28. HTN Flashcards
Secondary HTN can be caused by ____
renal disease (e.g. CKD), adrenal disease, obstructive sleep apnea, or drugs
Pathophysiology of HTN includes increased activity of the ____ and ____
sympathetic nervous system (SNS)
RAAS
Drugs that can increase BP
Amphetamines, ADHD drugs
cocaine
decongestants (e.g. pseudoephedrine, phenylephrine)
Erythropoiesis-stimulating agents
Immunousppressants (e.g. cyclosporine)
NSAIDs
systemic steroids
Normal BP: SBP < ___ and DBP < ____
<120/80
HTN Stage 1: SBP ____ or DBP ____
SBP 130-139 or DBP 80-89
HTN Stage 2: SBP ____ or DBP ___
SBP ≥140 or DBP ≥90
Natural products used for HTN
fish oil, coenzyme Q10, L-arginine, and garlic
When should HTN meds be started?
Stage 2 HTN (SBP≥140 or DBP≥90)
Stage 1 HTN (SBP 130-139 or DBP 80-89) and any of the following:
- Clinical CVD (stroke, HF, CHD)
- 10 yr ASCVD risk ≥10%
- does not meet BP goal after 6 months of lifestyle modifications
BP Goal
<130/80
Note: KDIGO 2021 BP in CKD recommended SBP <120 in pts with HTN and CKD
Initial Drug selection based on specific characteristics: non-black
Thiazide, DHP CCB, ACEi/ARB
Initial Drug selection based on specific characteristics: Black
Thiazide, DHP CCB
(NOT ACEi/ARB)
Initial Drug selection based on specific characteristics: Stage 3 CKD (eGFR <60) and/or albuminuria (albumin ≥30)
ACEi/ARB
Start 2 first-line drugs when baseline average SBP and DBP > ____ above goal
> 20/10 (>150/90)
Monitoring: Check BP every ___ and titrate med if not at goal
month
Concern with use of ACEi/ARBs and pregnancy
Boxed warning for fetal toxicity in pregnancy, should be stopped immediately
ACOG recommends ___ and ____ as first-line treatments in pregnant pts. ____ is alt but may be less effective at BP lowering.
labetalol and nifedipine ER
Methyldopa
Preeclampsia occurs after week ___ of pregnancy and is evident by elevated BP and proteinuria. In pts high risk of preeclampsia (e.g. pre-existing HTN, renal disease, DM), ____ is recommended after first trimester
20 weeks
daily low-dose aspirin is recommended after first trimester
Brand name of lisinopril/HCTZ
Zestoretic
Brand name of losartan/HCTZ
Hyzaar
Brand name of olmesartan/HCTZ
Benicar HCT
Brand name of valsartan/HCTZ
Diovan HCT
Brand name of benazepril/amlodipine
Lotrel
Brand name of valsartan/amlodipine
Exforge
Brand name of atneolol/chlorthalidone
Tenoretic