Hypertension Flashcards

(51 cards)

1
Q

What is hypertension?

A

persistent

  • systolic 130mgHg or more
  • diastolic 80mmHg or more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a hypertensive crises?

A
  • systolic > 180

- diastolic > 120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for primary hypertension?

A
  • positive family history
  • smoking
  • advanced age
  • inactivity
  • uncontrolled diabetes
  • race & ethnicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of secondary hypertension?

A
  • renal artery stenosis (most common
  • endocrine: hyperaldosteronism, Cushing syndrome, pheochromocytoma, acromegaly
  • oral contraceptives, decongestants, chronic steroids, TCA, NSAIDS
  • coarctation of the aorta
  • cocaine
  • obstructive sleep apnea (OSA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features of hypertension?

A

ASYMPTOMATIC
until -> complications of end-organ damage OR hypertensive crises

  • secondary hypertension features -> of underlying disease
  • non-specific symptoms -> headache, dizziness, tinnitus, blurred vision, epistaxis, chest discomfort, palpitations, bounding pulse on palpation, nervous, fatigue, sleep disturbances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the findings of renal artery stenosis & how do we confirm its presence?

A
  • abdominal bruit
  • hypokalemia
  • asymmetric kidney size
  • duplex ultrasonography & MRA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the findings of primary aldosteronism (Conn syndrome)?

A
  • arrhythmia
  • hypokalemia
  • metabolic alkalosis
  • increase aldosterone to renin ratio
  • oral sodium loading test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the findings in pheochromocytoma?

A
  • acute episodic rise in blood pressure
  • flushing, diaphoresis
  • headache
  • increased 24-h urinary metanephrines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the findings in Cushing’s syndrome?

A
  • central obesity
  • moon face
  • increase cortisol
  • hirsutism
  • overnight 1-mg dexamethasone suppression test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the findings in aortic coarctation?

A
  • blood pressure in upper extremities higher than lower extremities
  • absent femoral pulses
  • ECHO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should screening for hypertension occur?

A

Annual screening

  • > 40 years
  • any age with risk factors for primary HTN

Screening every 3 - 5 years -> everyone else

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should in-office BP measurement be taken?

A
  • if elevated -> repeat on other arm

- at least 2 readings on 2 separate visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are out-of-office BP measurements taken?

A
  • ambulatory blood pressure measurement

- home blood pressure monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do we evaluate end-organ damage?

A
  • renal function tests -> creatinine & eGFR
  • urinalysis & albumin to creatinine ration
  • ECG -> signs of hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the indicators of secondary hypertension?

A

new-onset or uncontrolled hypertension in adults -> screen for secondary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should elevated blood pressure be managed?

A

120-129/<80mmHg

- non pharmacological therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is stage 1 hypertension managed?

A

130-139/80-90mmHg -> estimated 10-y CVD risk

  • if more than 10% -> non pharmacological therapy & BP lowering medications
  • if less than 10% -> non pharmacological
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is stage 2 hypertension managed?

A

> 140/90mmHg

non pharmacological therapy + BP lower medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How long should non pharmacological therapy be used?

A

3 - 6 months -> if not getting better -> pharma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the first-line agents used for control of hypertension?

A
  • thiazide diuretics
  • CCBs
  • ACEI
  • ARBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which drugs do blacks respond to the most?

A

diltiazem & HCTZ

- thiazide like diuretics & CCB

22
Q

What are the second line drugs for management?

A
  • beta blockers
  • loop diuretics
  • aldosterone antagonists
  • alpha-1 blockers
23
Q

Which drugs have favorable effects on comorbidities?

A
  • BPH -> alpha blockers
  • essential tremor -> beta blocker
  • hyperthyroidism -> beta blocker
  • migrate -> beta blocker
  • osteoporosis -> thiazide diuretics
  • Raynaud phenomenon -> dihydropyridine calcium channel blocker
24
Q

What is the first-line treatment for HTN in pregnancy?

