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Geriatrics > HTN, Dyslipidemia, SIHD > Flashcards

HTN, Dyslipidemia, SIHD Flashcards

(47 cards)

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1
Q

Incidence of hypertension increases…

A

As we age

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2
Q

Hypertension in older adults often presents as…

A

Isolated systolic hypertension (ISH)

SBP more closely correlated with CV risk in patients 50+

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3
Q

Some physiological changes associated with HTN include ____. This increases risk for…

A

Decreased baroreceptor response, impaired cerebral autoregulation

Increased risk for orthostatic hypotension

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4
Q

We should avoid overly-aggressive BP reductions because…

A

Risk of tissue hypoperfusion and ischemia - keep DBP above 60

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5
Q

There is good evidence from multiple epidemiological + clinical studies, that lowering high BP reduces risk of…

A

CV events - MI, stroke, sudden cardiac death
HF, peripheral artery disease
CKD

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6
Q

The SPRINT-MIND trial demonstrated…

A

Decreased risk of mild cognitive impairment with intensive BP control (<120) vs. standard (<140) control over 5 years

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7
Q

Health behaviour management is key to reducing BP - however, in older adults we should be careful with some aspects such as…

A

Advising weight reduction - may increase frailty
Sodium restriction = hyponatremia, increased risk for orthostatic hypotension

Consider frailty with physical activity levels

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8
Q

To avoid unnecessary HTN treatment, we should teach and reinforce…

A

Proper BP measurement - avoiding artifically high readings

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9
Q

The SPRINT-Elders trial showed…

A

Benefit for preventing CV related deaths with intensive BP management (<120)

Non-significant increase in AE’s (hypotension, syncope, AKI)

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10
Q

When analyzing the SPRINT-Elders trial, we need to be aware of practical considerations, such as…

A

Numerous patient population excluded - diabetes, post-stroke/MI, orthostatic hypotension, dementia (increased fall risk)

Avg of 1 more drug per person - can they handle it?

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11
Q

Orthostatic hypotension is defined as…

A

> 20 systolic or >10 diastolic drop in BP within 1-3 minutes of standing

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12
Q

Orthostatic hypotension is a risk factor for…

A

Falls, hospitalizations, CV events

Functional decline

Asymptomatic still increases fall risk

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13
Q
A
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14
Q

Orthostatic hypotension is associated with…

A

Increased age
Diabetes
Parkinson’s disease
Dementia

Medications

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15
Q

Diastolic hypotension is an issue because…

A

It can lead to myocardial ischemia - avoid DBP dropping below 60 in individuals with established coronary artery disease

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16
Q

We should avoid intensive BP targets in frail patients because…

A

Risks (orthostatic hypotension, falls) + treatment burden likely will outweigh benefits.
Time to benefit is ~2.5 years - is this applicable to patient?

Inquire about patient/family preference

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17
Q

We should reconsider intensive BP targets in patients when…

A

Functional dependency, limited life expectancy, dementia present
Orthostatic hypotension, diastolic hypotension
SPRINT exclusion criteria

Patient/family preference

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18
Q

When choosing antihypertensives, we should ask…

A

Is there a compelling indication for one or more of the antihypertensive agents?

Similar to general population

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19
Q

If there is no compelling indication for specific anti-HTN medications, we should choose…

Study These Flashcards
A

Agents indicated for isolated systolic hypertension
ARB, TZD, DHP-CCB

20
Q

HTN medications for diabetes include…

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A

ACE/ARB for microalbuminuria - DHP-CCB > TZD 2nd line
No microalbuminuria = ACE/ARB, DHP-CCB, or TZD’s

