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CVPR: Renal > Hypertension > Flashcards

Flashcards in Hypertension Deck (13)
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1

Prevalence of HTN in US

  • 50-60 million people
  • 50% of 60-70 yo
  • 65% of 70-80 yo
  • 70% of 80+
  • normotensive ppl @ age 55 have 90% risk of developing HTN

2

CVD risk associated with HTN

  • Starting @ 115/75, CVD risk doubles w/each increase of 20/10 mmHG
  • positive linear association between systolic BP and ischemic HD mortality
    • more important risk factor in persons > 50 yo (vs. diastolic)

3

Essential HTN pathogenesis (2 theories)

  • MAP = CO x SVR
  • Theory 1: defect in renal sodium excretion => increased plasma volume => increased CO => autoregulatory increase in SVR => increase in BP
  • Theory 2: Na+ transport inhibitor inhibits Na+/K+/ATPase => increases cell Na+, cell can't extrude Ca2+ via NCX => increases cell Ca2+ => VSMC contraction => increase in SVR/BP

4

Elements of lifestyle modification tx for HTN

  • Weight reduction
    • 5-20 mmHg/10kg weight loss
  • DASH eating plan
    • 8-14 mmHg reduction
  • Dietary sodium reduction
    • 2-8 mmHg reduction
  • Increase physical activity
    • 4-9 mmHg reduction
  • Moderation of alcohol
    • 2-4 mmHg reduction

5

Classification of HTN

  • Normal = <120/<80
  • PreHTN = 120-139/80-89
  • Stage 1 HTN = 140-159/90-99
  • Stage 2 HTN = >160/>100

6

PreHTN tx

  • lifestyle modification
  • no antiHTN drugs
  • if pt has chronic kidney disease, give drugs for this/other compelling indication

7

Stage 1 HTN tx

  • lifestyle modification
  • thiazide diuretics for most
  • may consider ACE-i, ARB, BB, CCB or combo
  • drugs for compelling indications (e.g. chronic kidney disease)

8

Stage 2 HTN tx

  • lifestyle modification
  • Two drug combo: thiazide diuretics + ACE-i/ARB or BB or CCB







     

9

Secondary HTN definition/pathogenesis

  • Secondary hypertension (secondary high blood pressure) = high BP caused by another medical condition.

  • can be caused by conditions that affect your kidneys, arteries, heart or endocrine system.

  • can also occur during pregnancy.

10

Tx of secondary HTN


 

  • control both the underlying condition and the high blood pressure ==>
  • reduces the risk of serious complications — including heart disease, kidney failure and stroke.

 

 

11

CVD risk factors

  • HTN
  • tobacco use
  • physical inactivity
  • metabolic syndrome: obese, diabetes, dyslipidemia
  • microalbuminuria/GFR <60 ml/min
  • age
  • Fhx

12

Possible causes of HTN

  • sleep apnea
  • drug-induce
  • chronic kidney disease
  • primary aldosteronism
  • renovascular disease
  • chronic steroids/Cushing's
  • coarctation of aorta
  • thyroid/parathyroid disease
  • RAD PACTS: reno, apnea, drug, primary, aorta coarc, chronic, thyroid, steroids

13