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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
Cardiac hypertrophy
Aortic dissection
End stage renal failure

Hypertension is "SCARIE"


What are the general treatments of hypertension?

Lifestyle modifications
Treating underlying condition, secondary cause


What lifestyle modifications can improve hypertension?

Diet, exercise, weight loss, smoking cessation


What are the antihypertensive drug classes?

Thiazide diuretics
ACE inhibitors
Angiotensin receptor blockers
Beta 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


What are the goals of treatment for HTN patients below 60 years old? How do they differ for patients above 60?

under 60yo: target BP below 140/90
over 60 yo: target BP below 150/90