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CDM1 > Exam 1: HTN > Flashcards

Exam 1: HTN Flashcards

1
Q

Def: blood pressure

A

Pressure of blood pushing against the walls of your arteries

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2
Q

Def: systolic BP

A

Pressure of blood exerting against artery walls when heart is beating

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3
Q

Def: Diastolic BP

A

Pressure of blood exerting against artery walls while heart is resting between beats

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4
Q

Def: Systole

A

Ventricular contraction and blood ejection

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5
Q

Def: Diastole

A

Ventricular relaxation and blood filling

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6
Q

T/F: BP normally rises and falls throughout the day

A

True

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7
Q

Def: HTN

A

When BP is consistently too high

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8
Q

HTN: Uncontrollable Risk Factors: Genetics: 3 factors

A
  1. Race – African Americans develop HTN more often than caucasians (earlier and more severe)
  2. Family History – Predisposes pt developing HTN
  3. Age – BP increases with age >35 (men >45 and women >55)
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9
Q

HTN: Controllable Risk Factors: 6 Factors

A
  1. Obesity: BMI of 30+ more likely to develop HTN
  2. Poor diet: high NA intake, salt sensitivity, low K intake
  3. EtOH: heavy and regular consumption can increase BP
  4. Sedentary lifestyle: Increased likelihood of becoming overweight and developing HTN
  5. Stress: Possible risk factor (difficult to measure)
  6. Smoking
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10
Q

HTN: Drug Induced

A
  • Oral contraceptives
  • decongestants
  • systemic NSAIDs
  • systemic corticosteroids
  • Cyclosporine
  • herbals (Ma Huang, St. John’s Wort)
  • Amphetamines
  • MAOIs, SNRIs, TCAs
  • Recreational drugs (“bath salts”, cocaine)
  • High Na+ agents or solutions
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11
Q

HTN: Etiology

A
  • No clear, readily discernable cause of increased BP (primary or “essential HTN”)
  • Secondary causes: renal artery stenosis, sleep apnea, endocrine disorder, cerebral damage, drug induced
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12
Q

HTN: Normal BP levels + treatment/ f/u recommendations

A

SBP: <120
DBP: <80
Promote optimal lifestyle habits
Reassess in 1 year

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13
Q

HTN: Elevated BP levels + treatment/ f/u recommendations

A

SBP: 120-129
DBP: <80
Non-pharmacologic therapy
Reassess in 3-6 months

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14
Q

HTN: Stage 1 HTN levels + treatment/ f/u recommendations

A

SBP: 130-139
DBP: 80-89
ASCVD < 10% - non-pharmacologic therapy; reassess in 3-6 months
ASCVD > 10% - non-pharmacologic therapy AND BP med; reassess in 1 month

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15
Q

Measuring BP: Cuff length

A

~2/3 of the pt’s arm length

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16
Q

Measuring BP: bladder width

A

~40% of arm circumference

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17
Q

Measuring BP: Bladder length

A

Encircle 80% of arm circumference

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18
Q

Measuring BP: If arm is HIGHER than heart level ____estmiation of BP

A

Under

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19
Q

Measuring BP: If arm if LOWER than heart level __estimation of BP

A

Over

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20
Q

Measuring BP: If cuff is too SMALL, ___estimation of BP

A

over

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21
Q

Measuring BP: If cuff is too LARGE, ___estimation of BP

A

UNDER

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22
Q

HBPM Counseling Points

A
  1. Check and record x2/day (AM before meds, PM before dinner)
  2. Do NOT check BP 30 min after exercise, smoking, or intaking caffeine
  3. Pt should be seated with arm at heart level and resting for at least 5 min
  4. Avoid clothing with tight sleeves
  5. Midline of cuff should be over arterial pulse, lower end of cuff should be above bend of elbow
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23
Q

HTN: ACEI: MOA

A

Inhibits the conversion of Angiotensin I to II

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24
Q

HTN: ACEI: 3 Agents and dosing

A
  1. Lisinopril 10-40mg
  2. Captopril 12.5-150mg (BID/TID)
  3. Enalapril 5-40mg (QD/BID)
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25
Q

