Cardio- HTN Flashcards

1
Q

“HTN its not about BP its about ____”

A

global cardiovascular risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the “key to essential HTN”?

A

RAAS dysregulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is “essential” HTN?

A

aka primary HTN
“essential” = we dont know what causes it
-makes up 95% all HTN cases

other 5% secondary HTN -txt of underlying cause can cure it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

malignant HTN

A

usually above 180/120 and causes organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Each increment of ______ mmHg ____ the risk of CVD across the entire BP range starting from______ mmHg.

A

20/10 , doubles, 115/75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

age-related BP is from what?

A

As we age, systolic BP goes up, diastolic goes down, = pulse pressure increases

LOSE COMPLIANCE OF BLOOD VESSELS, NOT EXPANDING AND CONTRACTING AS MUCH WITH EACH PULSE,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

stroke, MI and HF relations to lowering BP?

A

STROKE- DIRECTLY RELATED TO BP
MI- NOT AS MUCH DIRECTLY RELATED
HF- DIRECTLY RELATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is he referring to when he says “number needed to treat” ?

A

epidemiology lingo: effectiveness of therapy - # of pt’s needed to treat to prevent one additional bad outcome

hadley: “With HTN and additional CVD risk factors, achieving a sustained 12 mmHg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated. “

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 BP measurement techniques: based on location

A
  1. in-office: 2 readings 5 min apart, sitting in chair
  2. ambulatory : measured constantly (like a fitbit) for eval of “white coat”
    * (if BP doesn’t drop 10-20% at night, might have CVD risk
  3. self-measurement : info in response to therapy, also for white coat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Home measurement of >_____ mmHg is generally considered to be hypertensive.

A

135/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the “target organs” that can be damaged by HTN?

A
Heart: HF, LVhypertrophy, angina, etc 
Brain: stroke/TIA
Kidney: Chronic kidney disease
(arteries and eyes also but...
heart, brain, and kidney you can actually MEASURE effect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3 objectives of eval of pts w/ HTN

A

Assess lifestyle and identify other CV risk factors or concomitant disorders that affect prognosis and guide treatment

Reveal identifiable causes of high BP

Assess the presence or absence of target organ damage and CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

urgent vs emergent HTN, what constitutes each and what will you do for each pt?

A

emergency- high BP and TARGET ORGAN DAMAGE
txt- hospital
urgent- high BP but NO TARGET ORGAN DAMAGE, (may have chronic target organ damage)
txt- immediate anti-HTN meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

lifestyle modification for HTN…what is the biggest help?

A

weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

BP extremely well correlated with ____

A

weight gain - get in normal BMI range, BP becomes optimized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if BMI goes too low your risk for HTN ____

A

increases! you can be too thin!

17
Q

preferred thiazide for HTN ?

A

chlorthalidone is a TRULY ONCE A DAY drug (unlike Hydrochlorothiazide but we use it more bc its cheaper)

-also- required less stringent BP goals (can have higher with DM)

18
Q

old guidelines: what was the BP goal for those under and over 60yo w/ HTN?

A

under: 140/90
over: 150/90

19
Q

what drugs can African Americans use and not use for HTN?

A

african american- ACE inhibitors dont work as well - use thiazide or CCB

20
Q

hadley’s strategy to dose HTN drugs

A

HADLEY’S FAVE- LAST ONE : begin 2 at the same time - two drugs at low dose with low ADRs is better than one drug with high ADRs

21
Q

SPRINT trial: people with chronic kidney and CVD… found lower risk for cardiovasc events with BP lower than _____

A

140 mmHG systolic goal

found significant decrease in CVD and renal when trying to get them to 120mmHg

22
Q

if you are over 50yo with >1 CV risk factor …

A

a lower BP goal is recommended- should shoot for 120

23
Q

HTN Drug Txt threshold for CVD risk: if risk is >10% and they are over _____, then you must consider medication. if their CVD risk if <10% but they are over _____, you must consider medication.

A

if risk >10%, and over 130/80 range, consider medication

if risk <10% and over 140/90 range, consider medication

24
Q

for stage 1 HTN you may consider using how many HTN drugs?

A

1 (anything past stage 1 will need >1 drug)

25
Q

what are the 1st line drugs for HTN ? (4 groups)

A

1st line : thiazides, diuertics, CCBs, ACE/ARBs

26
Q

new guidelines: history of CVD, HF,DM? BP needs to be < ____

A

130/80

27
Q

overall: old vs new guidelines for HTN along w/ other diseases like CVD/HFrEF ?

A

OVERALL- NEW GOALS ARE

<130/80 RATHER THAN <140/90

28
Q

what anti-HTN combo does Hadley like?

A

LIKES LISINOPRIL/HCTZ CAUSE ITS CHEAP AND WORKS WELL
1xday is better than twice a day
combo pill better than multiple

29
Q

what HTN med is good for DM pt but not for african americans?

A

ACEs

30
Q

for choice of HTN therapy… there are a number of potentially favorable effects. which ones would help HTN and osteoporosis? raynauds? bengin prostatic hyperplasia? LVH?

A

osteoporosis: thiazides
raynauds: CCB
benign prostatic hyperplasia: Alpha-block
LVHypertrophy: ACE/ARB

31
Q

potentially unfavorable effects from HTN drugs? from BB and ACE/ARBS?

A

BB: not for asthma, DM, CHF (initiate w/ caution-angioedema risk)
ACE/ARB: teratogen, angioedema, CHF

32
Q

4 ADRs from HTN drugs

A

Beta and alpha block: depression
diuretic: gout
thiazide: low Na+
RAAS drugs: high K+

33
Q

for renovascular disease, ACE/ARBs can raise what levels? good or bad thing?

A

serum creatinine levels
-these levels are already inc. b/c kidney isnt being perfused and needs even more
= good for impaired kidneys!

34
Q

if you add ___ then african americans can take an ACE

A

thiazide

35
Q

pt on BP medication should have what levels check twice a year?

A

potassium and creatinine

36
Q

NSAIDS can raise or lower BP?

A

raise