Hypertension Flashcards Preview

CSI- Winter > Hypertension > Flashcards

Flashcards in Hypertension Deck (38)
Loading flashcards...
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