7.2 HTN Flashcards
What are the risk factors for HTN?
Age Race (AA worse, Asian better) Obesity Stress Sedentary High salt diet
What are two signs/tests that can be done when renal artery stenosis is suspected?
High plasma renin
US of the renal arteries shows occlusion with atrophy of one of the kidneys
What are the two primary causes of renal artery stenosis?
Atherosclerosis in elderly males
Fibromuscular dysplasia in young females which is a developmental defect of the blood vessel wall resulting in irregular thickening
What are signs/symptoms of end-organ damage in malignant HTN?
Acute and progressive renal failure Pulmonary edema Aortic dissection Encephalopathy Papilledema CVA Subarachnoid hemorrhage MI Acute left ventricular dysfunction Microangiopathic hemolytic anemia
What kind of diseases are the most common cause of secondary HTN?
Renal diseases
What are signs of acute renal failure?
Decreased urine output Fluid retention as evidenced by swelling in legs or shortness of breath with crackles on lung auscultation Nausea Fatigue Drowsiness Confusion Seizures or coma when extreme
How is Hypertensive emergency treated?
IV medications are used until BP goal, then switch to oral. Below are the IV options to use initially.
Nitroprusside (watch out for cyanide poisoning with prolonged use, especially with renal or hepatic compromise)
Nitroglycerin
Labetalol (especially in those with aortic dissection or end-stage renal disease)
Nicardipine
Fenoldopam (peripheral dopamine-1 agonist)
Clevidipine
In HTN Encephalopathy, labetalol, nicardipine, esmolol are preferred and nitroprusside and hydralazine should be avoided. Lower MAP 25% over 8 hours.
What is the most common clinical presentation of someone with HTN emergency?
1) Cerebral infarction
2) Pulmonary edema
3) HTN encephalopathy
4) CHF
Others: intracranial hemorrhage, aortic dissection, eclampsia, acute MI
How should a patient with HTN emergency be assessed on physical exam?
BP supine and standing to assess volume depletion
BP in both arms to assess for aortic dissection
Eye exam for retinal hemorrhage, papilledema
Signs of heart failure: JVD, lung crackles, leg edema
CNS findings: changes to consciousness, visual field loss, focal deficits
Abnormal masses or bruits in abdomen
