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Flashcards in Hypertension Deck (24):

essential (primary) vs secondary HTN

Essential: we don’t know what causes it. Secondary: known cause


Prevalence of essential hypertension in US

50-60 million people


Lifetime risk of developing hypertension

90% lifetime risk for person who is 55yrs and normotensive


Is systolic or diastolic BP more important as CVD risk factor?

For people over 50 yrs, systolic is more important


Guyton hypothesis of essential hypertension

Primary defect in renal sodium excretion > increased plasma volume > increased cardiac output > autoregulatory increase in systemic vascular resistance > increase in BP (and afterload mediated normalization of CO)


Cellular hypothesis of essential hypertension

in vascular smooth muscle cell, inhibition of Na/K pump leads to elevated cell Na levels and decreased Na/Ca exchange (which normally pumps Na in and Ca out), so cell Ca levels increase. This increases systemic vascular resistance and thus increases BP


Percent reduction in stroke, MI and heart failure with lowering BP

stroke: 35-40%. MI: 20-25%. Heart failure : 50%


BP goal in patients with diabetes or chronic kidney disease



Describe how the following lifestyle modifications affect systolic BP: weight reduction, DASH eating plan, dietary sodium reduction, physical activity, moderation of alcohol

weight reduction: 1-20mmHg/ 10Kg weight loss. DASH eating plan: 8-14mmHg. dietary sodium reduction: 2-8mmHg. physical activity: 4-9mmHg. moderation of alcohol: 2-4mmHg


algorithm for treatment of hypertension

lifestyle modification first. 1) Without compelling indications: a. stage 1 hypertension- thiazides, consider ACEI, ARB, BB, CCB or combo. B. stage 2 hypertension- 2 drug combo of thiazide, ACEI, ARB, BB or CCB. 2) Wit compelling indications- drugs for compelling indications


classification of HTN from JNC-7

normal: 120/80. Pre-HTN: 120-139/80-89. stage 1 HTN: 140-159/90-99. Stage 2 HTN: >160/>100


When is ambulatory monitoring of BP used?

when office and self measurement don’t match up


causes of secondary hypertension

Chronic kidney disease, drugs, primary hypoaldosteronism


19yr old with 180/120 BP, loud abdominal bruit,

renal artery stenosis -fibromuscular hyperplasia in one of the renal arteries


symptoms of fibromuscular hyperplasia causing renal artery stenosis

rapid onset HTN


how to test for unilateral renal artery stenosis

ultrasound to look for blood flow (doppler), renal angiogram, MRI, CT with contrast, measure renin in right vs left renal vein (the elevated renin will be present in the blocked kidney b/c the kidney makes renin in response to decreased GFR)


Treatment for renal artery stenosis

HTN meds in the short run (ie. ACEI, ARBS), fix artery with stent or bypass the artery with another artery (best)


16 yr old w/ BP 140/92 (was normal 4 weeks ago), Na is 145, K is 2.5, bicarb 30,

metabolic alkalosis- primary aldosteronism


First test for hypokalemia

urine K- if low it is extrarenal, if high it is renal


causes of elevated aldosterone levels

secondary aldosteronism (high renin causes high aldosterone), or primary aldosteronism (not driven by something else)


types of primary aldosteronism

Aldosterone producing adenoma, idiopathic adrenal hyperplasia (bilateral)


Test to determine whether primary aldosteronism is unilateral or bilateral

Measure adrenal veins for aldosterone- the adrenal vein with elevated aldosterone is the side that is affected.


Treatment for aldosterone producing adenoma

Remove adrenal gland


treatment for idipathic adrenal hyperplasia

Cant remove both adrenals- treat with spironolactone for life