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Clinical 2.0 > Hypertension > Flashcards

Hypertension Flashcards

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1
Q

why dose hypertension seem to be more prevalent in the older categories

A

females live longer so more of them around

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2
Q

hypertension is a sig risk factor for?

A 
cerebrovascular disease
coronary artery disease
congestive heart failure
renal failure
peripheral vascular disease
dementia
atrial fibrillation 
erectile dysfunction
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3
Q

what does it mean when a patients home readings correlate with the doctors readings

A

white coat hypertension not an issue

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4
Q

what is the blood pressure target according to chep

A

140/90

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5
Q

what is the ultimate goal of therapy

A

reducecardiovascular and renal morbidity and mortality

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6
Q

what is the difference between the effects of systolic and diastolic levels and morbidity

A

increasing the diastolic doesnt really change the death rate, increasign systolic see a significant increase in death rate

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7
Q

what is the sprint trial

A

randomized control trial of intensive vs standard blood pressure control

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8
Q

who was involved in the sprint trial

A

9361 patients at high risk of CVD

people with DM2 or LVEF <35% were excluded

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9
Q

what were the interventions for sprint trial

A

intensive <120 vs standard <140 blood pressure control with any antihypertensive for 3.3 years

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10
Q

what were the outcomes of sprint

A

intensive slightly lowered the risk of CV complications and mortality but
increased the number of serious adverse events and renal failure

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11
Q

what did chep think of sprint

A

high risk patients should target<120 but caution should be taken in certain high risk groups

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12
Q

drug causes of hypertension

A

nsaid increase salt and fluid retention so increase CO therefore BP
decongestants
alcohol
estrogen

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13
Q

how long should you allow non drug therapy before considering medications

A

3-6 months

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14
Q

non drug measures

A 
salt intake - 2000mg 
dash diet - ruit, veges, low fat dairy, fiber, whole grain, low sat fat and cholesterol 
exercise 30-60 min 4-7 days 
bmi of 19-25
moderate alcohol intake 
reduce caffiene
stress management 
self monitoring BP
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15
Q

salt reduction recommended?

A

no RCT measuring health outcomes for when salt intake is less than 2.3g
likely to cause harm in both hypertensive andnormotensive people although there is no proof of this either

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16
Q

what was the allhat trial trying to determine

A

major outcomes in high risk hypertensive patients randomized to ACEi or CCB or diuretic

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17
Q

who was involved in the allhat trial

A

33357 patients with hypertension and 1 or more other risk factor for CHD events

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18
Q

what was the intervention in the allhat trial

A

chlorthalidone, lisinopril, or amlodipine for 5 years

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19
Q

what are the results of the allhat trial

A

all reduced BP the same
no diff between fatal CHD or non fatal MI
no difference in mortality

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20
Q

common side effects of thiazides

A

increase urination - short lived
muscle cramps
biochemical abnormalities

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21
Q

what are the biochemical abnormalities with thiazides

A

decreased sodium and potassium
increase uric acid
increased glucose and lipids - dont bother discussing

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22
Q

cautions for thiazides

A

history of gout
hypokalemia
hyponatremia

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23
Q

side effects of acei

A

cough

increase serum creatinine and potassium

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24
Q

cautions for aceis

A

history of bilateral renal artery stenosis
nsaid use becuase they inhibit prostaglandins which cause vasodilation so then there is vasoconstriction in the arteris coming into kidneys so little blood enters the glomerulus meanwhile the acei dilates the efferent and everything goes out with little coming in so no pressure

