Cardio- HTN Flashcards
“HTN its not about BP its about ____”
global cardiovascular risk
what is the “key to essential HTN”?
RAAS dysregulation
what is “essential” HTN?
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
malignant HTN
usually above 180/120 and causes organ damage
Each increment of ______ mmHg ____ the risk of CVD across the entire BP range starting from______ mmHg.
20/10 , doubles, 115/75
age-related BP is from what?
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,
stroke, MI and HF relations to lowering BP?
STROKE- DIRECTLY RELATED TO BP
MI- NOT AS MUCH DIRECTLY RELATED
HF- DIRECTLY RELATED
what is he referring to when he says “number needed to treat” ?
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. “
3 BP measurement techniques: based on location
- in-office: 2 readings 5 min apart, sitting in chair
- ambulatory : measured constantly (like a fitbit) for eval of “white coat”
* (if BP doesn’t drop 10-20% at night, might have CVD risk - self-measurement : info in response to therapy, also for white coat
Home measurement of >_____ mmHg is generally considered to be hypertensive.
135/85
what are the “target organs” that can be damaged by HTN?
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)
3 objectives of eval of pts w/ HTN
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
urgent vs emergent HTN, what constitutes each and what will you do for each pt?
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
lifestyle modification for HTN…what is the biggest help?
weight loss
BP extremely well correlated with ____
weight gain - get in normal BMI range, BP becomes optimized
if BMI goes too low your risk for HTN ____
increases! you can be too thin!
preferred thiazide for HTN ?
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)
old guidelines: what was the BP goal for those under and over 60yo w/ HTN?
under: 140/90
over: 150/90
what drugs can African Americans use and not use for HTN?
african american- ACE inhibitors dont work as well - use thiazide or CCB
hadley’s strategy to dose HTN drugs
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
SPRINT trial: people with chronic kidney and CVD… found lower risk for cardiovasc events with BP lower than _____
140 mmHG systolic goal
found significant decrease in CVD and renal when trying to get them to 120mmHg
if you are over 50yo with >1 CV risk factor …
a lower BP goal is recommended- should shoot for 120
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.
if risk >10%, and over 130/80 range, consider medication
if risk <10% and over 140/90 range, consider medication
for stage 1 HTN you may consider using how many HTN drugs?
1 (anything past stage 1 will need >1 drug)
what are the 1st line drugs for HTN ? (4 groups)
1st line : thiazides, diuertics, CCBs, ACE/ARBs
new guidelines: history of CVD, HF,DM? BP needs to be < ____
130/80
overall: old vs new guidelines for HTN along w/ other diseases like CVD/HFrEF ?
OVERALL- NEW GOALS ARE
<130/80 RATHER THAN <140/90
what anti-HTN combo does Hadley like?
LIKES LISINOPRIL/HCTZ CAUSE ITS CHEAP AND WORKS WELL
1xday is better than twice a day
combo pill better than multiple
what HTN med is good for DM pt but not for african americans?
ACEs
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?
osteoporosis: thiazides
raynauds: CCB
benign prostatic hyperplasia: Alpha-block
LVHypertrophy: ACE/ARB
potentially unfavorable effects from HTN drugs? from BB and ACE/ARBS?
BB: not for asthma, DM, CHF (initiate w/ caution-angioedema risk)
ACE/ARB: teratogen, angioedema, CHF
4 ADRs from HTN drugs
Beta and alpha block: depression
diuretic: gout
thiazide: low Na+
RAAS drugs: high K+
for renovascular disease, ACE/ARBs can raise what levels? good or bad thing?
serum creatinine levels
-these levels are already inc. b/c kidney isnt being perfused and needs even more
= good for impaired kidneys!
if you add ___ then african americans can take an ACE
thiazide
pt on BP medication should have what levels check twice a year?
potassium and creatinine
NSAIDS can raise or lower BP?
raise
