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Cardio Exam 3 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What percentage of adults have hypertension defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure
greater than 80 mmHg or are taking medication for hypertension

A

About half, 48.1%

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2
Q

About half of adults (45%) with uncontrolled hypertension have a blood pressure of _____

A

140/90 mmHg or higher.

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3
Q

certain groups of people are more likely to have HTN than others:

A
  • Men (50%) > than women (44%).3
  • non-Hispanic black adults (56%) > than in non-Hispanic white adults (48%), non-Hispanic Asian adults (46%), or Hispanic adults (39%).3
  • Among those recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic white adults (32%) than in non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic
    adults (25%).
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4
Q

“Essential” primary hypertension

A

an older term based upon a
hypothesis that as we age, our vasculature
becomes stiffer, and that higher and higher
blood pressures are required to maintain
optimal cardiac output.

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5
Q

Primary hypertension

A

sustained blood pressures meeting
criteria (e.g., ACC/AHA 2017) for hypertension
related to multiple genetic and environmental
factors.

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6
Q

Primary Hypertension Risk Factors

A
  1. Increasing age
  2. Obesity/Overweight
  3. Family history
  4. Race
  5. Exposure to systemic racism
  6. Diabetes Mellitus
  7. High Na+ Diet
  8. Sedentary lifestyle
  9. Reduced nephron number (acquired or genetic)
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7
Q

Definition of Secondary Hypertension

A

HTN with an identifiable cause or contributor
Examples:
Rx or OTC meds (e.g., NSAIDs, certain
weight loss meds, etc.)
Primary renal disease
Obstructive or central sleep apnea
Cushing’s syndrome

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8
Q

Secondary Hypertension Causes:
ABCDE

A

A: Accuracy of diagnosis, obstructive
sleep Apnea, Aldosteronism
B: Bruits (renal artery stenosis), renal
parenchymal dz (Bad kidneys),
C: excess Catecholamines, Coarctation
of the aorta, Cushing’s
D: Drugs, Diet, excess Erythropoietin,
and
E: Endocrine disorders

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9
Q

High BP stage 1

A

Systolic: 130-139
or
Dyastolic: 80 - 89

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10
Q

Hypertension stage 2

A

S: 140 or higher
or
D: 90 or higher

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11
Q

Patient-related ERRORS in BP: What are practice quidelines?

A

Recent meal, caffeine,
nicotine use, a full bladder, or recent activity. BEST
PRACTICE: Need to be comfortable, quiet
environment, 5 minutes sitting.

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12
Q

Procedure-related ERRORS in BP: what are practice guidelines?

A

Arm lower than heart, legs crossed, patient talking, fast deflation. BEST
PRACTICE: Arm at chest level. Feet flat, back
straight. Sit still, remain quiet.

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13
Q

Equipment-related ERRORS in BP: what are practice guidelines?

A

Wrong cuff size. Device
is not calibrated. BEST PRACTICE: Size cuff per
directions. Calibrate device regularly.

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14
Q

Clinician-related ERRORS in BP: what are practice guidelines?

A

Not giving enough time (i.e., 5 minutes), letting patient talk, incorrect positioning of patient

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15
Q

Complications, Manifestations, & Sequelae of HTn

A
  • Atherosclerosis à CAD àACS
  • Myocardial hypertrophy à
    Cardiomyopathy à Heart failure
  • Aneurysms à bleeds
  • Hypertensive retinopathy à
    loss/change of vision
  • Kidney disease
  • Metabolic disorder
  • TIA/CVA
  • Dementia/MCI
  • Sexual dysfunction
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16
Q

BP Diagnosis requires:

A

Two or more readings that meet criteria for HTN on two or more occasions

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17
Q

Diagnosis of HTN: In office readings

A

BP 130/80 (ACC) or 140/90 (AFP) or greater
* Reassess every 1-4 weeks to confirm
* a single BP reading of is 180/110 mm Hg or higher +CV disease requiring
immediate treatment

18
Q

Diagnosis of HTN: Home readings

A

135/85 mm Hg or greater
* more consistent and better reflect hypertension-mediated organ damage risk.
* can differentiate white coat hypertension,

19
Q

Diagnosis of HTN: 24-hour ambulatory monitoring

A

Must meet one of these three criteria
24-hour average BP of 130/80 mm Hg or greater, daytime average BP of 135/85
mm Hg or greater, or nighttime average BP of 120/70 mm Hg or greater.

20
Q

Initial Visit recommendations:
Patient with an Elevated BP

A

Elevated (120-129/< 80) OR Suspected
High Blood Pressure (≥ 130/≥ 80 for first
time).
* Discuss/Encourage Lifestyle
Changes,
* Suggest 2-week follow-up
* keep home BP log (get a BP cuff), or
consider 24-hour ambulatory BP
monitor (ABPM)
* Consider: CMP or BMP, UA. (Why?)