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25
side effects of beta blockers
``` cold extremeties fatigue nausea decreased HR decreased exercise toelrance vivid dreams impotence ```
26
cautions of beta blockers
asthma severe reynauds heart block over 60 years old
27
side effects of calcium channel blockers
``` flushing ankle edema headache (vasodilation in cerebral) increased HR non DHP: decreased HR, heart block, worsened HF, constipation ```
28
caution in CCB
history of heart failure
29
what was the relationship between dose and metabolic effects
increasing the dose leads to progressive hypokalemia and hyperuricemia without further rediction in systemic BP
30
what is th eBP reduction when using 1/2 of the standard doses
20% reduction
31
beta blocker reduction of cv events vs placebo
under 60 = better | over 60 = similar
32
beta blocker reduction of cv events vs other antihtn
under 60 = similar | over 60 = worse, tiny increase in strokes
33
what population should you use beta blockers in
over 60 yoa
34
when should beta blockers be used first line for bp reduction
if CHF or angina or as an option for atrial fibrillation
35
acei arbs beta blockers are less effective in which patients
black
36
compare thiazides acei ccb and beta blockers for cost and convenience
all relatively cheap and most once daily or twice daily dosing
37
monitoring for acei
cough... should go away in 2-4 weeks | check kidnye function, potassium and sCr levels in a couple of weeks
38
what should you monitor for thiazides
check sodium and potassium in a couple of weeks
39
according to chep what is the bp target for patients with diabetes
<130/80
40
why does usa and europe have target bp of 140/90 for peoplw with diabetes
there are no RCT that have ever shown a bp of 130/80 to reduce complications of DM2
41
what conclusions did thebmj have about antihypertensive treatment in patients with diabetes
antihypertensive treatment reduces risk of mortality in people with bp over 140. if systolic pressure is less than 140 further treatment is associated with an increased risk of cardiovascular death and no observed benefit
42
what does chep recommend for people with diabetes and hypertension along with cardiovascular or kidney disease
acei or arb
43
what does chep recommend recommend for people with diabetes and hypertension wihtout other disorders
acei arb dihydropyridine CCB thiazides
44
what was the allhat diabetes subgroup study
clinical outsomes in antihypertensive treatment of DM2 13101 patients compared chlorthalidone, lisinopril, and amlodipine
45
what was the results of the allhat diabetes subgroup study
no difference in outcomes between all agent no difference of incidence of ESRD no diference in coronary heart diseas, stroke, or combined CV disease
46
what was found in the study of ace inhibitor vs the placebo or other antihtn meds in patients without albuminnuria
acei are the only agents known to reduce incidence of microalbuminuria in diabetes vs placebo no sig decrease in incidence of doubling of SCr or ESRD
47
what was the result of acei vs placebo or other antihtn in patients with albuminuria
acei reduce the progression of nephropathy to ESRD
48
what is the target bp for diabetes
<140/90
49
what is the effect of combining different medications
doubles th eblood pressure effects but not the side effects
50
will taking antihtn at night improve outcomes and reduce side effects
maybe but lack of evidence so recommendations are difficult
51
elderly women are more sensitive to sym inhibition and volume depletion so they will have a higher chance of what
higher chance of orthostatic hypotension | increased morbidity and falls
52
what might low bp be associated in elderly
dementia cancer HF MI
53
what is isolated systolic htn
high systolic but low diastolic commin in elderly
54
what does isolated systolic htn increase in the elderly
increase risk of stroke, MI, renal failure
55
what was included in the hyvet study | hypertension in the very elderly
n=3845 all over 80 with a systolic BP >160 all had comorbid conditions: CV disease, DM2, smokers
56
what was the intervention in the hyvet trial
<150/80 target | indapamide and perindopril if needed vs placebo
57
what was the result of the hyvet study
BP <150/80 decreased CV events 3% over 2 years and 2.2% decrease in mortality
58
explain the u-curve in the elderly
as BP gets really high and really lo increase the mortality
59
how low is too low in the elderly
feeling hypotensive | <140/60???
60
are all diuretics equal?
chlorthalidone found to have a longer duration of action, more potent, better bp reduction HCTZ less CV event reduction
61
is hydrochlorothiazide the best diuretic
chlorthalidone or indapamide are equal to and very likely superior HCTZ
62
what is the treatment of hypertension after a stroke
anthtn therapy should be strongly considered | once patient is stable gradual BP reduction post stroke reduces risk of further strokes
63
what bp target is recommended post stroke
<140/90
64
what antihtn should be used posthtn
acei/diuretic combo but actually acheiving target bp may be more important than the agent
65
is combo of arb and ace recommended in patients with stroke
no
66
what antihtn do we have that can control bp and rapid heart rate
non DHP | beta blockers
67
how to treat a hypertensive emergency
quiet room to rest leading to a fall of BP >10-20mmhg tilt head of the bed 15 degrees up consider antihtn if above 180/100 for more than 3 hours

Clinical 2.0 (24 decks)

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