HTN: ACEI + ARBs: ADEs

A

ACEI-induced cough (increased bradykinin)
Angioedema (more common in AA pt)
Hyperkalemia
Benign increase in SCr (<30% from baseline)

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26
Q

HTN: ARBs: MOA

A

Antagonizes the angiotensin II type 1 receptor

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27
Q

HTN: ARBs: 3 Agents and Dosing

A
  1. Losartan 25-100mg QD
  2. Valsartan 80-320mg QD
  3. Irbesartan 150-200mg QD
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28
Q

HTN: ACEI and ARBs Clinical considerations

A

First line therapy
2nd line in AA pts due to low renin predisposition
Losartan’s uricosuric properties may be useful in pts with gout

Contraindicated with pregnancy
DO NOT USE ACEI with ARBs

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29
Q

HTN: More than ___ adults in the US have HTN

A

78 million

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30
Q

HTN: Primary Etiology

A

Unknown (~90% of all HTN cases)

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31
Q

HTN: Secondary Etiology

A

Renal artery stenosis, sleep apnea, endocrine disorders, cerebral disorder, drug-induced

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32
Q

HTN: BP = CO x TPR

Most pts with essential HTN have normal ___ but increased ____

A

Normal CO but increased TPR

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33
Q

HTN: ACEI + ARB: Monitor

A

BP, K+, SCr, BUN

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34
Q

HTN: CCBs: 2 Types and MOA

A
  1. DHP CCB - block slow Ca channels in vascular smooth muscle, dilates peripheral arterioles
  2. Non-DHP CCB - block slow Ca channels in myocardium, relaxing coronary vascular sm. muscle, decrease HR and AV node conduction
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35
Q

HTN: CCBs: Agents and dosing

A
  1. DHP CCBs: Amlodipine 5-10mg daily

2. Non-DHP CCBs: diltiazem 120-540mg daily, verapamil

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36
Q

HTN: CCBs: Clinical considerations

A

Alcohol increases effect of CCB
DHP CCB is 1st line therapy
Preferred agent in AA pts and elderly pts with isolated systolic HTN

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37
Q

HTN: CCBs: DHP ADEs

A 
Pedal edema
Gingival hyperplasia
Headache
Reflex tachycardia
Orthostatic hypotension
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38
Q

HTN: CCBs: Non-DHP ADEs

A

Bradycardia

Constipation (verapamil)

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39
Q

HTN: CCBs: Non-DHP Contraindications

A

Heart block and HF

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40
Q

HTN: CCBs: DHP: DDIs

A

Simvastatin doses >20mg (contraindicated)

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41
Q

HTN: CCBs: Non-DHP: DDIs

A 
P450 substrates
Simvastatin doses >10mg (contraindicated)
Beta blockers (avoid use)
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42
Q

HTN: CCBs: Monitor

A

BP
HR
Edema

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43
Q

HTN: Thiazides: MOA

A

Inhibit sodium reabsorption in DCT (increases Na and H2O excretion)

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44
Q

HTN: Thiazides: 2 Agents and dosing

A

HCTZ 12.5-25mg daily

Chlorthalidone 12.5-50mg daily

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45
Q

HTN: Thiazides: Clinical considerations

A

Relative contraindication in sulfa allergy
Use with caution in gout and renal insufficiency
First line therapy
Little efficacy in CrCl <30ml/min
Little benefit from HCTZ doses >25mg
Avoid in pts with active gout flares

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46
Q

HTN: Thiazides: Agent equivalents

A

25mg HCTZ = 12.5mg Chlorthalidone

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47
Q

HTN: Loops: MOA

A

Selectively inhibits NaCl reabsorption in the thick ascending limb of loop of Henle

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48
Q

HTN: Loops: Agent and Dose

A

Furosemide 20-80mg (1-2x/day)

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49
Q

HTN: Loops: Clinical considerations

A

Relative contraindication in sulfa allergy
Use with caution in gout and renal insufficiency
Ethacrynic acid does not contain a sulfa moiety
Preferred in symptomatic HF and later stage CKD (eGFR <30)
Use with caution in tinnitus
Most potent diuretic class

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50
Q

Which diuretic class is MOST potent?

