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
