Cardiology: Hypertension Flashcards
how is HTN defined?
systolic BP>140mmHg and or a diastolic BP >90mmHg based on 3 measurements separated in time.
how is essential HTN defined? what percentage of HTN does this represent?
HTN with no identifiable cause
represents 95% of cases of HTN
what is risk factor of essential HTN? (7)
family history of HTN or heart disease, a high sodium diet, smoking, obesity, ethnicity (blacks>whites), and advanced age
name some signs and symptoms of HTN?
asymptomatic until complications develop
what end organ damage should you evaluate for in HTN? in brain eye heart kidney
brain (stroke, dementia),
eye (cotton wool exudates, hemorrhage),
heart (LVH),
kidney (proteinuria, chronic kidney disease, renal bruits)
what labs should be ordered to evaluate for HTN?
obtain a UA, BUN/creatinine, a CBC, and electrolytes
what is first step in treating HTN? wht is most effective?
lifestyle modifications, weight loss is the single most effective lifestyle modification
what should BP goal be in healthy pts? for pts with diabetes or renal disease with proteinuria?
BP <130/80mmHg
name 3 first line agents used to treat HTN and that have been shown to decrease mortality?
diuretics, ACEIs, and beta-blockers
what routine test should be done to test for complications?
renal complications (BUN,creatinine, urine protein-to-creatinine ratio) cardiac complications (ECG evidence of hypertrophy)
a 40 year old male presents for a routine examination. his examination is significant for BP 145/75 mmHg but is otherwise unremarkable, as are his labs. What is the next best step?
with a single BP recording and no evidence of end-organ damage, the next best step should consist of a repeat BP measurement at the end of the examination with a return visit if BP is still high
name treatment for HTN using ABCD mnemonic?
ACEIs/ARBs
Beta-blockers
CCBs
Diuretics
name causes of 2ndary HTN? using CHAPS as a mnemonic
Cushing's syndrome Hyperaldosteronism (Conn's syndrome) Aortic coarctations Pheochromocytoma Stenosis of renal arteries
how is systolic and diastolic BP defined when normal, prehypertension, stage 1 HTN, stage 2 HTN? according to the JNC7
normal: 160/100
what drug therapy according to JNC7 for normal, preHTN, stage 1 HTN, and stage 2 HTN?
normal: encourage lifestyle modification
preHTN: no antihypertensive drug indicated
stage 1 HTN: thiazide diuretics for most pts, ACEIs, ARBs, beta-blockers, CCBs or a combination may be considered
stage 2 HTN: two-drug combination for most pts (usually a thiazide diuretic plus an ACEI, and ARB, a beta-blocker, or a CCB)
name 3 medications to treat BP in pts with uncomplicated medical history
diuretics, beta-blockers, ACEIs
name 5 medications to treat BP in pts with CHF
diuretics, beta-blockers, ACEIs, ARBs, aldosterone antagonists
name 5 medications to treat BP in pts with DM
diuretics, beta-blockers, ACEIs, ARBs, CCBs
name 4 medications to treat BP in pt post MI
beta-blockers, ACEIs, ARBs, aldosterone anatagonists
name 2 medications to treat BP in chronic kidney disease
ACEIs, ARBs
name 2 medications to treat BP in pts with BPH
diuretics and alpha adrenergic blockers
name 3 medications used to treat BP in pts with isolated systolic HTN
diuretics, ACEIs, CCBs (dihydropryridines)
name etiology of HTN in primary renal disease?
often unilateral renal parenchymal disease
how is primary renal disease that causes HTN managed?
treat with ACEIs, which slow the progression of renal disease
what is etiology of renal artery stenosis. (2) name common age group (2)
especially common in pts 50 yrs of age with recent onset HTN. etiologies include fibromuscular dysplasia (younger pt) and atherosclerosis (older pts)
how is renal artery stenosis diagnosed?
MRA or renal artery Doppler ultrasound
how is renal artery stenosis managed? unilateral, bilateral, what is second option
angioplasty or stenting
consider ACEIs in unilateral disease
in bilateral disease (ACEIs can accelerate kidney failure by preferential vasodilation of the efferent arteriole)
open surgery is a second option if angioplasty is no effective or feasible
in what pt population can OCP cause HTN
common in women >35 yrs of age, obese women, and those with long standing use
how is HTN caused in OCPs managed?
discontinue OCPs (effect may be delayed)
how does pheochromocytoma cause HTN? what is triad of symptoms?
an adrenal gland tumor that secretes epinephrine and norepinephrine, leading episodic HA, sweating, and tachycardia
how does Conn’s syndrome (hyperaldosteronism) cause HTN? name triad of symptoms
an most often 2ndary to an aldosterone-producing adrenal adenoma. causes triad of HTN, unexplained hypokalemia, and metabolic alkalosis
name diagnosis and management of HTN in pt with pheochromocytoma?
diagnose with urinary metanephrines and catecholamine levels or plasma metanephrine. surgical removal of tumor after treatment with both alpha and beta blockers
name diagnosis, expected lab results, and treatment of HTN caused by Conn’s syndrome.
metabolic workup with plasma aldosterone and renin level; increased aldosterone and decreased renin levels suggest primary hyperaldosteronism. surgical removal of tumor
name etiology of Cushing’s syndrome
due to an ACTH-producing pituitary turmor, an ectopic ACTH-secreting tumor, or cortisol secretion by an adrenal adenoma or carcinoma. also due to exogenous steroid exposure
Name management of Cushing’s syndrome
surgical removal of tumor; removal of exogenous steroids
name management of coarctation of the aorta
surgical repair
define hypertensive crises?
a spectrum of clinical presentations in which elevated BPs lead to end organ damage
how does hypertensive crises present?
renal disease chest pain (ischemia or MI) back pain (aortic dissection) changes in mental status (hypertensive encephalopathy)
how to diagnose hypertensive urgency
elevated BP with mild to moderate symptoms (HA, chest pain) without end organ damage
how is hypertensive emergency diagnosed?
elevated BP with signs or symptoms of impending end organ damage such as acute kidney injury, intracranial hemorrhage, papilledema, or ECG changes suggestive of ischemia or pulmonary edema
how is malignant hypertension diagnosed?
progressive renal failure and/or encephalopathy with papilledema
how is hypertensive urgency treated?
oral antihypertensives (beta blockers, clonidine, ACEIs) with the goal of gradually lowering BP over 24-48 hrs
hypertensive emergencies are treated how?
IV medications (labetalol, nitroprusside, nicardipine) with the goal of lowering MAP by no more than 25% over the first 2 hrs to prevent cerebral hypoperfusion or coronary insufficiency