A

Loop

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51
Q

HTN: Loops: Agent equivalents

A

Bumetanide 1mg = torsemide 20mg = furosemide 40mg

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52
Q

HTN: Thiazides and Loop: ADE

A

HYPER: uricemia, glycemia
HYPO: kalemia, natremia, volemia, tension

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53
Q

HTN: Thiazides and Loop: Relative ADEs: Hyperuricemia

A

Thiazides > Loops

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54
Q

HTN: Thiazides and Loop: Relative ADEs: Hyperglycemia

A

Thiazides = Loops

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55
Q

HTN: Thiazides and Loop: Relative ADEs: Hypokalemia

A

Thiazides < Loops

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56
Q

HTN: Thiazides and Loop: Relative ADEs: Hyponatremia

A

Thiazides < loops

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57
Q

HTN: Thiazides and Loop: Relative ADEs: Hypovolemia

A

Thiazides < loops

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58
Q

HTN: Thiazides and Loop: Relative ADEs: Hypotension

A

Thiazides < loops

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59
Q

HTN: Diuretics: Monitor

A

Obtain a complete metabolic panel to assess electrolyte levels and renal fxn 2 to 4 weeks after initiating therapy
K+, Glu, Na+, SCr, CrCl, Lipids, SUA

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60
Q

HTN: BB: MOA

A

Competitively inhibit catecholamine NT at B1 (cardiac) and B2 (SM/lungs) receptors

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61
Q

HTN: BB: Nonselective agents (B1 and B2 activity) and dosing

A

Propranolol 160-480mg BID
Propranolol LA 80-320mg daily
Nadalol 40-120mg daily

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62
Q

HTN: BB: 4 B1 selective (cardioselective) agents and dosing

A

Atenolol 25-100mg daily
Metoprolol succinate 50-400mg (daily, BID)
Metoprolol tartrate 50200mg (BID)
Bisoprolol 2.5-10mg daily

63
Q

HTN: BB: 2 Agents with B2 Agonist properties and dosing

A

Acebutolol 200-800mg BID

Pindolol 5-10mg BID

64
Q

HTN: BB: Mixed a1/BB Agents and dosing

A

Carvedilol (Coreg CR) 20-80mg daily
Carvedilol (Coreg) 6.25-50mg BID
Labetolol 200-800mg BID

65
Q

HTN: BB: Mixed BB/NO Agent and dosing

A

Nebivolol (Bystolic) 6-10mg daily

66
Q

HTN: BB: Nonselective clinical considerations

A

Avoid in pts with reactive airway disease

67
Q

HTN: BB: Cardioselective B1: Clinical Considerations

A

Preferred in pts with bronchospastic airway disease (that require BB) due to limited effect on pulmonary fxn
Selectivity is lost at higher doses

68
Q

HTN: BB: Agents with B2 agonist properties (ISA): Clinical considerations

A

Rarely used
Useful in pts who develop severe bradycardia with other non-ISA BB
Does NOT decrease mortality post MI

69
Q

HTN: BB: Mixed a1/BB: Clinical Considerations

A

Less effect on HR and CO > pure BB
Carvedilol: mortality benefit HF
Labetolol: preferred in pregnancy, hypertensive emergency (IV), has beta agonist effects

70
Q

HTN: BB: Mixed BB/NO: Clinical considerations

A 
B1 selective (3.5x more selective > bisoprolol) 
Role in HF questionable
71
Q

HTN: BB: General considerations

A

Not first line for uncomplicated HTN
Reserve for pts with co-existing condition (useful in HF, SIHD, post MI, afib, migraine, essential tremor)
Abrupt d/c cause rebound HTN (taper over 1-2 weeks)
Fatigue (2-6 weeks)
Caution in asthma/COPD

72
Q

HTN: BB: General Considerations: C/I

A

Sinoatrial or AV node dysfunction, decompensated HF, severe bronchospastic disease

73
Q

HTN: BB: ADEs

A 
Bronchospasm
Bradyardia
Fatigue, exercise intolerance
Insomnia/sleep disturbances
Sexual dysfunction
Masked s/sx of hypoglycemia (except sweating)
74
Q

HTN: BB: DDI with

A

Non-DHP CCBs

75
Q

HTN: Which HTN drug classes should not be used together?

