10.3 Flashcards
What is regulated by relaxing or contracting of the smooth muscle around arterioles?
Blood pressure
Normal blood pressure should be?
SBP:< 120
DBP: < 80
Elevated blood pressure?
SBP: 120-129
DBP: <80
Stage 1 blood pressure?
SBP: 130-139
DBP: 80-89
Stage 2 blood pressure?
SDP: > 140
DBP: > 90
The term applied to 95% of hypertensive patients when no single cause can be identified is..
Essential hypertension
____________ has an identifiable cause and should be suspected with early age hypertension or when there is difficulty controlling HTN with multiple medications. Those causes include:
- Renal disease
- Renal artery stenosis
- Pregnancy
- Pheochromocytoma
- Cushing syndrome
- Hyperthyroidism
- Estrogen use
- Drug induced
Possible physical findings of hypertension include
- Blood pressure elevation on 3 or more separate occasions
- Long term uncontrolled HTN
- Can have displaced PMI
- Can hear mitral valve murmurs
- Can hear S4
(Remember essential hypertension is usually asymptomatic)
Differential diagnosis:
Essential HTN
secondary HTN
Hyperthyroidism
Stimulant use
Adrenal steroids
OTC supplements
Anorexic meds
NSAIDS
oral contraceptive
Alcohol withdrawal
Obesity
Labs and imaging to evaluate for a new diagnosis of HTN include:
Fasting glucose
UA for proteinuria, hematuria, casts
CBC
chemistry
TSH
Lipid panel
EKG
Calculate 10- year atherosclerotic cardiovascular disease risk
Treatment for HTN
Modify lifestyle
Pharmacological
Pharmacologically speaking what is the goal blood pressure
< 140/90 in most patients
< 130/80 in patients with diabetes or kidney disease
First line pharmacological treatment for blood pressure?
Diuretics
Hydrochlorothiazide(HCTZ)
12.5-25 mg daily can titrate to max dose of 50mg daily
HCTZ has a contraindication to:
Sulfonamides, hepatic or renal impairment, seizure disorder, gout.
Angiotensin converting enzyme inhibitors (ACEi) first line
Lisinopril, enalapril, captopril
Working best for younger white patients and less in black patients
Angiotensin receptor blockers (ARBs)
Losartan: 50mg starting up to 100mg
Calcium channel blockers (CCB)
More effective in African American population
Diltiazem: 180mg-360 mg daily
Amlodipine: 2.5-10 mg daily