25
When should sodium nitroprusside be used?
in hypertensive emergencies
26
When should alpha-1 blockers be used in HTN management?
PRAZOSIN & DEXAZOSIN - HTN due to pheochromocytoma - BPH
27
When should loop diuretics be used in HTN?
FUROSEMIDE & TORSEMIDE | - in symptomatic HF
28
When are beta blockers used in management of HTN?
METROPOLOL & LABETALOL - ischemic heart disease - HF
29
What are the contraindications for CCBs?
patients with reduced ejection fraction (HFrEF) - dihydropyridines -> amlodipine, ninfedipine - non-dihydropyridines -> diltiazem, verapamil
30
patients with isolated systolic hypertension should be given what agents?
- Thiazide diuretics -> HCTZ, chlorathalidone | - dihydropyridines -> amlodipine, ninfedipine
31
What are the first line agents for patients with DM, renal disease, ischemic heart disease, & HF?
ACEi -> lisinopril, captopril | ARBs -> losartan, candesartan
32
What drugs are contraindicated in bilateral artery stenosis?
ACEi & ARBs
33
What should the target goal be for management of HTN?
less than 130/80mmHg
34
What should the target goal be for management of HTN?
less than 130/80mmHg
35
How should the management be followed up?
reassess after giving drugs in 1 month -> BP goal is met -> reassessment in 3 - 6 months -> if not met -> assess & optimize adherence to therapy & intensify treatment
36
What are the complications of hypertension?
``` Cardiovascular -> HF, heart attack Neurological -> stroke, TIA, vascular dementia Renal -> kidney failure Optic - hypertensive retinopathy - cotton wool spots - retinal hemorrhage - macular star (exudation into the macula)) - micro aneurysm - AV nicking ```
37
What is the difference between hypertensive emergency & urgency?
EMERGENCY -> crises with with signs of end-organ damage | URGENCY -> asymptomatic or isolated non-specific symptoms & non end-organ damage
38
What are the causes of hypertensive crises?
- drug non-compliance or abuse - pheochromocytoma - hyperthyroidism - acute renal disorders - eclampsia/pre-eclampsia
39
What are the cardiac signs of hypertensive crises?
- HF exacerbation & pulmonary edema -> dyspnea & crackles - MI -> chest pain, diaphoresis - Aortic dissection -> chest pain & asymmetric pulses
40
What are the neurologic signs of hypertensive crises?
- hypertensive encephalopathy -> headache, vomiting, confusion, seizure, blurry vision, papilledema - ischemic or hemorrhagic stroke -> focal neurological deficits, altered mental status
41
What are the renal signs of hypertensive crises?
acute hypertensive nephrosclerosis
42
What are the ophthalmic signs of hypertensive crises?
acute hypertensive retinopathy
43
What are the red flag symptoms in HTN?
- dyspnea - chest pain - altered mental status - focal neurological symptoms
44
How should hypertensive emergencies be treated?
1- ABCDE 2- ICU admission 3- IV agents to treat -> CCBs (nicardipine & clevidipine), nitric oxide dependent vasodilators (sodium nitroprusside & nitroglycerin), direct arterial vasodilators (hydralazine) reduce MAP by 10-20% within the first hour to prevent coronary insufficiency -> reduce by 5-15% over the next 23 hours
45
How should hypertensive urgency be treated?
select, reinstitute, modify oral antihypertensive therapy
46
What is white coat hypertension & what is its cause?
- HTN detected only in clinical settings | - caused by anxiety
47
increase in systolic BP >140mmHg with diastolic BP within normal limits (<90mmgHg) is?
isolated systolic hypertension - in elderly due to decreased arterial elasticity & increased stiffness - secondary to increased cardiac output -> anemia, hyperthyroidism, chronic aortic regurgitation, AV fistula
48
What are the features of isolated systolic hypertension & how should it be treated?
- head pounding - rhythmic nodding - bobbing of the head with heartbeats - thiazide diuretics or dihydropyridine CCB
49
What are the risks of HTN in pregnancy?
- placental abruption - stroke - multiple organ failure - disseminated vascular coagulation - intrauterine growth retardation - preterm birth - intrauterine death
50
What are the classifications of pregnancy hypertension?
- mild: >140/90mmHg | - severe: >160/110
51
What are the first lines of treatment in HTN in pregnancy?
Methyldopa Labetalol Hydralazine Nifedipine