A
  1. BB and Non-DHP
  2. ACEI and ARBs
  3. Direct Renin Inhibitors and ACEI/ARBs
  4. Aldosterone antagonists and K+ sparing diuretics
76
Q

HTN: BB: Monitor

A

BP, HR, Glu if you have DM, Symptoms of asthma/COPD

77
Q

HTN: A1 blockers: MOA

A

Selectively blocks a1 receptors on sm muscle cells of peripheral vasculature

78
Q

HTN: A1 blockers: 3 agents and dosing

A
  1. Doxazosin 1-8mg daily
  2. Prazosin 2-20mg (BID/TID)
  3. Terazosin 1-20mg daily
79
Q

HTN: A1 blockers: Clinical considerations

A

2nd line agent in men with BPH

NO benefit in preventing MI/CHD

80
Q

HTN: A1 blockers: ADEs

A 
Orthostatic hypotension
First dose syncope (1-3 after first dose)
Dizziness
Sexual dysfunction
Reflex tachycardia
Peripheral edema
81
Q

HTN: A1 blockers: Monitor

A

BP

Monitor pt after 1st dose and with each dose increase

82
Q

HTN: A2 agonist: MOA

A

stimulate A2 presynaptic receptors in the brain to increase inhibitory neuron activity and decrease sympathetic outflow

83
Q

HTN: A2 agonists: 3 Agents and dosing

A
  1. Clonidine 0.1-0.8mg BID
  2. Clonidine path 0.1-0.3mg weekly
  3. Methyldopa 250-1000mg BID
84
Q

HTN: A2 agonists: Clinical considerations

A

NOT a first line therapy
Avoid in HF pts
Possibly indicated in resistant HTN (clonidine) or pregnancy (methyldopa)

85
Q

HTN: A2 agonists: ADEs

A

CNS effects (impaired concentration, nightmares, sedation, drowsiness, fatigue, vertigo (methyldopa)
Orthostatic hypotension
Dry mouth
Depression (clonidine)
Abrupt d/c can cause rebound HTN (use clonidine patches to decrease rebound HTN)

86
Q

HTN: A2 Agonists: Monitor

A

BP
Mental state
HR

Methyldopa only: LFTs, CBC

87
Q

HTN: Direct Vasodilators: MOA

A

Act directly on vascular sm muscle to dilate arterioles (not veins)

88
Q

HTN: Direct vasodilators: 2 agents and dosing

A
  1. Minoxidil 10-40mg (QD or BID)

2. Hydralazine 20-200mg (BID/TID/QID)

89
Q

HTN: Direct vasodilators: clinical considerations

A

Little/no place as first-line agents
May consider 3rd or 4th line
For use in resistant HTN

90
Q

HTN: Direct vasodilators: ADEs

A 
Reflex tachycardia, palpitations
Headache, dizziness
Na+/H2O retention
Hirsutism (minoxidil)
Lupus-like syndrome (higher doses of hydralazine)
91
Q

HTN: Direct vasodilators: Monitor

A

BP, HR, SCr, hypotension, edema

92
Q

HTN: Direct Renin inhibitors: MOA

A

Blocks RAAS at its initial point of activation, prevents formation of ATI and ATII

93
Q

HTN: Direct Renin Inhibitors: Agent and dosing

A

Aliskiren 150-300mg daily

94
Q

HTN: Direct Renin Inhibitors: Clinical considerations

A

Do not use with ACEI or ARBs

Similar cautions as ACEI/ARBs

95
Q

HTN: Direct Renin Inhibitors: ADEs

A 
Slight rise in BUN, SCr at initiation of therapy
Hyperkalemia
GI upset (dose-related)
Cough (less than w/ ACEI)
Only 2 cases of angioedema reported
High fat meals decrease absorption
96
Q

