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Cardiology > Blood Pressure > Flashcards

Blood Pressure Flashcards

1
Q

What are the four systems that regulate blood pressure?

A

Heart
Blood vessel tone
Hormones
Kidney

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2
Q

Most powerful hormone system for regulating body volumes and BP is what?

A

Renin-Ang system

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3
Q

What component of the Renin-Ang system is a powerful vasoconstrictor?

A

Angiotensin II

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4
Q

What percentage of cases are essential HTN?

A

95%

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5
Q

HTN is a major modifiable risk fact for what disease?

A

cardiovascular

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6
Q

List some risk factors for essential hypertension

A

Insulin resistance
Glucose intolerance
Hyperinsulinemia
Body Weight
Gender
Age
Low socioeconomic class
Smoking
Family history
Medications
African American

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7
Q

What is a major determinate of BP?

A

body weight

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8
Q

List some exacerbators of essential hypertension

A

Obesity
Increased Na+ intake
Alcohol
Cigarette smoking
Polycythemia vera
Low K+ intake
NSAIDs
Sleep apnea
Metabolic syndrome

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9
Q

What is the most frequent symptom in HTN?

A

Headache

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10
Q

What are the main organs that suffer in HTN?

A

Heart
Brain
Kidney
Blood vessels

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11
Q

What are some physical exam findings suggestive of
secondary or potentially reversable causes of HTN?

A

Abdominal or flank bruits (renovascular issue)

Absent or diminished femoral pulses (coarctation)

Flank or abdominal masses (AAA of Polycystic kidney disease)

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12
Q

What lab is a marker of asymptomatic renal dysfunction in HTN
patients?

A

Microalbuminuria

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13
Q

What are the monitoring guidelines in HTN patients?

A

Annual urine microalbumin (UA)

Annual BMP

Annual lipids (HLD, LDL, triglycerides)

Baseline EKG (Repeat every 2-4 years)

Annual BUN/Creatinine

A1c or fasting glucose

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14
Q

What is the blood pressure goal in patients with no comorbidities?

A

<140/<90

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15
Q

What is the blood pressure goal in patients with DM or chronic kidney disease?

A

<130/<80

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16
Q

What is the blood pressure goal in patients 60 and older?

A

<150/<90

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17
Q

What lifestyle modifications in all patients needs to be addressed and encouraged?

A

Weight loss
Exercise
Diet (DASH)
Decreased Na+ intake
Decreased alcohol intake (1 drink a day: females; 2 drinks a day: males)
Tobacco cessation
Decrease stress

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18
Q

What class of medications for HTN is the DOC?

A

Thiazides

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19
Q

What is the creatinine clearance level that you need to discontinue Thiazides?

A

can’t use once CrCl <30

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20
Q

What class of medications for HTN must be avoided in pregnancy and renal artery stenosis?

A

ACE/ARBs

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21
Q

What class of medications for HTN has a questionable role in the treatment of essential HTN unless patient also have CHF or history of MI?

A

Beta Blockers

22
Q

What class of medications for HTN is contraindicated in COPD/asthma patients?

A

Beta Blockers

23
Q

What class of medications for HTN should never be used as monotherapy?

A

Alpha blockers

24
Q

What medication is the DOC for HTN in pregnancy?

A

Methyldopa

25
Q

What class of medications for HTN is a good addition for resistant HTN?

A

Calcium Channel Blockers

26
Q

What class of medications for HTN is contraindicated in heart failure?

A

Calcium Channel Blockers

27
Q

What class of medications for HTN can cause heart failure?

A

Direct vasodilators

28
Q

What class of medications for HTN is protective against strokes?

A

Calcium Channel Blockers

29
Q

What is the most common cause of secondary hypertension?

A

Renal Parenchymal Disease

30
Q

If you see these signs and symptoms in a patient with secondary HTN, which underlying cause should you suspect?

HTN is resistant to 3+ drugs

Renal artery bruits

Abrupt deterioration in kidney function after ACE initiation

Excess renin and aldosterone (unexplained hypokalemia)

A

Renal Artery Stenosis

31
Q

If you see these signs on imaging in a patient with secondary HTN, which underlying cause should you suspect?

Xray:
Indention of aorta
Rib notching

A

Coarctation of Aorta

32
Q

This secondary HTN condition is associated with bicuspid aortic valve

A

Coarctation of Aorta

32
Q

Catecholamine secreting tumor on adrenal medulla

A

Pheochromocytoma

32
Q

If you see these signs on imaging in a patient with secondary HTN, which underlying cause should you suspect?

Lab: 24hr urine 🡪 catecholamines and their metabolites

Vanillylmandelic acid (VMA) and metanephrine

A

Pheochromocytoma

33
Q

If you see these signs on imaging in a patient with secondary HTN, which underlying cause should you suspect?

Autonomic attacks – periodic, surges of severe throbbing HAs, profuse sweating, palpitations, tachycardia, severe retinopathy

A

Pheochromocytoma

34
Q

If you see these signs on imaging in a patient with secondary HTN, which underlying cause should you suspect?

Rounded face
Central obesity
Proximal muscle weakness
Hirsuitism
“buffalo hump”
Purple straie on abdominal wall

A

Cushing’s Syndrome

35
Q

What is the pathophysiology of Cushing’s Syndrome resulting in secondary HTN?

A

Excessive cortisol 🡪 blood expansion and stimulated synthesis of components of renin-angiotensin system

36
Q

Severely elevated blood pressure and symptomatic

Life threatening

Acute end organ damage

DBP >130

A

Hypertensive Crisis

37
Q

What is the goal in a Hypertensive Crisis?

A

Drop blood pressure rapidly!

Reduce blood pressure within first 2 hours by 15-25%

38
Q

If a hypertensive crisis is Catecholamine induced, what is the DOC?

A

Phentolamine

39
Q

Severely elevated blood pressure with minimal or no symptoms

Not life threatening

No end organ damage

DBP>115

A

Hypertensive Urgency

40
Q

What is the goal in a Hypertensive Urgency?

A

Reduce blood pressure within first 24-48 hours

41
Q

Which part of the blood pressure reading is a better predictor of morbid events?

A

Systolic blood pressure

42
Q

Characterized by encephalopathy or nephropathy with accompanying papilledema

Progressive kidney disease ensues if not treated

Treat like other hypertensive emergencies

A

Malignant Hypertension

43
Q

List some potential causes of resistant hypertension

A

Improper blood pressure measurement
Excessive Na+ intake
Inadequate diuretic therapy
Excessive EtOH intake
Medications

44
Q

In cases of resistant hypertension, what workup needs to be done?

A

Start looking into secondary causes!

45
Q

A palpable brachial or radial artery when the cuff is inflated above
systolic pressure

Falsely elevated blood pressure reading due to atherosclerosis of
blood vessels that won’t compress

A

Osler’s Sign (Pseudohypertension)

46
Q

Excessive fall in blood pressure on assuming upright position

Typically >20/>10 mm Hg

A

Orthostatic Hypotension

47
Q

List some causes of orthostatic hypotension

A

Diuretics (most common)
Vasodilators (most common)
Dehydration
Bradycardia
Heart failure
Diabetes
Nervous system disorders

48
Q

What are the two most common causes of orthostatic hypotension?

A

Diuretics
Vasodilators

49
Q

What are some complications of orthostatic hypotension?

A

Stroke
Falls
Brain damage (Repeated episodes of hypotension)
Increased risk of some forms of dementia

Cardiology (13 decks)

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