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Clin Med 2 - CARDS > HTN - waldron > Flashcards

HTN - waldron Flashcards

1
Q

how do you properly measure BP

A

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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2
Q

when does screening begin for HTN

A

adults ages 18+ without known HTN at every visit

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3
Q

what is stage 1 HTN

A

systolic: 130-139
or
diastolic: 80-89

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4
Q

what is stage 2 HTN

A

systolic: greater than 140
or
diastolic: greater than 90

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5
Q

what is HTN crisis

A

systolic: > 180
and/or
diastolic: >120

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6
Q

what is the definition of primary hypertension

A

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

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7
Q

What is Masked Hypertension

A

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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8
Q

what is the etiology of HTN

A

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

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9
Q

what are risk factors for HTN

A

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

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10
Q

what is secondary HTN

A

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

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11
Q

what are potential causes to secondary hypertension

A

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

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12
Q

what are drug related causes of HTN

A

NSAIDS
glucocorticoids
sympathominmetic agents
stimulants
alcohol
OCP

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13
Q

what are the signs and symptoms for secondary HTN

A

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

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14
Q

how is HTN diagnosed

A

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

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15
Q

what is the goal for diagnosing HTN

A

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

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16
Q

what are the labs to assist with dx HTN

A

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

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17
Q

what is the management for HTN

A

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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18
Q

what are the non-pharmacologic treatments for HTN

A

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

19
Q

what are the pharmaceutical therapies for HTN

A

Diuretics
BB
RAAS
CCB
others

20
Q

what medications are indicated for antiHTN with DM

A

ACEi or ARBs

21
Q

what medications are indicated for antiHTN with HF

A

ACEi, ARBs, BB, Thiazide diuretics, aldosterone antatgonists

22
Q

what is the primary cause of secondary HTN

A

sleep apnea

23
Q

what medications are indicated for antiHTN with MI

A

BB, ACEi (with LV dysfunction)

24
Q

what medications are indicated for antiHTN with Chronic Kidney disease

A

ACEs, ARBs

25
Q

what medications are indicated for antiHTN with isolated systolic HTN

A

diuretics (preferred), calcium antagonists

26
Q

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

A

CCBs are more effective than ACEi

27
Q

what HTN medications are recommended in CKD, Heart disease

A

ACEi/ARB

28
Q

what is resistant HTN

A

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

29
Q

what is the most common cause of resistant HTN

A

poor adherence to therapy

30
Q

what is malignant HTN

A

severe HTN (BP > 180/110)

31
Q

What is a Hypertensive emergency

A

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

32
Q

what is severe asymptomatic HTN

A

WITHOUT end-organ damage
usually chronic
outpatient management

33
Q

what is hypertensive urgency

A

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

34
Q

what is the treatment for hypertensive emergencies

A

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

35
Q

how do you work up hypertensive emergencies

A

ECG, urinalysis, serum BUn and creatinin
chest XR

36
Q

what is hypertensive encephalopathy

A

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

37
Q

what are risk factors for hypertensive encephalopathy

A

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

38
Q

what are the causes of orthostatic hypotension

A

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

39
Q

what are the risks for orthostatic hypotension

A

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

40
Q

what is the pathophysiology of orthostatic hypotension

A

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

41
Q

what are the symptoms with orthostatic hypotension

A

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

42
Q

what is the treatment for orthostatic hypotension

A

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

43
Q

what are the complications of HTN

A

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

Clin Med 2 - CARDS (11 decks)

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