking secondhand smoke DM HLD obesity low physical activity unhealthy diet
2
Q
what are the fixed risk factors of HTN?
A
CKD family history increased age low SES male obstructive sleep apnea psychosocial stress
3
Q
what are the cardiac consequences of HTN?
A
LVH HF atherosclerotic CAD microvascular dz arrhythmias (Afib)
4
Q
what are the cerebral consequences of HTN?
A
CVA
dementia
HTN-encephalopathy
5
Q
what are the renal consequences of HTN?
A
renal injury
ESRD
6
Q
what are the arterial consequences of HTN?
A
PAD
7
Q
what is primary/essential HTN?
A
elevated BP with no specific underlying disorder
80-90% of cases
8
Q
what is secondary HTN?
A
elevated BP with a specific underlying disorder
9
Q
what is hypertensive urgency?
A
severe BP elevation (>180/110) without symptoms of end organ damage
10
Q
what is a hypertensive emergency?
A
severe BP elevation (>180/110) WITH symptoms of end organ damage
11
Q
what physiological factors raise blood pressure?
A
Na retention vasoconstriction endothelin 1 activation of SNS pro-inflammatory Th1 cells
12
Q
what is normal BP?
A
<120/80
13
Q
what is elevated BP?
A
120-129/<80
14
Q
what is stage 1 HTN?
A
130-139/80-89
15
Q
what is stage 2 HTN?
A
≥ 140/90
16
Q
what are signs of secondary HTN?
A
features of Cushing syndome neurofibromatosis enlarged kidneys abdominal bruits precordial murmurs
17
Q
what are signs of target-organ damage?
A
motor or sensory deficit retinopathy Afib/arrhythmia pulmonary edema/congestion absent, reduced or asymmetrical pulses ischemic skin lesions carotid murmurs
18
Q
what lab tests need to be ordered when primary HTN is suspected?
A
CBC CMP lipid panel TSH UA EKG
19
Q
what is the treatment for elevated BP?
A
nonpharmacologic therapy (lifestyle changes)
20
Q
what is the treatment for stage 1 HTN in patients without other risk factors for CVD?
A
nonpharmacological therapy (lifestyle changes)
21
Q
what is the treatment for stage 1 HTN in patients WITH other risk factors for CVD? (HLD, DM, CKD, old)
A
nonpharmacologic therapy
AND
BP lower medication (RAS inhibitor or diuretic)
22
Q
what is the treatment for stage 2 HTN?
A
nonpharmacologic therapy
AND
BP lower medication (RAS inhibitor or diuretic)
23
Q
what are the nonpharmacological therapies?
A
weight reduction salt reduction DASH diet alcohol reduction increase physical activity
24
Q
which nonpharmacological therapy can most significantly lower BP?
A
DASH diet
25
what are the first line anti-HTN?
RAAS inhibitors
CCBs
thiazide diuretics
26
what anti-HTN is best for white ppl?
ACEI or ARBs
27
what anti-HTN is best for black ppl?
CCBs or diuretics
28
what anti-HTN is best for patients with DM2?
ACEI or ARBs
29
what anti-HTN is best for patients with CHF?
ACEI or ARBs or B-blockers
30
what anti-HTN is best for patients with BPH?
a-blockers
31
what anti-HTN is best for patients with Afib?
CCBs or B-blockers
32
what factors are important when reassessing BP?
```
detection of orthostasis
ID white coat syndrome
document adherence
monitor response
reinforce importance of treatment
```
33
what is the protocol for HTN urgency?
BP should be lowered gradually <160/100 but not acutely >20-25% of MAP over several days-weeks
34
what are the most common presentations of HTN emergency?
cerebral infarction
| pulmonary edema
35
what labs/imaging should be ordered for suspected HTN emergency?
```
EKG
CXR
UA
serum electrolytes
creatinine
```
36
what is the protocol for HTN emergency?
lower MAP gradually:
10-20% in 1st hour
5-15% over next 24 hours
37
in primary htn what is the source of the HTN
increase in total peripheral resistance
38
How does limit of Na intake influence a decrease in blood pressure
reduction in salt intake reduces fluid retention which lowers BP. In addition, lack of salt will activate RAAS which can be blocked pharmacologically.
