Exam 2 - HTN Flashcards
What BP is considered htn?
> 140/90
Why do we worry about HTN?
it can lead to stroke, HF, LVH
Which type of HTN has an unknown etiology, and is 2x greater in blacks?
essential (primary)
Which type of htn is from renal, endocrine, or congenital disease?
secondary
what factors can worsen htn?
fat
salty diet
cigs
nsaids
excess alcohol
what are the causes of htn?
genetics, enviro
inc SNS activity
inc RAA axis
high sodium
endocrine problem
does estrogen cause primary or secondary htn?
secondary
what can htn lead to in the heart?
chd, lvh, hf
what can htn lead to in the brain?
cerebrovascular disease
what else can htn lead to?
PAD
renal disease
which 3 things can cause kidney hypertension (a cause of 2ndary htn)?
renal artery stenosis
hyperplasia (FMH)
atherosclerosis
which comorbidity is associated with morbidity and mortality?
LVH
does LVH cause systolic or diastolic dysfunction?
diastolic
once you have LVH, can it regress?
YES with treatment
is cerebrovascular disease related to systolic or diastolic pressure?
systolic
what are the early symptoms of htn?
asx
morning headaches
what are late symptoms/findings of htn?
LVH causes SOB, DOE
Cerebral - TIA, stroke, hemorrhage
Heart - MI, angina, HF
What will you see in the retina on PE?
AV nicking
silver or copper wiring
hemorrhages or exudates
papilledema
What two lab levels are you especially looking for in htn?
creatinine, BUN
for renal function
What are treatment goals for someone over 60y?
bp < 150/90
Ideal goal is 140 systolic
What are treatment goals for someone under 60y
bp < 140/90
what are treatment goals for anyone over 18y with DM and CKD?
bp < 140/90
What is ideal treatment for HTN in a non-black?
thiazide diuretic
CCB
ACE-I/ARB
what is the ideal treatment for HTN in blacks?
thiazide diuretic
CCB
What is ideal tx for someone 18+ with HTN and CKD?
ACE-I/ARB
What is ideal tx for HTN after an MI?
add BB to whatever
what is ideal treatment for HTN + HF?
ACEI
ideal treatment for HTN + angina
CCB 1st line
BB 2nd line
ideal treatment for HTN + DM?
ACEI/ARB
+/- thiazide diuretics or CCB
How many meds is a hypertensive diabetic patient on on average?
3
Ideal treatment for someone with HTN and trouble urinating?
alpha blockers
What are the treatment guidelines for a person whose BP is >160 systolic or >100 diastolic?
start with 2 drugs
Non pharm treatment for HTN?
diet - low fat, low dairy, low ETOH, low Na
diet - high fruits, high veggies, high fiber
weight reduction
aerobic exercise
smoking cessation
What’s the DOC in htn?
thiazide diuretics
(a part of ANY drug combo)
what do thiazide diuretics decrease?
SVR
who do thiazide diuretics work better in?
blacks, elderly
which type of htn are thiazides best for?
isolated systolic htn
Which drug is less effective in blacks and the elderly?
beta blockers
which selective beta blocker is effective in HTN as well as HF and erectile dysfunction?
Nebivolol
MOA of nebivolol?
vasodilates via nitric oxide
are ACE-I useful as a primary med or as adjunct?
either but work best with diuretics
are direct renin inhibitors like aliskeren better as monotherapy or adjunct?
either
So CCBs are good for HTN but if a person has HF, you can’t give nondihydropyridines.
Why can’t you?
they’re inotropic and slow AV conduction
