Flashcards in MHD: Hypertension Deck (24):
Hypertension is defined as a blood pressure greater than:
Hypertension >/= 140/90
A new patient in your clinic is found to have a BP of 145/90. Do they have hypertension?
No. Need 2 data points, repeat measure at future visit for diagnosis of hypertension
What are the 3 stages of hypertension?
Prehypertension: syst = 120-139, diast = 80-89
Stage 1: 140-159, 90-99
Stage 2: >160, >100
What ethnicity have the highest prevalence of hypertension in the US?
African americans > Caucasians > Mexican-americans
How is hypertension associated with incidence of first heart attack and first stroke?
70% of people with first MI have hypertension
80% of people with first stroke have hypertension
What is the recommended treatments for pre-hypertension?
Lifestyle modifications, no meds
What is the difference between essential HTN and secondary HTN?
Essential HTN is idiopathic, caused by multifactorial processes (95% of all cases)
Secondary HTN has a identifiable systemic cause (5%) of cases (renal, endocrine, CV, neurological)
What is white coat hypertension?
BP higher in the MD office than at home due to anxiety associated with the doctor visit
What is malignant hypertension?
A BP > 200/120 with signs and symptoms
Encephalopathy, papilledema, hemorrhages, renal failure
What is pseudohypertension?
Peripheral arteries with advanced atherosclerosis are unable to be compressed as normally, so higher cuff pressures are required
This presents as a falsely elevated BP reading
How do systolic and diastolic pressures change with aging?
Systolic BP tends to rise, diastolic tends to fall
What is resistant HTN?
when BP goals are not met even though patients are adhering to full doses, appropriate 3 drug regimens w/ diuretics
Could be due to primary cause, secondary HTN
What is the difference between hypertensive urgency and hypertensive emergency?
Urgency is severe elevation in BP without acute end-organ damage
Emergency is severe elevation in BP with acute end organ damage, show signs and symptoms
How is BP managed in hypertensive emergencies?
Immediate, but gradual lowering of BP (maximum rate 10-20%/hour)
Exception: dissecting aneurysm
What is problematic about symptoms of hypertension?
Often silent, symptoms don't begin until there is end organ damage
How is blood pressure properly measured?
Patient seated in a chair (not the exam table)
Arm at heart level
Performed on skin (not over clothes)
Proper cuff size
Deflate cuff 2-3 mmHg/sec
What complications are associated with hypertension?
Cardiovascular disease has been associated with continuous, consistent HTN
Not an obvious cutoff value for BP
What are the sequelae of hypertension?
Ischemic heart disease or heart failure
End stage renal failure
Hypertension is "SCARIE"
What are the general treatments of hypertension?
Treating underlying condition, secondary cause
What lifestyle modifications can improve hypertension?
Diet, exercise, weight loss, smoking cessation
What are the antihypertensive drug classes?
Angiotensin receptor blockers
Calcium channel blockers
Is monotherapy typically used for HTN?
No. 2/3 of patients will need multiple agents for proper management of hypertension
What can be the causes of resistant hypertension?
Improper BP measurements
Excess sodium intake
Inadequate diuretic therapy
Inadequate medication dose or effectiveness
Excess alcohol intake