Chapter 32 Flashcards
What is the definition of hypertension?
Blood pressure greater than 140/90 on 3 to 6 readings over a period of weeks to months Separated by at least one week
What are the causes of secondary hypertension?
Reno or Renovascular disease, pheochromocytoma, sleep apnea, coarctation of the aorta, Cushing syndrome, other endocrine disorders
What should be highlighted as a sign of an organ damage during the physical examination?
Funduscopic exam (hypertensive retinopathy), pulse palpitation (coarctation of the aorta), cardiac exam (LVH) and abdominal exam (renal artery bruit).
What is the appropriate management for patients with essential hypertension
Lifestyle management then pharmacologic management
What are the routine diagnostic test for uncomplicated essential hypertension?
CBC, BMP, ECG, UA, lipid profile
What is stage one and stage two of hypertension?
140259/192 199
Greater than 160/100
What is the treatment for one episode of the 160/120?
Lifestyle modifications and pharmacotherapy are initiated immediately
How is stage one hypertension treated?
Monotherapy with ACEi or CCB
Alternative is low-dose Thiazides diuretic (Chlorthalidone is preferred over HCTZ). CCB It’s preferred in elderly and African American patients.
When should sequential monotherapy be recommended?
If there is no response to initial first line drug then switch to drug 2
When is it OK to give stage one hypertension patient medication?
After six months of lifestyle modification
What are the lifestyle modifications for lowering blood pressure?
Weight reduction, low sodium intake, dash diet (fruits and vegetables), reduction of alcohol intake, increased physical activity
What medication should be given to stage two hypertension patient?
ACEi plus CCB (benazepril plus amlodipine)
What additional test should be given for diabetic patients with hypertension?
Microalbuminuria
What additional test should be given to patient who are pre-hypertensive?
Echocardiography to identify possible LV hypertrophy in to evaluate the need for treatment
What patients have a goal of less than 140/90?
<60yo, chronic kidney disease or diabetic patients
