Aquifer Case 8: HTN Flashcards
what are the HTN screening guidelines?
screen for HTN in adults 18+ (grade A)
what is considered HTN?
American College of Cardiology = 130/80+
American Academy of Family Physicians doesn’t endorse these guidelines
which factors need to be asked about when evaluating a patient with HTN?
- family history of CVD
- h/o DMII
- h/o high cholesterol
- h/o or symptoms of CVD
- h/o or symptoms of CHF
- medication including over the counter and complementary medication s
- smoking, alcohol and/or drug use
what are the 3 goals of evaluating a new HTN diagnosis?
- assess for the presence or absence of target end organ disease
left ventricular hypertrophy, angina or MI, HF, cerebrovascular accident, TIA, chronic renal failure, peripheral vascular disease, retinopathy
- assess lifestyle and identify other CVD risk factors or cocominant disorders that may affect prognosis and guide treatment
- consider evolution for secondary causes of HTN
also ask about family history of DM, diet and psychosocial stressors
how is HTN diagnosed?
two elevated measurements 5 minutes apart, one in each arm, on two different visits
what is the best way to take a BP?
the length of the bladder of the cuff must be at least 80% of the arm circumference
the patient’s arm should be supported at heart level
the patient should be seated quietly for at least 5 minutes in a chair with their back supported; not on the exam table
what behavioral changes can help with HTN?
- weight loss
- DASH diet
- sodium restriction
- exercise
- limit alcohol
what are the DOC for HTN?
- thiazide**
- ACEi
- calcium channel blocker
what are some characteristics of thiazides?
- may cause older adults to become incontinent of urine
- should be used in caution in patient with h/o gout
- may affect electrolyte levels (hyponatremia or hypokalemia)
- can be taken in the evening
- doses of hydrochlorothiazide about 25 mg don’t decreased BP further or further reduce morbidity/mortality
which lifestyle modification decreases BP the most?
DASH diet
but if a person loses more than 11 kg of weight, that can result in a greater decreased in BP –> 1 mmHg/kologram weight loss
when do you start aspirin to prevent CVD?
initiate low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) 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 (grade B)
in patients 60-69, you have to weight the risks and benefits
when do you refer a HTN patient to a cardiologist or nephrologist?
failure to achieve blood pressure goal in patients who are adhering to full doses of an appropriate three-drug regimen
make sure to consider excess sodium intake, medication use like NSAIDS, excess alcohol intake, or white coat HTN
