Hypertension Flashcards
(52 cards)
What is White Coat vs masked hypertension?
WC: Consistently elevated by office readings but not out of office.
Masked is the opposite
What is a hypertensive emergency?
Severe hypertension with evidence of End organ damage (diastolic > 120)
What is hypertensive Urgency?
Severe hypertension w/ Diastolic >120 in asymptomatic Pts
What are the different types of Target organ damage in HTN?
LVH, MI, CHF Stroke, TIA CKD Retinal Complications Peripheral Artery Dis Death: Cerebral Vascular Accident, CV event, renal failure
How can LVH be diagnosed?
ECG or Echocardiography
Echo more sensitive but more $$
What are the different grades of HTN Retinopathy?
Gr 1 Generalized Retinal arteriolar narrowing
Gr 2 More severe narrowing, AV nicking
Gr 3 Previous + Hemorrhage, aneurism, hard exudates, cotton wool spots
Gr 4 Gr 1-3 + Optic disc swelling and macular edema
What are the Renal consequences of Hypertension?
Decrease in GFR Dec Tubular Funct Proteinuria GBM changes Expanded mesangial matrix Focal Segmantal GS Tubulointerstitial Fibrosis
How is Peripheral Arterial Disease Diagnosed?
Screen- Ankle Brachial Index
Arteriography for surgical candidates
What are the causes of Secondary Hypertension?
Apnea, Aldosteronism Bruits, Bad kidneys Catecholemines, Coarctation, Cushing's synd Drugs, Diet EPO, Endocrine disorders
What are clues suggestive of secondary HTN?
Worsening of control in previously stable Pt
No FHx
BP >180 syst >120 diast
Onset 50
How is Obstructive Sleep Apnea Diagnosed?
Formal Sleep Study
How is Primary Aldosteronism Diagnosed?
Aldosterone:renin ratio
PAC/PRA ratio: (Plasma aldosterone: Plasma renin activity ratio)
What are clues of Renovascular HTN?
Jump in 30% of Creatinine
May present as Acute/chronic Renal failure with HTN
How is Renovascular HTN Diagnosed?
Abdominal Bruit
-Screen duplex Doppler Ultrasonography
50+ yo MRAngiogrphy
Computed Tomographic Angiography
What is the Tx of Renal Vascular Hypertension?
Medical Therapy
Percutaneous Angioplasty
Surgery
How is Renal Parenchymal Disease Diagnosed?
Inc Creatinine
Dec GFR
Ultrasound (Det chronicity)
How is Coarctation of the Aorta diagnosed?
Physican Exam Pulses/Arm/Leg BP >20 systolic difference => Echo Children: Echo Adult- Consider MRA
How is Cushings syndrom diagnosed?
24hr Urin Cortisol
Dexameth Supression test
Check 8am cortisol
What drugs can contribute to HTN?
Antidepressants: Tricyclics Venlafaxine, fluoxetine NSAIDS Oral Contraceptives: combined Steroids Decongestants Triptans Wt loss
How does Elevated EPO Cause HTN?
Can elevate BP by polycythemia/hypervisc or direct pressor effects
How is Pheochromocytoma Diagnosed?
24hr Metanephrines and catecholamines
Plasma for fractionated metanephrines
What is the Tx of Pheochromoctoma?
Alpha Blocker (phenoxybenzamine) THEN Beta Blocker
How does Hyperparathyroidism cause HTN?
Primary
Secondary to chronic renal Insufficiency
Tx with surgery if clinically sig
What are the Steps of Diagnosis of HTN?
Step 1: Accuracy: BP cuff size, sleeves, brachial artery compressable. BP up on 2 visits
Step 2: BP Classification
Step 3: Look for CVD RF
Step 4: Target Organ Damage?
Step 5: IDable Causes of HTN?
Step 6: JNC8 Goals, LS mod, Meds, Followup and monitor
