Clinical Series Mutafova Flashcards
T/F prevalence of hypertension depends on age.
True. The prevalence of HTN increases with age.
T/F All patients with HTN will feel a physical change as a result of their high blood pressure.
False. Some patients never feel that they have HTN. Sort of asymptomatic.
What are the differences b/w men & women when it comes to HTN?
Below age 45, more men w/ HTN.
B/w age 45 & 65 equal amount of men & women w/ HTN.
After age 65, more women have HTN.
More women than men manage their HTN well.
What is the most common reason for a scheduled visit to the doctor?
HTN–huge economic burden
T/F Approximately 35 million people (around 10%) of Americans have HTN.
False. Around 78 million ppl have HTN in the U.S.
What associated diseases cause HTN to be such a high risk for morbidity?
Coronary Artery Disease
Stroke
Kidney Failure
What is pre-hypertension?
Ppl w/ blood pressure in these ranges.
Systolic: 120-139
Diastolic: 80-89
What is considered Stage 1 HTN?
Ppl w/ blood pressure in these ranges.
Systolic: 140-159
Diastolic: 90-99
What is considered Stage 2 HTN?
Ppl w/ blood pressure in these ranges.
Systolic: Over 160.
Diastolic: Over 100.
What is the usual BP target? What is the BP target for those w/ Diabetes?
Usual BP target: less than 140/90
Diabetes BP target: less than 130/80
What is primary or essential HTN?
It is high blood pressure with no clear cause & is probably caused by genetics, poor diet, lack of exercise, obesity. No clear cause.
What is secondary HTN?
High blood pressure caused by a different medical condition. Some of these medical conditions include: renal parenchymal disease renovascular HTN Pheochromocytoma Obstructive Sleep Apnea Thyroid Disease Coarctation of the Aorta
What is the difference b/w hypertensive urgency & emergency?
Urgency is a BP over 180/110 w/o organ damage.
Emergency is BP over 180/110 w/ organ damage.
What are examples of organ damage that are associated w/ hypertensive emergency?
Stroke Angina Pulmonary Edema Aortic Dissection Damage to Eyes & kidneys
If a patient has a BP of 170/110…what is this considered?
Hypertensive Crisis. Either systolic of 180 or higher OR diastolic of 110 or higher.
This hypertensive crisis can be either a hypertensive urgency or emergency.
If a patient has a BP of 190/90…and is using LSD…what is this considered?
Hypertensive Crisis b/c systolic over 180.
Hypertensive Emergency b/c of the use of LSD.
If a patient has a BP of 190/110…and is experiencing eclampsia…what is this considered?
Hypertensive Crisis b/c systolic over 180 & diastolic is 110 or higher.
Hypertensive Emergency b/c of eclampsia.
What is resistant hypertension?
BP that stays high despite 3 different types of HTN meds (3 different mechanisms of action).
What are some risk factors for resistant HTN?
Old age Obesity Obstructive Sleep Apnea Diabetes Chronic Kidney Disease
What is one of the complicating factors in diagnosing resistant HTN in a patient?
True resistant HTN is rare.
Need to make sure that the pt is being adherent to the BP meds.
Need to make sure it is not White Coat Syndrome.
So may be helpful to monitor BP 24 hours.
What is malignant HTN?
HTN that is somewhat difficult to treat & is associated w/ rapidly progressive end organ damage.
What do you call it when you have a patient w/ somewhat uncontrollable HTN w/ hypertensive encephalopathy?
Malignant HTN
What are some possible reasons for resistant HTN?
Sympathetic outflow that is way too high.
Abnormal renal salt & water handling.
Too high aldosterone or renal activity
Cardiac output, venoconstriction, & vasoconstriction that is variable.
HTN is a multifactorial disease. Explain in light of this the mosaic theory of BP regulation.
Basically it says, we don’t know what causes HTN. But these are interacting factors.
Environment–salt intake in diet
Genetics–predisposiiton
Anatomical–coarctation of the aorta
Adaptive–like the giraffe needs high BP to get blood to his head.
Hemodynamic–
HTN is a multifactorial disease. Explain in light of this the mosaic theory of BP regulation.
Basically it says, we don't know what causes HTN. But these are interacting factors. Environment--salt intake in diet Genetics--predisposiiton Anatomical--coarctation of the aorta Adaptive--like the giraffe needs high BP to get blood to his head. Hemodynamic--like blood volume Humoral Intrauterine programming Endocrine Neural Renal
What are 2 important factors that play a role in Page’s mosaic theory of HTN?
Reactive Oxygen Species
Inflammation
**they tend to increase sympathetic output, vascular tone, & sodium retention.
What are the 2 main mechanisms of creating HTN & what conditions contribute to each?
Increased Cardiac Output: Hypervolemia...like RAS Stress Pheochromocytoma Increased TPR: We don't know-->Primary HTN Athersclerosis Diabetes Stress Pheochromocytoma
What does Chronic BP elevations do to arteriolar blood vessels?
It causes hypertrophy of the blood vessel.
An increase in wall thickness
An increase in TPR
Somehow affects salt & water excretion
T/F Healthy eating & exercise should be done at all stages of HTN.
True.
What is the main goal of anti-hypertensive treatment?
To reduce the lifetime risk of cardiovascular disease.
For high risk patients: BP less than 130/80
When is monotherapy (or one drug therapy) indicated to treat HTN?
With Pre-HTN w/ other problems.
With Stage 1 HTN.
When are multiple HTN drugs required for treatment?
With Stage 2 HTN & any form of HTN that has other problems & calls for it.
Why would you use a combination of high renin & low renin drugs to treat HTN?
It is important to use drugs with different mechanisms of action in treating HTN.
BP control from taking 2 drugs can improve if….
the effects of the 2 drugs are additive or synergistic.
What 2 things can superior tolerability refer to in HTN treatment?
It is safer to treat a pt w/ 2 smaller doses of 2 different anti-HTN drugs instead of a higher dose of 1 anti-HTN drugs b/c of dose-dependent side effects.
OR
Side effects of one drug are neutralized by the taking of another drug.
