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Assessment Spring > Hypertension > Flashcards

Hypertension Flashcards

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1
Q

What is HTN classified as?

A

Systolic >130 and or DBP >80

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2
Q

HTN affects nearly ___ of adults

A

half

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3
Q

HTN affects over ____ million people

A

100

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4
Q

Lifetime risk of getting HTN

A

90%

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5
Q

Chronic HTN can lead to

A

IHD, stroke, renal failure, PVD, increased mortality

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6
Q

What is isolated systolic HTN

A

> 130 with DBP< 80

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7
Q

Isolated diasotlic HTN

A

SBP<130 and DBP >80

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8
Q

Combined HTN

A

> 130 and >80

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9
Q

What type of pulse pressure from HTN results in increased stifness and remodleing

A

Widened pulse pressure

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10
Q

HTN can result from increased ______ and _____

A

cardiac output, vascular resistance

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11
Q

Is secondary htn or primary correctable?

A

secondary

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12
Q

Secondary HTN causes

A

Hyperaldosteronism, thyroid dysfunction, OSA, Cushings, pheochromocytoma

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13
Q

What is the most common cause for HTN in children that is secondary

A

Renal disease or coarctation of the aorta

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14
Q

What supplements increase BP?

A

Ginseng, ma huang, Ephedra

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15
Q

Among children 70-85% of kids who have secondary htn from birth to 12 years have

A

Renal parenchyman disease, coarctation of the aorta

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16
Q

Among adolescents 12-18 years of age, what secondary cause represents 10-15% of secondary HTN

A

Coarctation of the aorta

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17
Q

In youg adults 40-64, 8-12% have secondary HTN from this

A

Hyperaldosternonism, Thyroid dysfunction, OSA, bushings, pheochromocytoma

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18
Q

In pts 65 and older 17% of HTN cause is from this

A

Athersclerotic renal artery stenosis, renal failure, hypothyroidism

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19
Q

Vasculopathy plays a role in multiple cv diseases, can be detected via what do measure common carotid intimal to medial thickness

A

Arterial pulse wave velocity

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20
Q

What two test trends track LVH progression

A

EKG and echocardiogram

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21
Q

What is resistant HTN

A

above BP goal despite 3+ antihypertensive drugs at max dose

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22
Q

What is controlled resistant HTN?

A

controlled bp requiring 4+ medicaitons

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23
Q

Refactory HTN

A

uncontrolled BP on 5 + drugs, only present in .5% of pts

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24
Q

Psuedo resistant htn

A

often due to bp inaccuracies IE white coat syndrome….. or medication non compliance

