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Flashcards in Hypertension lecture Deck (52):
1

what is defined as HTN?

equal or above 140/90

2

What percentage of HTN is secondary? (i.e. because of renal, endocrine, congenital etiologies)

5%

3

____% of cases of HTN are etiology unknown

95%

4

-Environmental factors
-Sympathetic hyperactivity
-RAA axis

can all lead to...

Hypertension

5

Obesity
Excess Na intake
Cigarette smoking
NSAIDs
Excess alcohol

Exacerbating factors of HTN

6

Estrogen use
Renal dz
Renal vascular HTN
Endocrine disorders
Coarctation of aorta (congenital)
HTN in pregnancy

All secondary causes of HTN

7

Hypertension accelerates progression of..

Renal insufficiency

8

Any form of chronic renal parenchymal disease can result in..

Hypertension

9

Marked increase of renin
2 forms:
Fibromuscular hyperplasia
Atherosclerosis

Renal artery stenosis

10

Fibomuscular hyperplasia (FMH) usually presents in who?

(BP markedly elevated; renal function preserved; arteriography diagnostic; angioplasty/stent beneficial in treatment.)

Young adults

11

Athersclerosis renal artery stenosis presents in..

(BP elevated and unresponsive to meds; renal function often impaired; intervention may or may not help; long term med Rx necessary.)

Older adults

12

Heart's response to pressure overload

Hypertrophy

13

Powerful predictor of prognosis, morbidity, mortality, and cardiac events once present.

LVH and hypertension

14

HTN is major predisposing cause of stroke. What part of BP is most closely correlated with stroke?

Systolic is correlated more with strokes

15

Retinal changes: 
Narrowing of arterioles (A/V over .50)
A-V nicking- (arteriosclerosis) 
Silver or copper wired appearance
Hemorrhages or exudates
Papilledema

signs of HTN

16

Creatinine
BUN
Potassium levels

MUST CHECK IN HTN PATIENTS! (among other things)

17

Why must you check potassium levels in HTN?

Bc will most likely put the pt on a diuretic, which can cause HYPOKALEMIA!*

18

if LVH seen on EKG, what next tests can you run?

Cardiac/echo doppler

19

DOC for diabetics with HTN

ACE inhibitor (or ARB) along with thiazide or CCB

20

Focus primarily on ______ as this is the most important target for reducing morbidity and mortality.

Systolic BP

21

Initial therapy for most HTN patients...

Thiazide diuretics

(cost effective, lower systolic BP)

22

Diuretics are most potent in...

Blacks, elderly and obese

(more effective in smokers)

23

is Chlorthalidone more or less potent than HCTZ?

MORE!

24

Avoid diuretics with...

Hypokalemia
Gout

25

Beta blockers are less effective in...

Black populations
Elderly

26

New (2008) selective β-blocker with vasodilating properties.
Nitric oxide mediated vasodilation
Loses selectivity in high doses

Nebivolol

27

What drug class is preferred for blacks and elderly?

calcium channel blockers

28

Progressive renal insufficiency; more common in black populations, especially in the presence of DM.

Nephrosclerosis

29

Usually asymptomatic. A.M. headaches may occur.
Late findings include:
-Symptoms related to LVH: Diastolic dysfunction (SOB, DOE).
-Symptoms related to cerebral involvement- *TIA, stroke, hemorrhage.
-Symptoms related to cardiac involvement- MI, angina, HF.

Nephrosclerosis

30

DOC for HTN and angina?

beta blocker or CCB

31

DOC for HTN and HF?

ACE inhibitor

32

DOC for HTN and diabetes? or for HTN and renal dz?

ACE inhibitor/ARB

33

Goals of treating HTN?

decrease endpoints!

(endopoints= MI, Stroke, LVH, PAD, all cause/cardiac mortality, HF and renal failure)

34

MI, Stroke, LVH, PAD, all cause/cardiac mortality, HF and renal failure.

Endpoints (what you are trying to avoid when treating HTN)

35

Focus primarily on _____ BP as this is the most important target for reducing morbidity and mortality.

systolic

36

#1 DOC for HTN

Thiazide diuretics

37

-Initial effects via decreased plasma volume
-chronic effects via decreased SVR.

Diuretics

38

Avoid in patients with hyponatremia and gout

Diuretics

39

More potent in blacks, elderly and obese. More effective in smokers.

Diuretics

40

Decrease BP by decreasing CO (-inotropic effect and ↓HR). SVR increases, renin levels decrease.
Less effective in black populations and in elderly.

Beta blockers

41

Very useful in patients with HTN and other co-morbid conditions: angina pectoris, post MI→↓mortality, HF→↓mortality, essential tremor, migraine headaches, arrhythmias/sudden death (class II anti-arrhythmic)

Beta blockers

42

selective β-blocker with vasodilating properties.
Nitric oxide mediated vasodilation
Loses selectivity in high doses

Nebivolol (Bystolic)

43

Mortality and other “end-point” benefits (post MI, HF) applicable primarily to....

lipid soluble beta blockers

44

Are beta blockers as successful in LVH regression compared to other treatments?

NO

45

May worsen acute HF; but clearly beneficial for patients with chronic compensated & stable HF and low ejection fraction- ↓mortality.
May worsen advanced PAD and rest pain.
Mask signs of hypoglycemia in Type I diabetics.
CNS: Fatigue, nightmares, depression, sexual dysfunction-

Beta blockers

46

Inhibit renin-angiotensin-aldosterone system and:
Inhibit Bradykinin degradation
Stimulate vasodilating prostaglandin synthesis.
Useful as initial Rx or when added to other drugs for HTN.

ACE inhibitors

47

ACE inhibitors Anti-hypertensive efficacy significantly improved when combined with...

diuretic

(synergistic effects)

48

May be useful for heart failure in patients who cannot take ACEI; do not inhibit bradykinin breakdown.
Renoprotective in diabetics.
Few side effects, and no cough.

ARBs

49

Act by peripheral vasodilation
Effective in all demographic groups, and are preferable in blacks and the elderly.
Additional protection against stroke

Ca channel blockers

50

In addition to vasodilation these drugs have negative inotropic, chronotropic and dromotropic (slow A-V conduction) effects.
Can exacerbate heart failure and cause SA and AV nodal dysfunction.
Also used as anti-anginals and in Rx of arrhythmias.

Nondihydro CCBs

51

Significant vasodilation, reduction in SVR.
Fluid retention and reflex tachycardia occur (role of ß-blockers and diuretics).
Unlikely to cause heart failure and conduction problems (in vivo).
Must use long acting preparations.
2nd or 3rd line agents in diabetics.

Dihydro CCBs

52

SE= headaches, periph edema

CCBs