HTN: Direct Renin Inhibitors: Monitor

A

K+, BUN, Scr

97
Q

HTN: Aldosterone Antagonists: MOA

A

Inhibitor aldosterone receptor in DCT, increase NaCl/H2O excretion while conserving K+
Block effect of aldosterone on arteriolar smooth muscle

98
Q

HTN: Aldosterone Antagonist: 2 Agents and dosing

A
  1. Eplerenone 50-100mg daily/BID

2. Spironolactone 25-100mg daily/BID

99
Q

HTN: Aldosterone antagonists: Clinical considerations

A

Avoid aldosterone receptors blockers if: Anuria, K+ > 5mEq/L or on K+ supps or K+ sparking diuretics, acute renal insufficiency (eGFR <30ml/min)

100
Q

HTN: Aldosterone antagonists: Special population

A

Used in HF in pts with reduced LVEF, primary aldosteronism, resistant HTN

101
Q

HTN: Aldosterone antagonists: ADEs

A 
Hyperkalemia
Hyponatremia
Gynecomastia (male breast)
Impotence
Hypotension
102
Q

HTN: Aldosterone antagonist: Monitor

A

K+, CrCl

103
Q

HTN: K-Sparing Agents: MOA

A

Reduce Na+ absorption into collecting duct and tubules

104
Q

HTN: K-sparing agents: Agents and Dosing

A

Amiloride 5-10mg daily/BID
Triamterene 50-100mg daily/BID
Triamterene/HCTZ TABS 37.5/25 - 75/50mg daily
Triamterene HCTZ CAPS 27.5/75 = 25/50mg daily

105
Q

HTN: K-sparing agents: Clinical Considerations

A

NOT recommended for initial tx of HTN per ACC/AHA and JNC8
weak diuretics, primarily used to prevent hypokalemia caused by other agents (i.e. thiazide or loop diuretics)
Avoid in pts with significant CKD (GFR <45)
Contraindicated if K>5.5, receiving K supps, or on meds that can increase K

106
Q

HTN: Which 2 med classes are recommended to AVOID if K+ > 5 (5.5), on K+ supps, or meds that can increase K

A

Aldosterone antagonists and K-sparing agents

107
Q

HTN: K-sparing agents: Monitor

A

K+, GFR

108
Q

HTN: Goals of therapy

A

<130/80 per ACC/AHA 2017

109
Q

HTN: Goals of Therapy: Lowest risk of CVD mortality at SBP of ____

A

120-124 mmHg

110
Q

HTN: All guidelines support use of ________ as first line therapy

A

Thiazides, CCBs, ACEI/ARBs

111
Q

HTN Classifications: Normal BP

A

120/80mmHg

112
Q

HTN Classification: Elevated BP

A

120-129/<80 mmHg

113
Q

HTN Classification: Stage 1 HTN

A

130-139/80-90 mmHg

114
Q

HTN Classification: Stage 2 HTN

A

> 140/90

115
Q

HTN Classification: Normal BP: Treatment and F/U

A

Continue healthy lifestyle habits

F/U in 1 year

116
Q

HTN Classification: Elevated BP: Treatment and F/U

A

Encourage therapeutic lifestyle modifications

F/U in 3-6 months

117
Q

HTN Classification: Stage 1 HTN: Treatment and F/U

A

ASCVD< 10%: Lifestyle changes
F/U 3-6 months

Clinical ASCVD, DM, CKD or ASCVD > 10%: pharmacotherapy + lifestyle changes
F/U in 1 month

118
Q

HTN Classification: Stage 2 HTN: Treatment and F/U

A

Start pharmacotherapy + lifestyle changes (consider 2 drugs)

BP >20/10mmHg above goal, start 2 diff meds (use caution for elderly)
BP >160/100 should be promptly treated, carefully monitored, and subject to upward med dose adjustment

F/U in 1 month

119
Q

HTN: which drug classes are shown to prevent CVD and are 1st line of therapy

A

Thiazide, CCB, ACE/ARB

120
Q

HTN: Which drug class is superior for HF prevention?

