EXAM #2: HYPERTENSION Flashcards
What is the life-time risk for a normotensive person at age 55 for developing HTN?
90%
How much does an increase in 20 mmHg (systolic) or 10 mmHg diastolic increase the risk for CVD?
Doubles it for EACH increase
How much does HTN increase the risk for CVD in women?
Triples the risk
In men, closer to doubles the risk
What is the general trend between HTN and mortality?
Increased HTN= increased mortality
Does JNC VIII define HTN?
No
What does JNC VIII do?
Recommends BP levels to begin drug therapy
What are the determinants from JNC VIII that play into the decision of when to start drug therapy for HTN?
1) Age
2) Coexisting disease i.e.
- DM
- Chronic renal disease
3) Race
IF the BP cuff is too loose, what will happen to your reading?
Overestimation of the BP
IF the BP cuff is too-narrow, what will happen to the BP reading?
Overestimate–it takes more pressure than usual to reach pressures that will occlude the artery
What are the five Korotkoff sounds?
1) Tapping sounds when the brachial artery opens
2) Soft murmurs
3) Louder murmurs
4) Muffling
5) Disappearance
Note that you measure 1st and 5th sounds in adults
What is borderline HTN?
BP occasionally exceeds normal
What is primary HTN?
Elevated BP without a known cause
*Note that 90% of HTN is PRIMARY
What is secondary HTN?
Elevated BP WITH a known cause
What is a HTN emergency?
- Life-threatening circumstance
- Focal/ generalized sx. of target-organ damage
*Requires rapid reduction of BP and typically involves a dBP greater than 120 mmHg
What are signs of target-organ damage?
1) Retinal damage
2) CNS sx.
What is malignant HTN?
HTN retinopathy grade III and IV WITH severe BP elevation
*Evidence of ongoing target organ damage (to the brain b/c the retina is part of the brain)
What is HTN encephalopathy?
Signs/sx. of cerebral edema caused by severe rise in BP
Outline the grading system for Hypertensive Retinopathy.
1) Arteriolar narrowing (take on a shiny copper appearance)
2) AV nicking
3) Hemorrhages and exudates
4) Papilledema
What stages of Hypertensive Retinopathy are indicative of target-organ damage?
Grades 3 and 4
How can you identify papilledema on fundoscopy if you’re unsure?
BVs look like they’re coming out of the side of the optic disc b/c it is pushed upward
What are the possible CNS consequences of HTN?
1) Decreasing cognitive function
2) TIA
3) CVA
What is the leading cause of end-stage renal disease?
Systemic arterial hypertension (SAH)
What are the early effects of SAH on the heart?
- Increased LV mass
- Consequent loss of LV compliance/ diastolic function (filling)
What are the chronic effects of SAH on the heart?
LVH with LV dilation
*Leads to death
What are the effects of SAH on the vascular system?
SAH is a major risk factor for:
1) ASCVD
2) MI
3) HF
4) Sudden cardiac death
What are the major goals in evaluating systemic HTN?
1) Assess CV risk factors
2) Look for identifiable reasons for SAH e.g.
- Renal parenchymal disease
3) Determine target-organ damage
List some of the common conditions that cause secondary HTN.
- Chronic renal parenchymal disease
- Primary aldosteronism
- Renovascular disease
- Cushing’s Syndrome
- Pheochromocytoma
- Coarctation of the aorta
- Thyroid or PTH disease
- Sleep apnea
- Drug-induced or related causes
What is the most common presentation of SAH?
Asymptomatic
What is the most common form of target organ damage in SAH?
IHD
What are the five diseases that require additional attention in SAH?
1) IHD
2) HF
3) DM
4) CKD
5) Cerebrovascular disease
What part of the physical exam should never be omitted on a patient with HTN?
Fundoscopic exam
*B/c this is the only location in the body that you can look directly at the BVs
What are the min. labs that should be ordered for patient with a new diagnosis of SAH?
1) Urine dipstick
2) Fasting glucose
3) Hematocrit
4) Serum creatinine
5) Serum Ca++ and K+
6) Lipid panel
*AND an ECG
What is unprovoked hypokalemia a sign of?
Secondary HTN
What is the utility of Echocardiogram in the diagnosis of SAH?
Determination of LV function
*Note that severe/ refractory HTN with NO LVH= v. recent onset or white coat syndrome
What is the JNC VIII recommendation for a systolic BP in drug therapy?
sBP less than 140 mmHg
What did the recent SPRINT trial show about drug therapy for HTN?
Intensive therapy i.e. a sBP less than 120 mmHg had fewer primary outcomes
Reducing blood pressure reduces what complication the most?
CVA
What are the non-drug therapies recommended for SAH?
1) DASH diet
2) Na+ restriction
3) Regular exercise
4) Maintain healthy weight
5) NO smoking
Why should antacids be avoided in patients with SAH?
Some antacids contain high Na+
According to the JNC VIII, what is the drug of choice for treating HTN?
Thiazide diuretics
What is the JNC VIII recommendation on when to start drug therapy?
sBP= 150 mmHg dBP= 90 mmHg
What is the recommended initial anti-HTN therapy in the black population?
Thiazide diuretic or Ca++ blocker
What is the first-line therapy for HTN in patients with CKD?
ACEI or ARB
What is the most common adverse effect of ACEIs?
Chronic dry cough
