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Renal II Exam Three > 8-19 Hypertension CIS - Pales > Flashcards

8-19 Hypertension CIS - Pales Flashcards

1
Q

What are the different stages of HTN? Numbers for each?

A

Normal:
Systolic <120 AND Diastolic <80

Prehypertension
Systolic 120-139 OR Diastolic 80-89

Stage 1 hypertension
Systolic 140-159 OR Diastolic 90-99

Stage 2 hypertension
Systolic ≥160 OR diastolic ≥100*

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2
Q

What are the criteria for determining HTN based on readings? Is it based on 1 reading?

A

Calculation of seated blood pressure is based on the mean of two or more readings on two separate office visits.

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3
Q

If a patient has checked their blood pressure several times and reported the following numbers to you: 135/92, 145/90, 128/86, 152/85; do they have HTN?

A

Yes, mean is roughly stage 1 HTN, checked at least two separate times

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4
Q

What are the contributing/risk factors for developing essential HTN?

A

Genetic predisposition
Abdominal Obesity
Salt intake
Alcohol intake
Age

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5
Q

A patient with essential HTN has c/o headaches. Is this due to elevated BP?

A

HA are probably coexisting, not directly due to HTN

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6
Q

What pathologies is HTN a risk factor for?

A

Stroke
Myocardial Infarction
Heart Failure
ESRD
Atrial Fibrillation
Aortic Dissection
PVD

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7
Q

What is the likely mechanism of increased BP with essential HTN?

A

Vasospasm is main cause of elevated BP

– RAS activation leading to vasoconstriction of small vessels

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8
Q

What is the mechanism for the gradually increasing BP seen with older adults?

A

decreased vascular compliance in larger vessels, esp aorta

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9
Q

What are some lifestyle modifications that can reduce essential HTN?

A

Weight reduction

DASH diet

Dietary Na+ reduction

Physical activity

Moderation of EtOH consumption

Stop smoking

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10
Q

For a patient with essential HTN, should you start patient on a medication or should you wait for life-style modifications to take an effect

A

Start meds, tell them to start lifestyle changes immediately

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11
Q

What is the initial recommended HTN Tx for non-black patients?

A

ACE Inhibitors
ARB
CCB
Thiazide diuretics

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12
Q

What is the initial recommended HTN Tx for black patients?

A

CCB

Thiazide diuretics

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13
Q

26 year old female with no medical history presents with 30 lbs weight gain over 2 mo time, headaches, increased thirst and urination, muscle weakness. Patient has abdominal striae, moon face, fat deposition between shoulder blades.
VS: T: 97, BP 165/105, P: 60
Lab: Glucose 350 (normal 60-100)
No family History of HTN or DM

What is the cause of this patient’s HTN?

A

Patient has Cushing’s Syndrome

  • oversecretion of cortisol by adrenal glands
  • Cortisol-mediated enhancement of epinephrine vasoconstriction
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14
Q

What diagnostic tests are appropriate to check for Cushing’s Syndrome?

A

24 hours urinary catecholamines

dexamethosone suppression test

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15
Q

When should you suspect secondary HTN?

A

Compelling finding on initial evaluation

Hard to control HTN (either new onset or well controlled HTN becoming hard to control)

Atypical age of diagnosis (less than 30)

Absence predisposing factors

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16
Q

89 year old male with h/o HTN for 40 years usually well controlled on amlodipine, HCTZ, and losartan presents with worsening blood pressure control. Home BP measurements: 170/100, 155/95, 190/110

On exam: bilateral abdominal bruits.

What diagnostic test would you like to order for this patient?

A

renal arteriogram, check creatine to make sure contrast doesn’t kill him;

or use US or renal AA Doppler

CT angiogram a possibility too

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17
Q

What diagnostic tests are helpful with renovascular HTN?

A
  1. Captopril Test (reactive rise in renin and large fall in BP after administration)
  2. DSA
  3. MRI – angiography
  4. Arteriography
  5. Renal vein renin ratio (ratio of 1.5 or greater)
18
Q

What are the 2 main causes of renovascular HTN?

A

atherosclerosis

fibromuscular dysplasia

19
Q

Compare and contrast atherosclerosis vs. fibromuscular dysplasia in regards to:

age

sex

b/l

progressive

response to angioplasty

associated risks

A

Atherosclerosis

Age >50

Sex Male

Bilaterality 33%

Progressive +++

Response to Angioplasty +

Fibromuscular dysplasia

<40, Female, 60%, +, +++

20
Q

What medications should you be careful in prescribing to a patient with renovascular HTN?

