1. Hypertension Flashcards
Most common type of HTN?
Primary (essential)
(HTN is most common chronic disease in US)
Primary HTN risk factors
Black
Economically disadvantaged
Obesity
Family history
Lifestyle (diet, alcohol, smoking, sedentary)
Primary HTN symptoms
Often none
If symptomatic, Headache most common
Primary HTN diagnostics
High BP from two readings on two separate occasions
Secondary HTN causes
MOST COMMON:
Renovascular
Secondary HTN symptoms/signs
Age <20 or >50 at dx
High BP at dx (160/120)
Three trials of different BP meds not effective
Secondary HTN diagnostics
GOLD STANDARD: Renal angiogram for renovascular cause
(Maybe check TSH)
Hypertensive Crisis. Compare Emergency vs Urgency
Both BP 180/120
Emergency = End organ damage
Retinal exam, encephalopathy (confusion, syncope), oliguria/azotemia
Urgency = No end organ damage yet
Put them in a quiet room
Lower BP slowly (160/100 over hours)
Clonidine/Captopril
Primary HTN first line treatments for all
Non-pharm!
Diet (lower sodium, increase potassium, DASH)
Decrease alcohol/tobacco
Exercise, weight loss
Primary HTN, when to start meds?
Ambulatory BP above or equal to 135/85
Avg. Office BP above or equal to 140/90
BP goal 130/80 if comorbidities or age 65+
Can you combine HTN drugs from the same groups?
No!
Who do ACE/ARBs work best for with HTN?
Young white patients
ACE/ARBs are drug of choice if HTN patient has this comorbidity…
Diabetes or CKD
Side effects of ACE/ARB
Cough
Teratogenic
Angioedema
Hyperkalemia
Which condition (not pregnancy) makes ACE/ARB contraindicated for HTN tx?
Bilateral renal artery stenosis
Who do calcium channel blockers work best for in HTN treatment?
They work equally for all
But preferred in older blacks since ACE/ARBs less effective for them
Calcium channel blocker side effects
Headache
Constipation
Peripheral edema
Bradycardia (dilt/ver)
For treatment of HTN only, are thiazide or loop diuretics preferred?
Thiazides
Best starter drug for mild/moderate HTN?
Thiazide diuretic
Who do thiazide diuretics work best in?
Old, black, obese
Thiazide diuretics side effects
Hypokalemia
Hyponatremia
Increased uric acid
GOOD side effect! Increased calcium in blood, so less osteoporosis
Aldosterone blockers side effects
Gyno
Hyperkalemia
The only time beta blockers should be first line for HTN is when …
CAD hx is present
Alpha blockers side effects
Orthostasis (give at night!)
Drug of choice for pregnant women with HTN?
Methyldopa
