Lec 15 HTN Flashcards Preview

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Flashcards in Lec 15 HTN Deck (67):
1

What are cutoff numbers for hypertension in normal person?

systolic BP > 140 mmHg and/or
diastolic BP > 90 mmHg

2

How do you diagnose hypertension?

2 readings separated apart

pt should not ingest caffeine or smoke for 30 min before reading

sit for 5 min with arm at heart level before BP is checked

3

What is prevalence of hypertension?

more prevalent with age
about 30% of population

4

What are the 4 systems determine of BP regulation?

- heart [CO]
- peripheral vasculature [tone]
- kidney [regulate blood volume]
- hormones/reflexes [modulate]

5

What is role of heart in BP regulation?

provides CO that fills the vascular tree

6

What is role of peripheral vasculature in BP regulation?

vascular tone/resistance --> modulates tone from heart

7

What is role of kidney in BP regulation?

- regulates intravascular volume
- essential to maintain chronic HTN state --> w/out renal involvement cannot maintain HTN

8

What is equation for BP [MAP]?

MAP = CO * TPR

9

What is equation for CO?

CO = HR*SV

10

What factors determine SV?

- contractility
- venous return [preload]
- afterload

11

What factors determine venous return [preload]?

blood volume
venous tone

12

What is renal regulation of BP?

kidneys sense drop in BP --> secrete renin --> converts angiotensinogen to AT1 --> ACE converts to AT II

ATII:
--> directly increase BP by constriction
--> causes aldosterone release --> Na/H2O retention --> increase volume

13

What is essential hypertension?

cause of HTN cannot be explained == multiple etiologies together increasing CO or TRP

makes of 90% of HTN

14

What is secondary hypertension?

hypertension attributed to definable cause

makes up 10% of HTN

15

What is pressure natriuresis?

homeostatic mechanism by which if you increase BP --> get increase urine volume and Na excretion --> decrease blood volume --> pressure back to normal

this process is blunted in kidneys of pt with HTN

16

What is baroreceptor reflex?

baroreceptors = in aortic arch and carotid sinuses; sense increase in stretch of aorta due to pressure --> baroreceptors stimulated --> increase PNS and inhibit SNS--> vasodilation + decrese HR and co --> BP drops back to normal

== moment to moment modulation of blood pressure

17

What nerves carry baroreceptor signals?

CN IX carries from carotid sinus
CN X from aortic arch

18

What are causes of essential hypertension?

- genetics

- black > white > asian

- systemic abnormalities: sympathetic overactivity in response to stimulus, abnormally vasoconstricted

- renal: excess Na/H2O retention, hormone dysregulation [normal renin level in HTN pt]

19

Is diastolic or systolic or both HTN most prevalent?

- in young people mostly isolated diastolic HTN
- as you get older = more and more isolated systolic HTN

b/c chronic exposure to hemodynamic stress, vessels stiffer, increase calcification --> higher systolic when push the blood into aorta but don't have sufficient elastic recoil --> low diastolic

20

What are some clinical clues that should make you think it might be secondary HTN?

- very young < 20 yo
- new HTN after age 50 in someone who never had problem before
- severe rapid onset

21

What are major causes of secondary HTN?

step1

mostly renal disease including fibromuscular dysplasia in young patient

22

What are renal causes of secondary HTN?

- parenchymal damage to kidneys --> decrease # of functioning nephrons --> secrete less Na/H2O --> more blood volume --> CO/BP up

23

What lab findings if renal cause of secondary HTN?

- high serum creatinine
- abnormal urinalysis

24

What is renovascular cause of 2ndary HTN?

renal artery stenosis due to atherosclerosis or fibromuscular dysplasia

stenosis --> reduced renal blood flow --> more renin --> RAAS = vasoconstriction + Na retention

25

What is treatment of renovascular secondary HTN?

ACE inhibitors
renal artery revascularization

26

What are clinical signs of renovascular hypertension?

abdominal bruit
unexplained hypokalemia [due to overactive aldosterone]

27

What is aortic coarctation?

congenital narrowing of aorta

28

What should you think it pt with HTN and way higher BP in arms than legs?

aortic coarctation causing secondary HTN

coarctation located distal to left subclavian

29

What should you think if pt with HTN and lower BP in left vs right arm?

aortic coarctation causing secondary HTN

coarctation located at origin of left subclavian

30

What happens in aortic coarctation associated hypertension?

- reduced blood flow to kidneys --> stimulate RAAS --> higher level Ang II and vasoconstriction

31

What are signs that hypertension might be due to aortic coarctation?

- blood pressure discrepancy
- midsystolic murmur
- rib notching on CXR= collaterals

32

What is pheochromocytoma? how does it cause HTN?

