Hypertension Flashcards
(37 cards)
Most common cause of secondary hypertension
Renal/renovascular disease (renal artery stenosis)
Essential Hypertension
No identifiable cause
>95% of cases
Most common secondary cause of htn in young women
birth control pills
Major complications of HTN
cardiac: coronary artery disease, CHF with left ventricular hypertrophy, stroke, renal failure
- -> account for majority of deaths related to untreated HTN
End organ damage of HTN
heart, eyes, CNS, kidneys
Aortic dissection
htn associated with increased risk
Goals in evaluating patient with htn
look for secondary causes
assess damage to target organs
assess overall cardiovascular risk
Retinal changes
- AV nicking: discontinuity in retinal vein secondary to thickened arterial walls)
- cotton wool spots: infarction of nerve fiber layer in retina
- -> can cause visual disturbances in scotoma
more serious diseases: hemorrhages and exudates
papilledema: ominous, seen in severely elevated bp
Nephrosclerosis
arteriosclerosis of afferent + efferent arterioles and glomerulus
Definition of htn
blood pressure of:
>140/90 in general population
>130/80 in diabetics and renal disease
Other kidney manifestations
decreased gfr
dysfunction of tubules
–> eventual renal failure
Diagnosing hypertension-what not to do
Never based on one bp reading (unless severe htn or evidence of end organ damage)
Diagnosing htn-what to do!
establish diagnosis based on at least 2 readings over a span of 4 weeks
Accurate bp reading
arm at heart level
pt seated comfortably
pt sit quietly for >= 5 minutes
no caffeine or smoke cigarette in past 30 minutes
adequate cuff size (bladder should encircle 80% of arm)
Lab tests to evaluate target organ damage in htn
- urinalysis
- chemistry panel: serum K, BUN, Cr
- fasting glucose (if pt is diabetic check for microalbuminemia)
- lipid panel
- EKG
- -> if h&p or lab tests suggest 2ndary cause of htn order appropriate tests
Management of normal bp
no treatment
120/80
Management of prehypertension
lifestyle modification
120-139/80-89
Management of Stage I htn
lifestyle modification, drug therapy
140-159/90-99
Management of Stage II HTN
lifestyle modification and drug therapy (2 drug combo for most)
>=160/>=100
Antihypertensive therapy in pregnant women
always obtain pregnancy test in reproductive age women before starting anti htn meds;
- thiazides, ACE inhibitors, calcium channel blockers, and ARBs are contraindicated in pregnancy!*
- Beta blockers and hydralazine are safe in pregnancy
Alcohol and bp
alcohol has pressor action; excessive use can increase bp
Therapy in pt with moderate to severe htn
consider initiating therapy immediately instead of waiting 1-2 months to confirm diagnosis
Best initial pharmacotherapy in African-Americans
thiazide diuretics bc “salt-sensitive” htn is more common in this group
if African American pt has diabetes, ACE inhibitor is still initial agent of choice
Side effects of thiazide diuretics
hypokalemia (check serum K regularly); hypokalemia can be exacerbated by high salt intake
other: hyperuricemia, hyperglycemia, elevation of cholesterol and triglyceride levels, metabolic alkalosis, hypomagnesemia
