8- HTN Flashcards
pre-HTN criteria
120-139/80-89
HTN if <60 y/o
> 140/90
HTN is >60 yo
> 150/90 (unless has CKD or diabetes –> then 140/90)
to make HTN diagnosis, what do you need to do
at least two elevated measurements - five minutes apart, one in each arm, should be made on two or more visits.
patient cant be sick
recommended HTN med for black people
Calcium channel blocker or thiazide diuretic
recommended HTN med for people with chronic kidney disease
ACEI or ARB
recommended HTN med for people with diabetes
ACE Inhibitor, ARB, calcium channel blocker, or thiazide diuretic
recommended HTN med for non-black people
ACE Inhibitor, ARB, calcium channel blocker, or thiazide diuretic
what is the most cost-effective antihypertensive drug.
thiazides
Thiazide diuretics should be avoided in patients with a history of
gout
thiazide side effects
hyponatremia
elderly–>incontinent
Initial Laboratory Testing for New Diagnosis of Essential Hypertension
EKG UA blood glucose- undiagnosed DM hematocrit- anemia? serum potassium serum Ca BUN, Cr, GFR serum cholesterol urinary albumin excretion
why do we measure serum Ca?
One-third of patients with hyperparathyroidism and hypertension may have illness attributable to renal parenchymal damage due to nephrolithiasis.
Increased calcium levels can also have a direct vasoconstrictive effect. I
Which lifestyle change will decrease blood pressure the most?
lose weight
When to Initiate Aspirin in Hypertensive Patients
in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
If the blood pressure is still not at goal, JNC 8 next recommends selecting a drug treatment titration strategy:
Maximize first medication before adding second or
Add second medication before reaching maximum dose of first medication or
Start with two medication classes separately or as fixed-dose combination.
when are alpha blockers used in HTN?
They are only utilized as an adjunct in hard-to-control blood pressure.
often prescribed in prostatism but should not be used as a first line anti-hypertensive in patients with benign prostatic hypertrophy (BPH).
do alpha blockers decrease mortality?
no
side effects of thiazides
May exacerbate urine incontinence.
Monitor chemistry levels, especially sodium and potassium.
Avoid in patients with gout.
Start at lower doses in elderly patients who may be very sensitive to medication effects.
May slow demineralization in osteoporosis.
ACEI side effects
Monitor potassium and creatinine levels.
A rise of up to 20% above baseline in creatinine is acceptable after initiating use.
cough is common (5-20%) due to bradykinin production.
ACEI contra
pregnant woman
History of angioedema
ARBs contra
pregnant woman
what other disorders are CCBS useful for
Raynaud syndrome.
supraventricular tachyarrhythmias.
CCBs common side effect
leg edema
Blood pressure (BP) control rates are lowest in which races
Mexican Americans and Native Americans
