8/11- Hypertension Flashcards
Hypertension is a risk factor for what huge cardiovascular disease?
Atherosclerosis
What is the most common and treatable coronary risk factor?
Hypertension
What is the blood pressure associated with the lowest risk of stroke and CAD?
A. 120/80 (normal BP is less than/= 120/80)
B. 115/75
C. 135/80
D.under 140/90 (“non-hypertensive”)
E. >/= 140/90 (“hypertension”)
What is the blood pressure associated with the lowest risk of stroke and CAD?
A. 120/80 (normal BP is less than/= 120/80)
B. 115/75
C. 135/80
D.under 140/90 (“non-hypertensive”)
E. >/= 140/90 (“hypertension”)
B- this is ideal; associated with LOWEST RISK for stroke and CAD (but not proven by studies?)
What increase in BP corresponds to doubling risk of stroke and CAD death?
20 mmHg increase doubles risk of STROKE and CARDIAC DEATH
Determinants of blood pressure?
Cardiac output
- Stroke volume
- Heart rate
Vascular resistance
- Vessel structure
- Vessel function
What is mean arterial pressure (equation)?
MAP = CO x SVR
How do the following affect CO and BP?
- Heart failure
- Decrease in intravascular volume
- Increase in intravascular volume
- Heart failure: reduces CO and thus decreases BP
- Decrease in intravascular volume: reduces CO and BP
- Increase in intravascular volume: increases CO and BP
How is HTN defined?
Repeated BP measurements >/= 140/90 mmHg
- Just need systolic >/= 140 OR diastolic >/= 90
(only one number needs to be at or above cutoff)
How does age affect BP? SBP? DBP?
Age is a powerful determinant of BP
- SBP rises with increasing age
- DBP rises until 4th decade then plateaus and drops in the 6th decade
What is “essential hypertension”?
Unknown cause
What is “secondary hypertension”? Causes?
Due to a specific cause
Causes:
- Renal artery stenosis (ALWAYS CHECK; can intervene via stenting to reduce BP)**
- Renal disease
- Birth control pills
- Aldosteronism
- Pheochromocytoma
- Coarction of aorta
Rare (under 10%)
- Renal tumors
- Arteritis of the renal artery (PAN)
- Cushing’s syndrome (excess cortisol)
- Acromegaly: excess growth hormone
- Hypercalcemia due to hyper-PTH
What is pre-hypertension?
BP between 120/80 and 140/90
Stages of HTN?
(Pre-HTN: under 140/90)
Stage I: under 160/100
Stage II: BP > 160/100 (pic b)
What happens to pulse pressure as SBP rises and DBP decreases in older patients?
Pulse pressure increases
(Pulse pressure = systolic - diastolic BP)
How does using a tight cuff affect BP measurements?
Cuff too tight “raises” BP
What is signified by the disappearance of Korotkoff sounds?
Diastolic BP
What is the clinical significance of pre-hypertension?
- Increased risk of CV morbidity/mortality
- Increased future development of HT
- Drug therapy is not recommended EXCEPT in diabetics
- Non-pharmacologic therapy is advised
What is the GOAL BP in most pts with HTN?
A. under 140/90
B. under 120/80
C. under 115/75
D. As low as tolerated
What is the GOAL BP in most pts with HTN?
A. under 140/90
B. under 120/80
C. under 115/75
D. As low as tolerated
A- the reasonable goal
What is the goal BP in hypertensives with diabetes or chronic renal disease?
A. under 140/90
B. under 130/80
C. under 120/80
D. under 115/75
What is the goal BP in hypertensives with diabetes or chronic renal disease?
A. under 140/90
B. under 130/80
C. under 120/80
D. under 115/75
What is isolated systolic hypertension (ISH)?
What percentage of people with HTN have this?
- SBP >/= 140 mmHg
- DBP under 90 mmHg
This comprises 2/3 of all hypertensives above 65 yo
Which is more powerful as a risk factor for stroke and CAD: SBP or DBP?
SBP is more powerful than DBP as a risk factor for stroke and CAD (> 50 yo)
- Reduction of SBP lowers both stroke and CAD
Describe the RAAAS system?
- Initial insult
- BP fails
- Renin produced by kidney
- Angiotensin (causes BP rise directly and release of:)
Aldosterone (causes salt retention and increase in BP)
What is the target of ARB drug?