A

Do not prescribe ACE inhbitors – can cause renal failure if b/l

21
Q

54 year old African-American male presents with anxiety, tremors, weight loss. Despite his weight loss, he is having a hard time buttoning the top button on his shirt. His wife also said that he was looking “weird” (NEW COMPLAINT)
VS: T 100, BP 165/100, P 119

Patient has exopthalmos

What is causing his elevated BP?

A

Hyperthyroid disease – Grave’s disease

22
Q

What tests would you like to order for his BP?

A

Test with TSH levels -> should be low due to suppression due to high T4

can also do radioactive iodine scan

23
Q

What treatment would you like to do for high BP related to Grave’s disease?

A

Treat with beta blockers

-propranolol until underlying disease treated

24
Q

55 year old male with no previous history of HTN (last check was 3 mo ago at PCP office) presents to ER with severe muscle weakness without focal deficit. No Chest pain or SOB. Patient is on no medications. BP 210/120. Potassium is 1.9 (normal 3.5-5.3). Creatinine is normal. Urine is negative for protein.

Does this patient has a hypertensive emergency (hypertensive crisis)? Why or why not?
What is the most likely cause of this patient’s HTN?

A

No –> no end organ damage

primary hyperaldosteronism – Conn’s disease

25
Q

What are the definitions for HTN urgency and emergency?

A

Urgency

A systolic BP > 180 or a diastolic BP > 130 and NO evidence of end organ damage.

Emergency

May occur at any BP, but involves ACUTE DAMAGE to at least one organ system.

26
Q

What are the signs of HTN on the heart?

A

MI (A),

Angina (A),

Aortic dissection (A),

Aneurysmal dilatation of large vessels (C),

LVH (C),

CHF (A)

27
Q

What are the signs of HTN on renal system?

A

Hematuria (C),

Proteinuria (C),

ARF (A)

28
Q

What are the signs of HTN on the CNS?

A

Cerebral edema (A),

Altered mental status (A),

Bleed (A),

Stroke (A) or

TIA (A)

29
Q

What are the signs of HTN with the eyes?

A

Retinal hemorrhages or exudates (A or C),

Papilledema (A)

A-V nicking (C)

30
Q

What are some consequences of secondary hypoaldosteronism?

A

Causes are:

  1. Diuretics
  2. CHF
  3. Cirrhosis
  4. Ascites
  5. Nephrosis
  6. Others
31
Q

What is the difference in renin and aldosterone levels with primary and secondary aldosteronism?

A

primary:
Elevated aldosterone and low renin levels < Potassium

secondary:
Elevated aldosterone and elevated renin levels

32
Q

Why is someone with primary hyperaldosteronism weak?

A

due to hypokalemia

33
Q

What medication would you choose to treat Conn’s Disease?

A

Treat with spironolactone, or aldosterone antagonist

34
Q

Other than hyperaldosteronism, what other adrenal condition can cause secondary hypertension?

A
  1. Sleep apena
  2. Drug induced causes
  3. Chronic kidney disease
  4. Primary aldosteronism
  5. Renovascular disease
  6. Steroid therapy or Cushing’s syndrome
  7. Pheochromocytoma
  8. Coarctation of the aorta
  9. Thyroid disease
  10. Parathyroid disease
  11. Pain induced
35
Q

What other (not hyperaldosteronism) adrenal conditions can cause secondary HTN?

A

Pheochromocytoma

36
Q

What is coarctation of the aorta?

A

Narrowing of medial layer of aorta.

Commonly at ligamentum arteriosum

37
Q

What are the 3 types of coarctation of the aorta?

A

Interrupted

Preductal

Postductal

38
Q

How do you Dx a coarctation of the aorta?

A

1.Differences in upper and lower extremities

  1. Blood Pressure
  2. systolic hypertension in an infant
  3. 20mm hg between arms

3.Heart Sounds – if isolated a systolic ejection murmur in the aortic outlet and between scapulae.

  1. Radiology –
  2. Cardiomegaly
  3. Rib notching
39
Q

Match the following suffixes to the appropriate class of medications:

  • pril
  • lol
  • pine
  • sartan
  • zosin

HCTZ, Chlorthalidone

Hydralazine, Minoxidil

Clonidine, Methyldopa

Aliskiren

Verapamil, Diltiazem

A

ACE Inhibitors -pril

b-Blockers (and a-b)-lol

Dihydropyridine CCB –pine

ARBs -sartan

Alfa Blockers -zosin

Thiazide Diuretics - HCTZ, Chlorthalidone

Direct Vasodialators - Hydralazine, Minoxidil

Central Sympatholytics - Clonidine, Methyldopa

DRI - Aliskiren

Non-Dihydropyridine CCB - Verapamil, Diltiazem

40
Q
A

Renal II Exam Three (13 decks)

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