A

Thiazide superior compared to amlodipine (CCB) and lisinopril (ACEI)

121
Q

HTN: Which drug class is LESS effective for lowering BP and preventing stroke?

A

ACEI less effective than CCB and thiazide

122
Q

HTN: Which drug class is equally effective in reducing CVD events other than HF?

A

CCBs = diuretics

123
Q

HTN: Which drug classes are contraindicated for sulfa allergy?

A

Thiazides and loops

124
Q

What is white coat HTN?

A

Pts get nervous when they get BP measured at a clinic so BP is more elevated than normal

125
Q

Why should pts not use ACEI and ARBs together for HTN?

A

Increased risk of CV and renal risk

126
Q

T/F: BB are recommended as 1st line therapy

A

False – BB are NOT recommended as 1st line in absence of CV co-morbidities such as CAD and CHF

127
Q

HTN: Which drug classes are NOT considered first line?

A

Alpha/beta blockers, alpha agonists, direct vasodilators, aldosterone antagonists, loop diuretics

128
Q

T/F: If pt is not at goal on 2-3 meds, adding fourth med can fix their HTN

A

False – additional treatment above 3 meds tends to be ineffective or poorly tolerated
!!!: consider referral to HTN specialist

129
Q

HTN: Special Populations and Therapy: Black patients

A

Higher prevalence of HTN, lower control rates, higher rates to M/M attributed to HTN

Therapy: Thiazide or CCB (most pts will need 2+ meds to reach goal)

130
Q

HTN: Compare: ACEI and CCB for HF and stroke

A

ACEI LESS effective than CCB in preventing HF and stroke

131
Q

HTN: Compare: Thiazide and ACeI for CVD

A

Thiazide MORE effective in improving cerebrovascular, HF, and combined CV outcomes than ACEI

132
Q

HTN: Compare: CCB and Thiazide for HF

A

CCB LESS effective than thiazide in preventing HF but same for other CV

133
Q

HTN: Compare: ACEI and CCB for reducing BP

A

ACEI is less effective in reducing BP compared to CCB (possibly due to low renin production)

134
Q

HTN: Special Populations and Therapy: Elderly

A

Goal BP <130/80 (use clinical judgement)
Complicated in elderly due to high risks, ADEs, poly-pharmacy, etc.

Therapy: DHP CCBs effective in older pts with ISH

135
Q

HTN: Special Populations and Therapy: Men

A

Antihypertensives have effect on erectile dysfunction
Neutral: ACEI/CCB
Worse: Thiazides/BB

Note: treat compelling indications first

136
Q

HTN: Special Populations and Therapy: Pregnancy

A

Preferred therapies: Hydralazine or labetalol (severe elevations of BP), nifedipine, methyldopa
AVOID: sodium nitroprusside d/t risk of cyanide toxicity

C/I: ACEI/ARB, aliskiren, spironolactone

137
Q

HTN: Special Populations and Therapy: Pregnancy: Preeclampsia

A

BP > 140/90mmHg occuring after 20weeks of gestation in women who were normotensive + one of the following: >300mg proteinuria in 24h, platelets <100,000, LFTs >2x ULN, development of renal dysfunction, pulmonary edema, cerebral/visual disturbances

Eclampsia: preeclampsia + new onset of seizures

Treatment: birth of baby

138
Q

HTN: Special Populations and Therapy: HF

A

BP Goal <130/80 mmHg
1st line:
ACEI - cornerstone of HF therapy
ARB - valsartan and candesartan
BB - class 2-3 HF, metoprolol succinate, bisoprolol, carvedilol
Diuretic
Aldosterone antagonist 0 indicated in NYHA class 2 HF with LVEF <30 or class 3-4

AVOID: non-DHP CCB

139
Q

HTN: Special Populations and Therapy: Post-MI

A

BP Goal: <130/80
1st Line:
ACEI/ARB
BB - choose one without ISA, start with metoprolol