“Angiotensin II receptor blocker”
- AT1 receptor
What is the target of ACEI?
“Angiotensin converting enzyme inhibitor”
- Blocks AI -> AII
What conditions are associated with hypertension? Via what factors?
- Obesity (CO increased)
- Alcohol (CO increased)
- Smoking (NE and SVR increased)
- Diabetes (SVR and CO increased)
What are three major HT complications?
- HT heart disease
- HT crises
- Other target organ damage (TOD)
Hypertensive heart disease (HT heart disease) causes what?
- CAD angina or AMI
- Heart failure
CHF may result from what 2 main sources?
- Diastolic dysfunction due to LVH
- Systolic dysfunction due to MI (due to CAD)
How is a hypertensive crisis defined? Associated with what?
- Systolic BP > 200
- Diastolic BP > 120
This is usually associated with vascular damage
Hypertensive crisis causes what?
- Hypertensive emergency (requires hospital admission)
- Hypertensive urgency
What are the two key differences between HT urgency and emergency?
Emergency is a life-threatening complication and requires immediate hospitalization
What are some HT emergencies?
- Hypertensive encephalopathy
- Acute stroke (hemorrhagic or ischemic)
- Retinal hemorrhages or papilledema
- Acute pulmonary edema
- Acute myocardial infarction
- Acute renal failure
- Acute aortic dissection
What is included in target organ damage due to HTN?
- Peripheral vascular disease
- Aortic aneurysm or dissection
- Nephrosclerosis leading to renal failure
- Thromboembolic or hemorrhagic stroke
Algorithm for treatment of HTN?
Initial drug choices without compelling indications?
Stage I HTN:
- Thiazide type diuretics for most
- May consider: ACEI, ARB, BB. CCB, or combo
Stage II HTN:
- 2 drug combo for most (typ thiazide-type diuretic and ACEI or ARB or BB or CCB)
Initial drug choices with compelling indications?
- Drugs from the compelling indications
- Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed
Compelling Indications for specific drug classes
ACE inhibitor or ARB must be top choice for use in:
- Diabetic pt
- Chronic kidney disease
- Congestive heart failure
All of the following anti-HT drugs reduce CV complications of HT except:
A. Diuretics
B. Beta blockers
C. Calcium channel blockers
D. Alpha blockers
E. ACEI and ARB
All of the following anti-HT drugs reduce CV complications of HT except:
A. Diuretics
B. Beta blockers
C. Calcium channel blockers
D. Alpha blockers
E. ACEI and ARB
Suffixes to recognize drug class- all of the following are true except:
A. –olol for beta blocker
B. –zosin for alpha blocker
C. –pril for ACEI
D. –sartan for an ARB
E. –retic for a thiazide diuretic
Suffixes to recognize drug class- all of the following are true except:
A. –olol for beta blocker
B. –zosin for alpha blocker
C. –pril for ACEI
D. –sartan for an ARB
E. –retic for a thiazide diuretic
Which initial drug(s) is/are preferred in a diabetic hypertensive with BP 170/92?
A. Hydrochlorothizide 25 mg every morning
B. Amlodipine 5 mg every morning
C. Lisinopril 10 mcg every morning
D. A and C
E. B and C
Which initial drug(s) is/are preferred in a diabetic hypertensive with BP 170/92?
A. Hydrochlorothizide 25 mg every morning
B. Amlodipine 5 mg every morning
C. Lisinopril 10 mcg every morning
D. A and C
E. B and C
- Diabetic, so
- Stage II, so need 2 drug combo
Which anti-HT drugs are preferred as initial therapy in an uncomplicated TH BP 146/90?
A. Diuretics
B. Beta blockers
C. Alpha blockers
D. ACEI or ARB
E. Ca channel blockers
Which anti-HT drugs are preferred as initial therapy in an uncomplicated TH BP 146/90?
A. Diuretics
B. Beta blockers
C. Alpha blockers
D. ACEI or ARB
E. Ca channel blockers
How to individualize drug selection for:
- DM or renal failure
- Systolic CHF
- CAD
- DM or renal failure: ACEI or ARB*
- Systolic CHF: ACEI or ARB
- CAD: BB or CCB
*These are contraindicated in SEVERE renal failure, but can use in mild (and actually may help prevent HTN/progression of renal disease)
