Cardiology #3 (Hypertension) Flashcards
What is hypertension defined as?
- Systolic blood pressure of 130 mmHg or more and/or diastolic blood pressure 80 mmHg or more
- Elevations must be at least 2 different readings on 2 separate visits
What is considered Stage I hypertension?
Systolic: 130-139
Diastolic: 80-89
What is considered stage II hypertension?
Systolic: 140 or greater
Diastolic: 90 or greater
What is the MCC of primary hypertension?
Idiopathic etiology
What is the MCC of secondary hypertension?
Renovascular (renal artery stenosis, etc.)
What are other causes of secondary hypertension?
- Cushing syndrome
- Pheochromocytoma
- Coarctation of the aorta
- Sleep apnea
- Alcohol use
- OCPs
What is the initial management of a newly diagnosed hypertensive patient?
- Lifestyle modifications
- -Salt restriction ( < 2.4 g/day)
- -Smoking cessation
- -Exercise ( > 30 minutes/day most days/week)
- -Diet (DASH diet)
- -Weight reduction (achieve BMI 18.5-24.9)
- -Limited alcohol consumption (< 2 drinks/d in men, < 1 drink/d in women)
What are the components of an initial workup for a patient with hypertension?
- 12 lead ECG
- Funduscopy (retinopathy)
- Creatinine
- Cholesterol
- Urine albumin to creatinine ratio
In patients who fail a trial of diet and exercise, what is the next treatment step?
Medical management with medication
What are some complications of uncontrolled hypertension?
- Cardiovascular: CAD, heart failure, MI, aortic dissection, PVD
- Neurologic: TIA, stroke, ruptured aneurysms, encephalopathy
- Nephropathy: (2nd MCC of end stage renal disease in the US)
- Optic: retinal hemorrhage, blindness, retinopathy
What is the blood pressure target in a hypertensive patient? How about if they are 60 years or older?
140/90 mmHg
< 150/90 mmHg in adults 60 years or older
What two classes of anti-hypertensives should be used in African Americans?
Thiazides
CCB
What class of anti-hypertensives should be used if the patient also has gout?
CCB
What is the only ARB that doesn’t cause hyperuricemia?
Losartan
If the patient has hypertension and DM, what classes of meds should be used?
ACEi and ARB
What are some examples of ACE inhibitors?
- Pril
- -Lisinopril
- -Enalapril
- -Ramipril
- -Benazepril
What are the common side effects of ACE inhibitors?
- Cough
- Hyperuricemia
- Hyperkalemia
- Angioedema
- 1st Dose Hypotension
Think, CHHAD uses ACEs
If the patient has Atrial flutter or A-fib, what medications should help with both conditions?
- Beta Blockers
- CCB
What is one major contraindication of an ACE and ARB?
Pregnancy
Name some Beta Blockers. Which are cardioselective (B1)? Which are nonselective (B1, B2). Which cover (B1 and B2)?
Cardioselective: Atenolol, Metoprolol, Esmolol
Nonselective: Propanolol
Both: Labetalol, Carvedilol
Adverse effects of Beta Blockers
- Fatigue
- Depression
- Impotence
- Hypoglycemia in DM
Nonselective BB are contraindicated in patients with ______ or _______ because it may worsen Reynaud’s or peripheral vascular disease
asthma
COPD
Name 6 thiazide-type diuretic medications
- Hydrochlorothiazide
- Chlorthalidone
- Furosemide
- Spironolactone
- Amiloride
- Eplerenone
Which diuretics are potassium sparing diuretics and what does that mean?
Spironolactone, Amiloride, Eplerenone
-Inhibits aldosterone-mediated Na/H20 absorption (spares potassium)
What is a common side effect of Spironolactone?
- Hyperkalemia
- Gynecomastia
MOA of diuretics
-Prevent kidney Na/water reabsorption at the distal diluting tubule.
What are some common side effects of diuretics?
Hyperglycemia Hyperlipidemia Hyperuricemia Hypokalemia Hyponatremia
Name some calcium channel blockers
- Nifedipine
- Amlodipine
- Verapamil
- Diltiazem
Name some ARBs
-Artans
- Losartan
- Valsartan
- Irbesartan
- Candesartan
What is a hypertensive urgency?
-SBP > 180 mmHg and/or DBP > 120 mmHg without evidence of end organ damage
What is the rate of reduction for hypertensive urgency?
Gradual reduction of mean arterial pressure by no more than 25% over 24-48 hours with ORAL medications (Clonidine, Captopril, Labetalol, Nicardipine, Furosemide)
What is the treatment goal for a patient with hypertensive urgency?
Blood pressure 160/100 or less
What is the medication of choice for a patient with hypertensive urgency and what is the common side effect of this medication?
Clonidine
Rebound hypertension if discontinued abruptly (mimics pheochromocytoma)
Symptoms of hypertensive urgency
-General: Headache (MC), dyspnea, chest pain, AMS, delirium, seizures, nausea, vomiting
What is a hypertensive emergency
SBP > 180 and/or DBP > 120 with evidence of end organ damage
Management of hypertensive emergency
IV blood pressure agents and reduce MAP gradually about 10-20% in first hour and then additional 5-15% over the next 23 hours
First-line treatment for a patient with HTN encephalopathy (confusion, headache, nausea, vomiting)
Nicardipine, Clevidipine, Labetalol, Sodium Nitroprusside
What is the treatment for aortic dissection associated with hypertensive emergency?
BB: Labetalol, Esmolol
