Chapter 14 - Hypertension Flashcards
Strongest predictor in terms of BP measurement of cardiovascular risk stratified by age
Age < 50 = DBP Age 50-59 = SBP, DBP, PP Age > 60 = SBP
Rate of renal artery disease in HTN
33% has disease 9.6% has > 60% RAS
Stages of hypertension and SBP/DBP
TABLE 14.1
Techniques to measure blood pressure
ROUTINE 1) 5 min rest 2) quiet room 3) arm level of heart 4) no caffeine/smk for 30 min 5) BP cuff 80% of arm 6) two measurements AMBULATORY BP monitoring
Ambulatory blood pressure monitoring definition
HTN = 24hr average > 130/80 daytime average > 140/85
Definition of white coat hypertension
1) elevated BP in physician office > 140/90 2) 24 hr BP < 130/80
Secondary causes of hypertension and signs and symptoms
TABLE 14.2
Generation of Ang II
Angiotensinogen from liver Renin converts it to angiotensin I ACE converts it to angiotensin II
NO effects
1) vasodilation 2) increase inflammation 3) increase coagulation
Lifestyle recommendations to reduce HTN
1) weight loss 2) limit Na intake 3) engage aerobic physical activity x 30 min/day
Heart outcomes prevention evaluation
HOPE study ramipril reduced CV events in patients with HTN and PAD BP < 128/75 is beneficial
SPRINT study
9361 patients with HTN and CV risk BP target < 120 is significant better than 140 for MI, ACS, CHF, death
Thiazide diuretic key points
1) Chlorthalidone, HCT, indapamide, metolazone 2) indication: first line therapy, low renin, black, elderly 3) SE: hyperuricemia, hypokalemia, insulin resistance, erectile dysfunction 4) block sodium and chloride transport in distal convoluted tubule 5) ALLHAT trial shows benefit of thiazide compared to others 6) prevent kidney calcium stones 7) effect reduced by high Na intake and NSAID use
Loop diuretic key points
1) Bumetanide, ethacrynic acid, durosemide, torsemide 2) Indicaton: CHF, impaired kidney function 3) SE: hypokalemia, volume depletion MOA: thick ascending limb of LoH block reabsorption of Na, Cl, K associated with SULFA allergic reaction
Potassium-sparing diuretic and aldosterone antagonists
1) Amiloride, eplerenone, spironolactone, triamterene 2) indication: hypokalemia from other diuretic, primary aldosteronism, CHF, proteinuria 3) SE: hyperkalemia, GI side effects, gynecomastia
Beta blocker key points
1) indicaton: CAD, afib, CHF 2) SE: hyperlipidemia, bradycardia, insulin resistance, depression
ACE inhibitor key points
1) indication: CAD, CHF, LVH, proteinuria, younger patients 2) SE: angioedema, cough, hyperkalemia, AKI HOPE trial UKPDS trial = benefit of ACE i in HTN and diabetes improve death
ARB hey points
1) indication: CAD, CHF, LVH, proteinuria 2) SE: angioedema, hyperkalemia, AKI LIFE trial = ARB help with lower CV morbidity/mortality
Renin inhibitor key points
1) Aliskiren 2) HTN 3) SE: angioedema, hyperkalemia, GI side effects ALTITUDE study - higher risk of CV and renal events - rarely used drug
Calcium channel blocker key points
Dihydropyridine: amlodipine, felodipine, isradipine, nicardipine, nimodipine, nifedipine Nondihydropyridine: diltiazem, verapamil indication: blacks, elderly SE: LE edema, constipation, bradycardia
Alpha blocker key points
1) Doxazosin, terazosin 2) indication: HTN, BPH 3) SE: dizziness, fatigue increase risk of heart failure ALLHAT study
Central alpha agonist
1) clonidine, methyldopa 2) indication: resistant hypertension, pregnancy 3) SE: rebound HTN, fatigue, dry mouth, ED
Vasodilators key points
1) hydralazine, minoxidil 2) indication: resistant HTN with CHF or impaired renal fxn 3) SE: fluid retention, tachycardia
ONTARGET study
Combination arb and acei increases AE without benefit
Rheos device
pulse generator to bilateral carotid to generate carotid massage to reduce Htn
symplicity DEVICE
decrease renal sympathetic afferent and efferent activity reduces BP