39
Why are ACE inhibitors less likely to work in African Americans with primary HTN
they have low renin primary HTN so there is nothing to block (in addition, allergies)
40
What conditions are likely to indicate secondary HTN
Abrupt onset
HTN <30 y/o
Accelerated/malignant HTN
41
What are the categories of the first line drugs used to treat HTN
Thiazides
ACEi
ARBs
CCB dihydropyridines or nondihydropyridines
42
What is the mechanism of the thiazide diuretics?
block Na-Cl cotransporters in the distal convoluted tubule
43
A low GFR would make what class of drugs less effective?
Thiazides
44
What drug is long lasting and used by many HTN experts for this reason?
Chlorthalidone
45
what is the mechanism of action of furosemide
blocks Na-K-Cl cotransporter in the thick ascending loop of henle
46
What are loop diuretics indicated for
HF
Pulmonary Edema
HTN
47
What are notable toxicities of furosemide
Hypo-"saltemia" lose all salts
ototoxic
48
You need a loop diuretic but cyka blyat your patient has a sulfa allergy because they are weak. what loop diuretic can you give your weak baby patient
ethacrynic acid
49
how do potassium sparing diuretics work?
block Na the ENaC channel or Aldosterone at the collecting duct after K+ has been reabsorbed
50
What are the Potassium sparing diuretics
Amiloride - blocks ENaC
Spironolactone - Blocks aldosterone
51
What is the clinical indication of Amiloriode
Offsets K+ loss from other diuretics
hyperkalemia risk
52
What is the clinical application of spironolactone?
counteracts K+ loss from other diuretics
reduce fibrosis in HFrEF post MI
53
Where does aliskirin work on the RAAS
blocks renin
54
what is a universal process that occurs in people recently put on ACE inhibitors
Decrease in GFR -> increase in serum creatinine
55
What is the clinical application of captopril and other ACEi
HTN
Acute HTN/Emergency
HFrEF
Diabetic nephropathy
56
What are two notable side effects of ACEi
cough
| angioedema
57
What is the mechanism of the -sartan drugs
block angiotensin II receptors
58
What is candesartan notable for
irreversible binding and longer half life.
59
Which AT receptors do -sartan drugs have a higher affinity
AT1
60
What is the mechanism of action of aliskirin
blocks direct effects of renin
61
What is a disadvantage of aliskirin
its new and expensive but does have few toxicities
62
You have a pregnant lady with HTN, what will you not giver her 100 percent
ACEi
63
What are the dihydropyridine CCB
Nifedipine
| Amlodipine
64
What are the uses Amlodipine is limited to
CAD
| HTN
65
Which category of CCB is cardioactive
non-dihydropyridine - verapamil; diltiazem
66
When taking dihydropyridine CCB what interaction is important to look for
CYP3A4 active drugs
67
What is the key difference between Nifedipine and Verapamil
nifedipine at therapeutic doses exerts smaller direct ionotropic effects and no chronotropic, but DOES have large vasodilation, HR, and CO because of reflex SNS
68
What a-blockers were used early but not tolerated due to their extensive adverse effects
Phentolamine
| Phenoxybenzamine
69
What is the mechanism of action for propranolol
nonselective beta blockers (class II antiarrhythmic)
70
what is the mechanism of action of atenolol or metoprolol
B1 selective blocker
71
What is the risk of abruptly stopping a or B blockers
Tachycardia and HTN spike -> death
72
why are B blockers no longer a first line therapy for HTN
dont prevent MI, HF, or death
higher incidence of stroke
73
What is the clinical use of hydralazine
hypertensive emergency in pregnancy
HFrEF
74
What is the mechanism of action of nitroprusside
venous and arteriolar dilation
75
How does renal HTN affect systemic hypertension
stenosis decreases renal perfusion which activates RAAS
76
Presence of what effects indicated BL renovascular HTN
Flash Pulmonary Edema
Progressive Renal Failure
Refractory Congestive Cardiac Failure
77
What drug is classically used for IV HTN emergency
Sodium Nitroprusside