140
Q

HTN: Special Populations and Therapy: Stable Ischemic Heart Disease (SIHD)

A

BP Goal <130/80
1st line: BB, ACEI/ARB

BB: metoprolol, carvedilol, nadolol, bisoprolol, propranolol, timolol (AVOID atenolol)

Uncontrolled HTN:

  • with angina: DHP CCB
  • without angina: DHP CCB, thiazide, or aldosterone antagonist
141
Q

HTN: Special Populations and Therapy: Diabetes

A

Goal <130/80
Therapy: ACEI/ARB (CCB or thiazide)
ACEI/ARB recommended in pt with UACR > 300mg/g or 30-299mg/g
CCB/Thiazide first line for AA pts
Loop diuretic considered if CrCl/eGFR <30

142
Q

HTN: Special Populations and Therapy: CKD

A

BP Goal 130/80
1st line: ACEI/ARB
2nd line (add on) or 1st line with stage 1 or 2 CKD and UACR <300:
- Thiazide (less effective than loops in pts with decreased kidney fxn)
- CCB (non-DHP > DHP in terms of kidney protection, BUT DHPs preferred due to ADE profile)

143
Q

HTN: CKD Definition

A

Kidney damage for > 3 months (GFR <60 for at least 3 months, with or without UACR > 300)

144
Q

HTN: Special Populations and Therapy: Recurrent Stroke Prevention

A

BP Goal: <130/80 (lower BP to goal once stabilized)
1st line: ACEI/ARB, thiazide, combination of 2 (combo shown to decrease incidence of recurrent stroke)
2nd line: CCB, aldosterone antagonist

145
Q

HTN: Resistant HTN

A

Office BP above goal AND >3 HTN meds
Office BP at goal with >4 HTN meds
Risk factors: older age, obesity, CKD, black race, DM

146
Q

HTN: Hypertensive Urgency vs Emergency

A

Urgency: Severe elevation >180/120 without target organ damage (TOD), cause usually non-adherence

Emergency: BP >180/120 with TOD
Decrease BP by 25% within 1 hour, immediate treatment with IV agents to salvage viable organ tissue

147
Q

HTN: Non-pharmacological treatment: Examples

A

Weight reduction, exercise, decrease Na intake, increase potassium intake, decrease alc intake, DASH diet

148
Q

HTN: Non-pharmacological treatment: Weight reduction

A

5-10% of weight loss (ultimate goal IBW)
~1 mmHg for 1kg lost
Synergy from weight loss and HTN meds

~5mmHg SBP reduction

149
Q

HTN: Non-pharmacological treatment: Exercise

A

30-45min or aerobic activity most days of the week OR 90-150 min per week
Regular and modest aerobic activity decreases BP in normotensive and HTN pts

~5-8 mmHg SBP reduction

150
Q

HTN: Non-pharmacological treatment: Sodium intake

A

< 2.4g of Na+/day (~1 tsp of table salt)
Optimal goal <1.5g of Na+/day
Reduce daily Na+ intake by 1g from initial

Decreases salt and water retention

~5-6 mmHg SBP reduction

151
Q

HTN: Non-pharmacological treatment: Potassium intake

A

3500-5000mg K+/day through diet
K+ can lower BP especially in pts (response can double)

~4-5 mmHg SBP reduction

152
Q

HTN: Non-pharmacological treatment: Alcohol Consumption

A

Men: limit to 2 drinks/day
Women: limit to 1 drink/day
Most benefit in pts who drink more than 3 drinks/day

~4mmHg SBP reduction

153
Q

HTN: Non-pharmacological treatment: DASH diet

A

Fresh foods, low fat dairy, reduced sat fats, avoid processed foods
Particularly effective for middle-aged and older pts, African-americans, and those who already had high BP

~11 mmHg SBP reduction

154
Q

HTN: Non-pharmacological treatment: Other coniderations

A

Limit caffeine to 2 cups/day or 8 fl oz
Smoking cessation
Nutritionist referral?

CDM1 (19 decks)

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