CARDIO-HTN* Flashcards
Who are at risk for HTN
**POSTmenopause Blacks 60+ M, W- 23% White/Hispanic, 40+ Obese PMH CVD
What is the MC reason for medical office visits and prescription drugs in the US?
HTN
1:4 Americans
31% unaware-silent killer
What does the USPSTF recommend BP screening adults?
starting at 18
○ Annual >40 years
○ Annual high risk patients
○ 3-5 years for normotensive, avg risk patients
○ BP readings outside clinical setting for diagnostic confirmation, treatment
PEDs- BP at 2y, then 1-3-5yr FH
Pts >60yo: BP<152/95. Did this person meet goal of HTN?
NO. 2017
Pts <65yo: GOAL is <130/80;
Pts >65yo w comorbid: GOAL <150/90
PT has BP of 132/90 at first visit, what is diagnosis?
ALWAYS NEED 2+ properly measured readings
AT 2+ visits after an initial screen
Pt has a BP of 128/80 at 2 visits? What is the diagnosis?
Elevated:
○ systolic 120-129
diastolic <80
Pt has a BP of 135/88 at 2 visits? What is the diagnosis?
HTN STAGE 1
● Hypertension:
○ Stage 1: systolic 130-139 or diastolic 80-89
○ Stage 2: systolic ≥140 or diastolic ≥90 or higher
USPSTF- 2017 ABPM- one criteria of ABPM can DX HTN
What is the pathphysicology of blacks risk for HTN?
poorly understood:
AA lower renin levels L/T ACEI not useful in AA’s
What system will make a pt more sensitive to stress?
INC SNS
enhanced beta-adrenergic responsiveness-sensitive to stress and fight-or-flight response
How do the kidneys contribute to HTN?
○INC HR (via stretch of atria w/BV)_DEC LV contraction rate/DEC CO, stimulate RAAS
INC angiotensin vasoconstriction, SNS
Reduced adult nephron size - smaller so can’t filter as well → low filtrate L/T activated RAAS
Aldosterone-INC NA channels for resorption and H20 retention, lowers K
What genetics and neonatal factors play are role HTN?
■ intrauterine neonatal risk HTN: hypoxia, drugs, nutritional deficiency, smoking mom
■ malnutrition, infections
○ Genetic:2 HTN parents=2x risk
What is the main cause of secondary HTN?
Renal artery stenosis*- 10%
consider of HTN resistant if Pt on multi meds
What questions should you ask for HTN?
STOP BANG- Snore, Tired, Observed, Pressure, BMI, Age, Neck cir, Gender M.
HTN 2/2 OSA
Screen OSA pt
What happens if mechanical obstruction in Aorta?
Coarctation of the Aorta
SECONDARY HTN
DEC flow is responsible for the elevation of BP in the upper extremities vs lower
How is the endocrine system connected with HTN?
● Pheochromocytoma- Catecholamine-secreting tumors
● Primary hyperaldosteronism- HTN BP is dependent on mild volume expansion that occurs
● Cushing’s syndrome d/t elevated cortisol
● Ectopic ACTH — Severe hypertension and hypokalemia
● Hyper/Hypothyroidism
● Hyperparathyroidism
What suggestions are needed for blacks in risk of HTN?
●MC and severe
● higher sodium intake leads to higher BP
● Excess alcohol intake
● Smoking (ruins endothelium)
● Obesity and sedentary lifestyle
● Dyslipidemia
● Personality traits / Stress – hostile, anxious, type A
Pt is 25 and here for annual PE, what can be used for CVD risk?
app ASCVD risk calculator- use Q 4-6yr Pt 20-79 age gender race lipids BP DM smoking
Why is HTN treated so aggressively early?
**complications Small vessel damage**GOAL prevent End organ dz. CHF LVH-ventricular arrhythmia MI ESRD renal-check microalbumin, SCr/yr stroke Retinopathy- HTN MC PV- ask ED pain walking, intermittent claudication Emergency
What should be included on all HTN cases?
Mini Mental/MOCA - r/o HTN complication in brain
Risk of CVA or intracranial HTN
How do you work up HTN?
**BMP- Chem 7- Na, K, BUN, Scr, Cl/HCO3, Glucose
CBC-WBC, Hgb, Ht (thick), bands, MCV +-
Fasting lipids- TGs (high), LDL(high), HDL (low not good)
UA- microalbuminuria DM
ECG- LVH, arrhythmias, MIs (q-wave, STEMI, inverted T-wave). Q2y
ROS- TSH, toxicology
What lifestyle modification will manage HTN?
whole foods <200mg Na/ day INC K+- aldosterone factor- watch toxic Exercise Wt loss- 10kg (22 loss= 5-20 reduction in BP Stress control Dec. Alcohol NO smoke Risk for DM-screen
Pt 45y smoker obese has > 6-7% risk with 10yr calculator? What should they take?
Statin therapy- not for everyone, Atorvastatin
ADE- monitor LFT, lipid
or has: pre/DM and high LDL/low HDL/ high cholesterol, metabolic syndrome,
ASA aspirin 81mg
Check DM
What should you include in PE for HTN risk pt?
vitals EYES-retinopathy: flame, cotton, exudates Brain-CN, HA Neck- bruits, thyroid Heart- PMI displaced, Arrythimia, Murmurs, thrills, lifts Lungs- Basal crackles/rales ABD- pulses, width AAA, bruits, acite PV- pules, cap, pitting edema, lesions M- Erectile Dys
Mr. Pressure, 55 years, BP 145/85. What is the biggest concern?
SBP > 140 mmHg higher CVD risk factor than DBP.
● risk of CVD doubles with each increment over 20/+10 mmHg
● normotensive at 55y have a 90% lifetime risk for developing HTN