21
Q

HTN medications for CAD include…

Study These Flashcards
A

ACE/ARB - beta-blocker or CCBs for patients with stable angina

22
Q

HTN medications for HF include…

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A

Remember quadruple therapy - ACE/ARB or ARNI, Beta-blocker, MRA, SGLT2i

23
Q

HTN medications for past-stroke or TIA include…

Study These Flashcards
A

ACE/ARB, TZD combination

24
Q

HTN medications for non-diabetic CKD with proteinuria include…

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A

ACE/ARB, diuretics as additive therapy

25
If our patients have persistently high blood pressure despite treatment, we should evaluate...
Adherence Secondary causes of hypertension (medications - NSAID's)
26
With diuretics, we need to monitor...
Electrolytes - specifically potassium + sodium TZD's may increase gout risk Watch for orthostatic hypotension + worsening urinary urgency/incontinence
27
With ACEI/ARB's we should monitor...
Electrolytes - potassium SCr Sitting + standing BP Angioedema (rare) *Generally well tolerated*
28
CCB's can cause or exacerbate...
Peripheral edema, especially at higher doses Non-DHP CCB likely to be constipating ## Footnote Can split dose or take at nighttime to minimize
29
Non-DHP CCB's should be avoided in...
HFrEF Combination with beta-blockers
30
Non-DHP CCB's may be useful to...
Control HR in AFib
31
Beta-blockers are not recommended as...
First line anti-HTN medications for adults 60+
32
Beta-blockers are recommended in older adults if compelling indications exist. This includes...
Post-MI HFrEF Rate control in AFib May be used as add-on therapy for HTN
33
With beta-blockers we need to monitor...
Fatigue Decreased exercise tolerance Contribution to degree of frailty?
34
Statin use for secondary prevention of CV events...
Should be started/continued regardless of age - mild-moderate frailty Benefits generally outweigh risks ## Footnote Time to benefit ~2 years
35
Statin use for primary prevention of CV events after 75 years of age...
Lack of evidence to support who should receive statin therapy for primary prevention of CV events Shared decision making regarding CV risk factors, functional status, medication burden, AE's from statin ## Footnote Generally benefits > risks but consider the individual
36
Evidence for high vs. moderate intensity statin therapy indicates...
High-dose statins for high-risk patient groups (Post-MI, post-stroke) - however, more susceptible to statin AE's, but benefit > risk Moderate-dose statins may be preferred in older adults especially outside of acute post-event period (1 year)
37
Do other cholesterol medications have a role in older adults?
Limited role PCSK-9 inhibitor for familial hypercholesterolemia Fibrates in severe hypertriglyceridemia Ezetimibe - limited evidence for improving CV outcomes with/without statins ## Footnote Consider deprescribing if appropriate to decrease pill burden
38
Stable coronary artery disease is defined by history of severe atherosclerosis. This includes...
Stable angina Previous ACS or PCI Coronary artery bypass grafting Signs, symptoms, complications of inadequate blood flow to heart muscle due to atherosclerosis ## Footnote Considered secondary CV disease prevention
39
CAD is considered stable when...
There is no CV event in the past year
40
When evaluating stable CAD, we should consider...
Time since event Symptom stability Activity level Patient goals + preferences
41
Medication regimen post-ACS usually includes...
ACEI/ARB Beta-blocker Statin ASA (indefinitely) Other anti-HTN needed to control BP Other anti-anginals if needed - CCB's (if BB CI or not tolerated), nitroglycerin
42
If there is a history of GI bleed, this can be given with indefinite ASA...
PPI
43
Beta-blockers have evidence of ____ up to 3 years, ____
Reducing CV risk post-MI - titrated to resting HR of ~60 BPM
44
Beta-blockers can be re-evaluated post-MI based on...
Symptoms and comorbidities Indefinitely for HFrEF, can continue if angina symptoms continue or for AFib requiring rate control ## Footnote Poorly tolerated = re-evaluate of 3+ years post-MI
45
Short-acting nitroglycerin can be used for...
Rescue Prophylactically, prior to activities which provoke symptoms ## Footnote Always good to have just in case
46
With nitroglycerin, we should monitor for...
Dizziness, headache Hypotension Flushing Edema ## Footnote Ensure proper use
47
Long-acting nitrates (patches) may be added when...
BB +/- CCB's are CI, not tolerated, or not providing adequate symptoms relief ## Footnote Monitor BP - ensure adequate nitrate free period

Geriatrics (12 decks)

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