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Flashcards in Hypertension Deck (38)
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1
Q

Blood pressures that qualify as “HTN”

A

BP is 140/90 in office multiple times or 135/85 at home= HTN

2
Q

Blood pressures that qualify as “HTN”

A

BP is 140/90 in office multiple times or 135/85 at home= HTN

3
Q

Prehypertension

A

120-139 mmHg SBP or

DBP 80-89 mmHg

4
Q

Prehypertension

A

120-139 mmHg SBP or

DBP 80-89 mmHg

5
Q

Stage 2 HTN

A

> 160 mmHg SBP or

> 100 mmHg DBP

6
Q

Prehypertension

A

120-139 mmHg SBP or

DBP 80-89 mmHg

7
Q

Etiology of HTN

A
  1. Overactivitation of SNS and RAAS
  2. Blunting of pressure-natriuresis relationship
  3. Variation in CV/renal development
  4. Elevated intracellular Na+/Ca+
  5. Exacerbating factors

NSAIDs cause hypertension, too much salt intake, family history, smoking, alcohol can all cause HTN
**Sleep apnea is a MAJOR cause of CV problems, A-Fib, HTN

8
Q

Stage 2 HTN

A

> 160 mmHg SBP or

> 100 mmHg DBP

9
Q

Higher BP and left untreated= higher incidence of

A

kidney disease

10
Q

Another major cause of Secondary HTN……

A

Renal/renovascular causes:

  1. FMD (fiber musculodysplasia) in young women (young woman with refractory HTN, reversible cause of high BP in young women; “beads on a string”)
  2. Refractory HTN
  3. Bruits, PAD, Cr increase with ACE-I
  4. Pulmonary edema

OR primary renal disease

11
Q

Clinical Example- If Creat is 1.2, give ACE inhibitor, creat goes up to 2.0; suspect _________

A

bilateral renal artery stenosis

*Flash pulmonary edema with HTN (recurrent), think renal artery stenosis

12
Q

Other random causes of Secondary HTN

A
  • Oral contraceptives, NSAIDs, cocaine/stimulants, antidepressants, calcneuriun inhibitors
  • Pheochromocytoma, primary aldosteronism, Cushing’s syndrome, Sleep apnea Syndrome, Coarctation of the aorta, Hypothyroidism, Primary hyperparathyroidism
13
Q

Other cases of Secondary HTN

A

Renal/renovascular causes:

  1. FMD (fiber musculodysplasia) in young women (young woman with refractory HTN, reversible cause of high BP in young women; “beads on a string”)
  2. Refractory HTN
  3. Bruits, PAD, Cr increase with ACE-I
  4. Pulmonary edema
14
Q

Clinical Example- If Creat is 1.2, give ACE inhibitor, creat goes up to 2.0; suspect _________

A

bilateral renal artery stenosis

15
Q

HTN may cause episodic presentations of

A

Pheochromocytoma

-Anxiety, palpitations, profuse perspiration, tremor, HA

16
Q

Most cases of HTN are

A

asymptomatic (“silent killer”)

  • Headaches
  • If severe can cause encephalopathy with N/V, confusion, vision changes (retinopathy)
17
Q

During HTN, optho exam will show

A

Cotton wool spots, AV nicking, hemorrhage, papilledema

-flame hemorrhages, hard exudates too

18
Q

_________ should be in every treatment plan

A

Diet and exercise should always be in treatment- every 10 kg of weight loss BP can drop 10-20 mmHG

Fruits veg, Mediterranean diet can drop it 10 mmHg; low sodium intake; moderate alcohol; DASH diet; physical activity and weight loss

19
Q

What meds to start with for treatment?

A

ALL race/age groups receive lifestyle modification

AA: CCB and thiazide
White (ISOLATED HTN): ACE-I and BB

However, many pts have comorbidities which should prompt targeted therapy
ie: AA pt with DM should receive ACE-I first

20
Q

What meds to start with for treatment?

A

ALL race/age groups receive lifestyle modification

AA: CCB and thiazide
White (ISOLATED HTN): ACE-I and BB

However, many pts have comorbidities which should prompt targeted therapy
ie: AA pt with DM should receive ACE-I first

21
Q

Who gets ACE inhibitor?

A

Whites with isolated HTN, pts with systolic heart failure, post MI, proteinic chronic kidney disease

22
Q

Who gets Beta Blocker?

A

Pts with angina pectoris, a fib and flutter rate control

23
Q

Don’t use alpha blocker if

A

EF is low

-use alpha blocker for pt with BPH

24
Q

Don’t use alpha blocker if

A

EF is low

-use alpha blocker for pt with BPH

25
Q

TEST: If patient has angioedema, don’t use

A

ACE inhibitor

pregnancy don’t use ACE inhibitor, ARB, or renin inhibitor

26
Q

For patient in ER with HTN, don’t give _________, give ________

A

hydrochlorothyazide

give Lasix (furosemide)- loop diuretic

**can give thiazides for more long term care after

27
Q

Side effects of Diuretics (Thiazides, loop)

A
  • Initially lower plasma volume but decrease SVR (systemic vascular resistance) long-term
  • electrolytes, gout, ED, hyperkalemia
28
Q

Renin inhibitors

A

Lack efficacy data over ACE-I/ARB

29
Q

Renin inhibitors

A

Lack efficacy data over ACE-I/ARB

30
Q

ACE-I

A

Inhibits RAAS, prevents degradation of bradykinin

31
Q

Aldosterone receptor blockers

may cause

A
  • CHF, cirrhosis

- Can lead to gynecomastia, hyperkalemia, breast pain

32
Q

Aldosterone receptor blockers

may cause

A
  • CHF, cirrhosis

- Can lead to gynecomastia, hyperkalemia, breast pain

33
Q

CCBs

A

Peripheral vasodilation with less reflex tachy/fluid retention
**Caution in CHF

34
Q

Alpha Blockers

A

-Lower PVR; useful with BPH

**First-dose hypotension, caution in CHF (have to start slowly and use at nighttime, cant use of EF is low)

35
Q

Central sympatholytic (clonidine, methyldopa)

A
  • Stimulate alpha in CNS thus reducing efferent peripheral SNS outflow
  • ED, rebound HTN, dry mouth, caution in pregnancy with methyldopa
36
Q

Direct vasodilators (list 2)

A

Hydralazine/minoxidil

37
Q

HTN Urgencies

A
  • Treat when acute end-organ damage or BP > 220/125*

- Reduce ~ 25% in first 1-2 hrs and then target

38
Q

HTN Urgencies

A
  • Treat when acute end-organ damage or BP > 220/125*

- Reduce ~ 25% in first 1-2 hrs and then target