Clinical Application to High Blood Pressure Flashcards
Diagnosis of HTN
> 140 and/or 90
On 2 or more office visits
and/or
Current use of antihypertensive medications
Prevelance Demographics
AA>Caucasians> Mexican-Americans
Prehypertension
Systolic: 120-139
Diastolic 80-89
Lifestyle modifications, no meds
Hypertension
Stress Weight Blood glucose Smoking Caffeine Cardiopulmonary fitness
Malignant Hypertension
Hypertastic arteriolosclerosis Younger male AA BP >200/120 Signs/Symptoms: headache, nausea, vomiting, encephalopathy, papilledema, retinal hemorrhage Renal failure
Psuedohypertension
Peripher arteries are rigid from advanced arteriosclerosis, cuff cannot compress the artery
Diabetes mellitus
Chronic renal failure
PAD
Isolated Systolic Hypertension
With age systolic BP rises while diastolic falls
Widened pulse pressure
Systolic > 140
Diastolic
Resistant Hypertension
Failure to reach targeted BP in patients who are on drug therapies (3 drugs including diuretic)
Look into secondary causes
Hypertensive Urgency
Severe elevation without acute end-organ damage
> 180/120 with headache
Can be sent home from office with F/U (if pressure is responsive to meds)
Most commonly are patients who stopped taking their meds
Hypertensive Emergency
Severe elevation WITH acute end-organ damage
Hypertensive encephalopathy, intracerebral hemorrhage, acute MI, acute LV failure, acute aortic dissection, renal crisis, acute glomerulonephritis, microangiopathic hemolytic anemia
Requires hospitalization to lower BP (IV meds, given in ICU)
Hypertensive Emergency Management
Reduce MAP 10-20% per hr
Reduce up to 25-30% in first 24 hours
Transition to oral meds after target pressure stabolizes
EXCEPTIONS: Dissection aortic aneurysm (rapidly lower pressure), acute phase of ischemic stroke (reperfusion candidates, need to rapidly lower pressure to be eligible for tPA)
HTN Clinical Manifestations
Usually none
Silent killer
No symptoms until end organ damage
Diagnosis
ECG Urinalysis Blood glucose and hematocrit Serum K, creatinine, estimated GFR, Ca Fasting lipid profile
Complications of HTN
Risk of CVD beginning at 115/75 and doubles with each increment of 20/10 up to 185/115
Benefits of Lowering Blood Pressure
For each 20 mmHg decrease in systolic BP: 30% decrease heart and 40% decrease risk of stroke mortality