- catecholamine-secreting tumor
- release NE/E --> vasoconstriction + tachycardia
- have palpitations/tachy/headache
- diagnose based on catecholamine level in serum/urine

33

What is treatment for pheochromocytoma?

surgical resection
alpha and beta blockade

34

What are endocrine causes of secondary hypertension?

too much Ne/E --> pheochromocytoma

too much aldosterone --> primary [conn syndrome] or secondary [renin secreting tumor]

too much cortisol [Cushing]

35

How do you differentiate between primary and secondary aldosteronism as cause for HTN

primary = conn syndrome = adrenal adenoma or hyperplasia adrenal glands --> high aldosterone so suppresses renin
= high ratio aldosterone:renin

secondary = renin secreting tumor --> lots of renin --> causes lots of aldosterone
= low ration ald:renin

36

Why does cushing syndrome cause HTN?

- excess cortisol stimulates RAAS

also have: round face, central obesity, prox muscle weakness

37

how does hyperthyroidism cause HTN?

- cardiac hyperactivity/high HR --> increase BP/blood volume

38

how does hypothyroidism cause HTN?

diastolic hypertension
increase in peripheral vascular resistance

39

What medications/drugs cause HTN?

- oral contraceptives
- glucocorticoids
- erythropoetin
- sympathetomimetics [OTC cold remedies]
- alcohol
- cocain

40

What are consequences of chronic HTN?

physio/structural derangements - increase work of heart, arterial damage, loss of elasticity, endothelial dysfunction

41

How much does CV risk change with each increase in 20/10 mmHG BP increment?

doubles

42

What are cardiac effects of HTN?

ventricular hypertrophy due to high afterload --> ventricular stiffness --> diastolic HF

CAD: HTN --> development atherosclerosis --> decreased myocardial O2 supply --> increased work

43

Is most common form of heart failure in elderly diastolic or systolic?

diastolic

44

What is hemorrhagic stroke?

rupture microaneurysms induced by long-standing HTN

45

What is ischemic stroke?

thrombosis of atherosclerotic plaque in cerebral vessel --> get embolism of plaque which causes ischemia

46

What is aortic aneurysm? Where is it usually found?

prominent abnormal aortic dilation
most common in abdominal below level of renal arteries

if it ruptures you die

associated with HTN

47

What is aortic dissection?

ripping between intima and media in aorta; can be in ascending or descending aorta

high mortality

associated wtih HTN

48

What is a hypertensive urgency?

SBP > 180 or DBP > 110 without evidence of end-organ damage

need immediate evaluation but does not need hospital admission

49

What is hypertensive emergency?

severe HTN [SBP > 180, DBP > 110] with evidence of acute organ damage

need immediate hospitalization

50

What are symptoms of hypertensive emergency

- hypertensive encephalopathy = mental status changes, headache, blurred vision
- SOB [pulm edema]
- papilledema on fundoscopy

51

What does it mean if abnormal K in HTN?

sign of too much aldosterone --> may be primary or secondary aldosteronism or renovascular problem

52

What are non-pharm treatments for HTN?

- weight [each 10 kg = 5-20 mmHG drop in BP]
- exercise
- diet
- salt restriction < 6g/day

53

Why give a diuretic in HTN? For who?

- decrease circulating volume, CO
- give in mild-moderate HTN with normal renal function
- good for uncomplicated HTN

54

Why give Beta blocker in HTN? For who?

- reduce HR and contractility --> reduce CO + decrease renin
- reduces mortality if you've had MI or in heat failure

55

What are side effects of beta blockers?

bronchospasm [asthma], fatigue, sex effects

56

Why give alpha-2 adrenergic agonists in HTN?

Reduce sympathetic outflow
poor side effects, dont usually use

57

Why give alpha 1 antagonists in HTN?

sympatholytic
relaxes smooth muscle + reduces prostatic enlargement

= good for older men

58

What meds do you give if primary essential uncomplicated HTN?

- diuretics
- ACE inhibitors/ARBs
- Ca channel blockers

59

What meds do you give f HTN with CHF?

step1

- diuretics
- ACE inhibitors/ARBs
- beta blockers in compensated
- aldosterone antagonists [spirinolactone]

60

What meds do you give if HTN with DM?

step1

- ACEI/ARBs = main b/c protects against diabetic nephropathy

- Ca channel blockers
- diuretics
- b blcokers
- a blockers

61

Why do you give ACE inhibitor in HTN?

reduce mortality in pts with acute MI, chronic HF or at high risk for vascular disease

good for diabetic nephropatyn

side effects = dry cough, hyperkalemia

62

When do you use spironolactone?

in symptomatic heart failure for HTN
mech = aldosterone blockade

63

When do you use eplerenone?

in pt with acute MI complicated by heart failure
= aldosterone blockade

64

What med for HTN pt pos-MI?

give beta blocker

65

What med for HTN if chronic kidney disease?

ACEI/ARB

66

What med for HTN might you avoid in woman of child bearing age

ACE-I = teratogenic

67

Who should you be cautious about prescribing diuretics?

elderly = susceptible to dehydration