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