21
Q

Visit recommendations for Patient with Confirmed HTN: Stage I

A
  • Calculate ASCVD Risk.
  • If <10%, Lifestyle Changes
  • If >10%, Lifestyle Changes + Anti-HTN
    therapy
22
Q

Visit recommendations for Patient with Confirmed HTN: Stage II

A
  • Lifestyle Changes + Anti-HTN therapy
    regardless of ASCVD score
  • Follow-up q4 wks (optimally q2wks by
    phone/text/email) while titrating or switching
    meds until BP goal met.
  • Follow-up in 3-6 months after initial
    “stability”
23
Q

Adult recommended sodium intake

A

1500 mg
1/2 tsp has 1200 mg

24
Q

American Heart Association Physical Activity Recommendations

A

Reduce sodium
Exercise: 40 min of moderate intensity exercise 3-4 days a week
Reduce/eliminate alcohol
* Women - 1.5 standard drinks/day
* Men - 2 standard drinks/day

25
Q

Hypertensive Emergency:

A

Relatively uncommon - reported as 1-2 cases
per million per year.
* Acute elevation of BP that results in
Target Organ Damage (TOD).
* Can be life-threatening,
* Requires quick work up and immediate
treatment

26
Q

Target organ damage (TOD) examples

A

Intracerebral hemorrhage,
Acute MI, Acute LV failure with pulmonary
edema, dissecting aortic aneurysm,
pheochromocytoma, eclampsia, etc

27
Q

Presentations of Hypertensive Emergency

A

Malignant hypertension:
Hypertensive encephalopathy:
Hypertensive thrombotic microangiopathy:

28
Q

______ :Severe BP elevation
(commonly >200/120 mm Hg) associated with advanced bilateral retinopathy (hemorrhages, cotton wool spots, papilledema).

A

Malignant hypertension

29
Q

_____ : Severe BP elevation
associated with lethargy, seizures, cortical blindness and
coma in the absence of other explanations.

A

Hypertensive encephalopathy

30
Q

_____: Severe BP elevation associated with hemolysis and thrombocytopenia in the absence of other causes and improvement with BP-lowering therapy.

A

Hypertensive thrombotic microangiopathy

31
Q

Other presentations of hypertensive
emergencies include:

A
  • cerebral hemorrhage,
  • acute stroke,
  • acute coronary syndrome,
  • cardiogenic pulmonary edema,
  • aortic aneurysm/dissection, and
  • severe preeclampsia and eclampsia
32
Q

Symptoms of hypertensive emergency include:

A

headaches, visual disturbances, chest pain,
dyspnea, neurologic symptoms, dizziness, and
more unspecific presentations.

33
Q

Medical history for hypertensive emergency:

A

preexisting hypertension, onset and duration
of symptoms, potential causes (nonadherence
with prescribed antihypertensive drugs,
lifestyle changes, concomitant use of BP
elevating drugs

34
Q

Hypertensive Emergency
Management must be balanced against 2 ideas:

A
  • Risk of TOD if BP is not reduced
    enough in a rapid enough manner.
  • Risk of events with rapid lowering,
    e.g., stroke, AKI, or MI.
  • vascular beds habituated to chronic
    BP elevation.
35
Q

Hypertensive Emergency workup

A

EKG, CXR, UA, CMP, Cardiac
biomarkers. CT or MRI of the brain as
indicated, Contrast CT or MRI or Echo
if aortic dissection suspected

36
Q

Sympathetic hyperreactivity

A

amphetamines, sympathomimetics or cocaine
* consider benzodiazepines before antihypertensive
treatment.
* DON’T USE BB!!
* Phentolamine, a competitive alpha-receptor blocking agent and clonidine, a centrally sympatholytic agent with additional sedative properties are useful if
additional BP-lowering therapy is required.
Nicardipine and nitroprusside are suitable
alternatives.

37
Q

Pheochromocytoma:

A
  • responds well to phentolamine.
  • Beta-blockers only after alpha-blockers have been introduced to avoid acceleration of hypertension.
  • Urapidil and nitroprusside are additional suitable options
38
Q

Hypertensive Urgency - NO Target Organ Damage workup

A

EKG, CXR, UA, CMP. Cardiac biomarkers;
CT or MRI of the brain as indicated; Contrast CT or MRI or Echo if aortic dissection suspected.

39
Q

Hypertensive Urgency - NO Target Organ Damage Management

A

Reinstitute/intensify oral anti-HTN drug
therapy and arrange follow-up
Reduce over hours to days, to target to BP < 160/<
100.
Avoid reduction in MAP > 25-30% over 1st 2-4 hours.
Long-term target < 140/< 90

40
Q

Hypertensive Urgency - NO Target Organ Damage PEARL

A

Laying in quiet room can reduce BP by 10-20

Cardio Exam 3 (8 decks)

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