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Flashcards in Hypertension Deck (38)
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1

Blood pressures that qualify as "HTN"

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

2

Blood pressures that qualify as "HTN"

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

3

Prehypertension

120-139 mmHg SBP or
DBP 80-89 mmHg

4

Prehypertension

120-139 mmHg SBP or
DBP 80-89 mmHg

5

Stage 2 HTN

> 160 mmHg SBP or
> 100 mmHg DBP

6

Prehypertension

120-139 mmHg SBP or
DBP 80-89 mmHg

7

Etiology of HTN

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

Stage 2 HTN

> 160 mmHg SBP or
> 100 mmHg DBP

9

Higher BP and left untreated= higher incidence of

kidney disease

10

Another major cause of Secondary HTN......

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

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

bilateral renal artery stenosis


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

12

Other random causes of Secondary HTN

-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

Other cases of Secondary HTN

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

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

bilateral renal artery stenosis

15

HTN may cause episodic presentations of

Pheochromocytoma
-Anxiety, palpitations, profuse perspiration, tremor, HA

16

Most cases of HTN are

asymptomatic ("silent killer")
-Headaches
-If severe can cause encephalopathy with N/V, confusion, vision changes (retinopathy)

17

During HTN, optho exam will show

Cotton wool spots, AV nicking, hemorrhage, **papilledema**

-flame hemorrhages, hard exudates too

18

_________ should be in every treatment plan

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

What meds to start with for treatment?

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

What meds to start with for treatment?

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

Who gets ACE inhibitor?

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

22

Who gets Beta Blocker?

Pts with angina pectoris, a fib and flutter rate control

23

Don't use alpha blocker if

EF is low
-use alpha blocker for pt with BPH

24

Don't use alpha blocker if

EF is low
-use alpha blocker for pt with BPH

25

TEST: If patient has angioedema, don't use

ACE inhibitor

(pregnancy don't use ACE inhibitor, ARB, or renin inhibitor)

26

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

hydrochlorothyazide

give Lasix (furosemide)- loop diuretic

**can give thiazides for more long term care after

27

Side effects of Diuretics (Thiazides, loop)

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

28

Renin inhibitors

Lack efficacy data over ACE-I/ARB

29

Renin inhibitors

Lack efficacy data over ACE-I/ARB

30

ACE-I

Inhibits RAAS, prevents degradation of bradykinin