HTN - waldron Flashcards by Lindsey Dutton

how do you properly measure BP

have pt relax, sitting in a chair at least 5 min
patient should avoid caffeine, exercise, smoking 30 min prior to measurement
emptied bladder
neither patient or observer should talk during rest period/during measurement
clothing free area

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when does screening begin for HTN

adults ages 18+ without known HTN at every visit

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what is stage 1 HTN

systolic: 130-139
or
diastolic: 80-89

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what is stage 2 HTN

systolic: greater than 140
or
diastolic: greater than 90

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what is HTN crisis

systolic: > 180
and/or
diastolic: >120

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what is the definition of primary hypertension

result of sustained increases in blood pressure secondary to increased peripheral resistance and blood volume

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What is Masked Hypertension

controlled office BPs but uncontrolled BPs in out-of-office settings
risk of CVD and all-cause mortality is similar to that noted in those with sustained HTN

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what is the etiology of HTN

multifactoral
genetic
ethnicity
environmental factors (stress)
dietary factors (sodium, ETOH)
obesity
aging

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what are risk factors for HTN

obesity
alcohol abuse
sedentary lifestyle
tobacco use
excessive emotional stress
obstructive sleep apnea
poor diet

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what is secondary HTN

elevated BP caused by another medical condition
sometimes more difficulty with control
underlining medical illness needs to be addressed

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what are potential causes to secondary hypertension

Obstructive Sleep Apnea (OSA)
chronic kidney disease
primary aldosteronism
renovascular disease
cushing syndrome

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what are drug related causes of HTN

NSAIDS
glucocorticoids
sympathominmetic agents
stimulants
alcohol
OCP

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what are the signs and symptoms for secondary HTN

often asymptomatic
persistent or severe headache
SOB
fatigue
epitaxies
anxiety
feeling of pulsation in the neck or head

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how is HTN diagnosed

History
PMHx
FamHx
medications
social hx (diet, habits)
exposures (lead)

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what is the goal for diagnosing HTN

identify end-organ damage, signs of secondary HTN, reversible exacerbating factors

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what are the labs to assist with dx HTN

urinalysis
CBC
fasting lipid profile
CMP
Optional: uric acid, 24hour urine creatinine and protein

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what is the management for HTN

treatment goal: attain and maintain target BP
reduce cardiovascular and renal morbidity and mortality
patients < 60yo: <140/ <90
patients > 60: <150 / <90

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what are the non-pharmacologic treatments for HTN

weight loss
heart-healthy diet
sodium reduction
potassium supplementation, preferably by diet
increase Physical activity
no more than 2 standard drinks per day for men and 1 for women
smoking cessation

what are the pharmaceutical therapies for HTN

Diuretics
BB
RAAS
CCB
others

what medications are indicated for antiHTN with DM

ACEi or ARBs

what medications are indicated for antiHTN with HF

ACEi, ARBs, BB, Thiazide diuretics, aldosterone antatgonists

what is the primary cause of secondary HTN

sleep apnea

what medications are indicated for antiHTN with MI

BB, ACEi (with LV dysfunction)

what medications are indicated for antiHTN with Chronic Kidney disease

ACEs, ARBs

what medications are indicated for antiHTN with isolated systolic HTN

diuretics (preferred), calcium antagonists

what type of medication is more effective at reducing strokes in AA patients

CCBs are more effective than ACEi

what HTN medications are recommended in CKD, Heart disease

ACEi/ARB

what is resistant HTN

persistent HTN despite 3+ medications - one must be a diuretic at adequate dose

what is the most common cause of resistant HTN

poor adherence to therapy

what is malignant HTN

severe HTN (BP > 180/110)

What is a Hypertensive emergency

WITH end-organ damage dissecting aortic aneurysm acute pulmonary edema acute coronary syndromes (STEMI, NSTEMI, unstable angina) renal injury encephalopathy stroke eclampsia *requires hospitalization

what is severe asymptomatic HTN

WITHOUT end-organ damage usually chronic outpatient management

what is hypertensive urgency

very high BP (diastolic pressure > 120-130) acute complications are unlikely, so immediate BP reduction not required start 2 drug oral antiHTN combination with close eval of treatment efficacy, continued outpatient very high BP without organ damage commonly occurs in highly anxious patients or those who have had very poor sleep quality over a period of weeks

what is the treatment for hypertensive emergencies

admit to ICU immediate short -acting BP reduction with IV drugs - nitroglycerin, nitroprusside, labetalol, esmolol, hydralazine

how do you work up hypertensive emergencies

ECG, urinalysis, serum BUn and creatinin chest XR

what is hypertensive encephalopathy

brain dysfunction secondary to excessively high BP SUDDEN ONSET (most cases) -HA, V, balance difficulties, confusion complications include seizures, retinal hemorrhage

what are risk factors for hypertensive encephalopathy

kidney failure, abrupt medication discontinuation, pheochromocytoma, MAOI + tyramine, eclampsia

what are the causes of orthostatic hypotension

inadequate autonomic response (neurogenic) OR insufficient intravascular volume or circulation (non-neurogenic)

what are the risks for orthostatic hypotension

older adults (>70yo), polypharmacy, peripheral neuropathy, neurodegenerative d/o

what is the pathophysiology of orthostatic hypotension

autonomic dysfunction affecting baroreflex - no change in HR or BP severe volume depletion - increase HR meds 40% have no definite cause

what are the symptoms with orthostatic hypotension

in response to change in position, usually vs gravity dizziness/lightheadedness visual blurring neck pain, HA 50% have systolic HTN when supine/sitting

what is the treatment for orthostatic hypotension

avoid meds related to orthostasis modify diet treat underlying causes modify activity may consider compression stockings consider medication therapy

what are the complications of HTN

increases afterload - leads to congestive HF, increases myocardial oxygen demand arterial damage - accelerated atherosclerosis, aneurysm, dissection, kidney disease, stroke