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25
how does bmi affect bp?
Increased BMI shoes an increased relationship between HTN and BMI
26
Overweight adults should aim for what body weight?
Ideal
27
How much dose bp drop for every 1kg of body weight lost?
1mmhg
28
How is drinking associated with HTN?
Excessive alcohol use
29
What two things are inversely related to HTN and cerebro vascular disease
Potassium and calcium intake
30
If pts have evidence of ischemic heart disease ect when should they be treated with meds?
If bp is > 130
31
What medications are effective usually in non black HTN pts
ACE-I, ARBS, CCBS, thiazide diuretics
32
In black pts with out heart failure or ckd, evidence supports using inital therapy these bp meds
CCB, thiazide diuretics
33
Use what BP meds with people who have CKD, to improve kidney outcomes
ACE-I or ARBS
34
If someone has secondary HTN via renal artery stenosis and it isnt repairable, what drugs should you give
ACE-I + diuretics
35
If someone has bilateral renal artery stenosis what drugs do you not give as they can worsen renal failure
ace-i, arbs, direct renin hibitors
36
What medication is used to treat primary hyperaldosteronism
Spironolactone
37
Is elevated BP a direct prompt to delay surgery in asymptomatic pts without risk factors?
NO
38
Unless the pt is experiencing extreme HTN >180 or DBP >110 or end organ injury
DO NOT DELAY SURGERY
39
Stopping Beta blockers or clonidine is associated with what before surgey
rebound HTN
40
Stopping what blood pressure med before surgery is associated with increased perioperative cardiovascular risk
calcium channel blockers
41
Pts with chronic htn that have end organ damage are less resilient to periods of what
hypotension
42
HTN pts are vulnerable to what stage of anestheisa
Induction; induction drugs produce htn
43
What beta blocker can you give on induction to help negate the negative affects of htn
Esmolol
44
Pts who have poorly controlled htn on diuretics often have what also?
hypovolemia
45
Giving pts what before induction may provide better hemodynamic stability?
Volume; fluids!... be cautious in pts with LVH or diastolic dysfunction
46
Hypertensive crisis is categorized based on presence of end organ damage
urgent: without emergent: with
47
Women with pregnancy induced htn (PIH) may experience end organ dysfucntion such as encephalopathy with what diasotlic bp
>100
48
Current guidlines state for peripartum HTN immeidate treatment for
SBP>160 and DBP>110
49
First line drug for peripartum HTN
Labetaolol
50
For rapid arterial dialation use what drug (gold standard)
SNP; sodium nitroprusside
51
Which drug is a 3rd generation CCB for rapid arterial dilation
Clevidipine; short half life.... expensive
52
What other ccb for rapid arterial dialation that is a second generation CCB?
Nicardipine
53
Why is nicardipine less titratable than clevidipine?
Longer half life (30 minutes)
54
Pulm HTN is defined by
mean PA (mPAP) >20mmhg
55
What are the signs of pulm htn
Accentuated S2 and S4 "gallop", LE swelling
56
Pulm htn is divided into how many sub classes?
Three
57
First subclass of pulm htn
isolated precapillary HTN
58
Second pulm htn class
isolated post capillary HTN
59
Third class of pulm htn
Combined pre and post capillary htn
60
Pre capillary htn
PVR > 3.0 wood units w NORMAL LAP or PAWP (<15mmhg)
61
Postcapillary htn
incrased pulm venous presure due to elevated LAP c/b heart disease >15mmhg; NORMAL PVR
62
Combined pre and post
chronic pulm htn with secondary pulm artery constriction PVR>3.0wu, PAWP > 15mmhg
63
What is high flow pulmonary htn
w/o elevation in PVR or LAP results from increased blood flow usually by a shunt or high cardiac output states
64
Pul htn values
65
How is pulm htn diagnosed
Right heart cath
66
If someone has pulm htn a TTE reveals what?
RA and RV enlargement; elevated tricuspid velocity
67
Even if PASP>41 mmhg on an echo is relativley sensitive for pulm HTN, it cant provide what
acurate measurement of of mPAP
68
Mild PH
mPAP 20-30mmhg
69
Moderate PH
mPAP 31-40mmhg
70
Severe PH
mPAP > 40mmhg
71
How much can cardiac output increase without a marked change in mPAP
4 fold increase
72
Pulm htn without an indentifiable risk factor
Idiopathic PAH
73
What percent of pul HTN cases are genetic?
3%
74
What receptor is involved in genetic pulm htn
mutations in bone morphogenic protein receptor type 2 (BMPR2)
75
1 year mortaility rate of Pulm HTN pts
15%
76
76
3 classes of pulm HTN drugs
-Prostanoids -Endothelin receptor antagonist -Nitric oxide/guanylate cyclase enhancers
77
Of the prostanoids, which is the only one proven to reduce mortality
Epoprostenol
78
Endothelian receptor antagonist improve what
hemodynamics and exercise capacity
79
Nitric oxide/guanylate cyclase drugs cause pulm vasodialtion by
stimulating guanylate cyclase and cGMP in smooth muscle cells
80
Which drugs prolong the half life of nitric oxide
PD-5 inhibitors; ...PD-5 breaks down nitric oxide
81
If a dialted pulm artery is compressed what can happen
RLN nerve damage and hoarseness
82
To ensure a pt is diagnosed correctly, a left heart cath is indicated to ensure what
an accurate LVEDP
83
what percent of pts are non responsive to inhaled nitric oxide
85-90%
84
Those people that do repsond to nitric oxide usually also respond to what
Calcium channel blockers
85
Main intraoperative goal of anesthesia with someone who has pulm HTN
ensure mechanical coupling between right ventricle and pulm circulation to ensure adquate left sided fillling
86
HPV will what to pulm htn
further increase RV afterload
87
Three procedures to consider with someone who has pulm htn.. all increase risk of problems in someone who as pulm htn
-othropedics -Laparoscopy -Thoracic surgery
88
During single lung ventialtion, ______ pulmonary vasodialtors are recommended
Inhaled

Assessment Spring (5 decks)

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