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Mar: Sem 2 - Health Assessment > Exam 4 Hypertension part I > Flashcards

Exam 4 Hypertension part I Flashcards

1
Q

how is HTN defined by the american college of cardiology and AHA?

A
  • sustained SBP > 130 mmHg
  • and/or a DBP > 80 mmHg

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2
Q

HTN
* effects > ____ million people in US
* nearly ____ adults

A
  • 100 million
  • 1/2

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3
Q

HTN effects ____% of African Americans, ____% of Whites, ____% of Asians, ____% of Hispanics

A
  • 40%
  • 30%
  • 29%
  • 27%

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4
Q

HTN Ddsproportionately effects ____ income countries, and the lifetime rx of developing HTN in the US is ____%

A
  • low-middle
  • 90%

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5
Q

What are the classifications of BP in adults:
* normal
* elevated
* stage 1 HTN
* stage 2 HTN

A

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6
Q

Clinical consequences of chronically elevated BP underscore a high age-related association with …?

A
  • ischemic heart disease
  • stroke
  • renal failure
  • retinopathy
  • PVD
  • overall mortality

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7
Q

In the surgical population, studies have found HTN to be a common risk factor for perioperative ____, particularly if untreated

A

morbidity & mortality

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8
Q

Chronic HTN represents a spectrum of elevated blood pressure to severe disease. What are the 3 different classes and how are they defined?

A
  • isolated systolic HTN (SBP >130 mm Hg and DBP < 80 mm Hg)
  • isolated diastolic HTN (SBP < 130 mm Hg with DBP >80 mm Hg)
  • combined systolic and diastolic HTN (SBP >130 mm Hg and DBP >80 mm Hg)
  • risk association, pharmacologic therapy, and tx goals can vary among subtypes

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9
Q

In addition to SBP and DBP elevation, a ____ is alsoa risk factor for cardiovascular morbidity as it correlates withvascular remodeling and “stiffness”

A

widened pulse pressure

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10
Q

HTN can result from a wide range of primary & secondary processes that increase …?

A
  • cardiac output
  • vascular resistance
  • or both

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11
Q

The cause of primary HTN is unclear, but contributing factors include ?

A
  • SNS activity
  • dysregulation of the RAAS
  • deficiency in endogenous vasodilators

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12
Q

Genetic and lifestyle risk factors assoc w/HTN include

A
  • obesity
  • alcoholism
  • tobacco

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13
Q

A minority of pts w/ HTN havesecondary HTN resulting from a potentially correctable ____ or ____ cause

A

physiologic or pharmacologic

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14
Q

what does this graph show?

A
  • Top L: Correlation btw SBP and Ischemic heart dz mortality across 5 age groups
  • Top R: Correlation btw DBP and Ischemic heart dz mortality across 5 age groups
  • Bottom L:Correlation btw SBP and Stroke mortality across 5 age groups
  • Bottom R: Correlation btw DBP and stroke mortality across 5 age groups

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15
Q

what drugs may elevate blood pressure?

A
  • antiinfective
  • antiinflammatory
  • chemotherapeutc
  • herbal
  • illicit
  • immunosuppressive agents
  • psychiatric
  • sex hormones
  • steroirds
  • sympathomimietics
    CHIAA PISSS elevates my BP

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16
Q

Most comon causes of secondary HTN in children (birth -12 yr) and % of pt with thunderlying cause.

A
  • renal parenchymal disease 70-85%
  • coartation of the aorta

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17
Q

Most comon causes of secondary HTN in adolescents (12 -18 yr) and % of pt with thunderlying cause.

A
  • coratation of aorta 10-15%

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18
Q

Most comon causes of secondary HTN in young adults (19-39 yr) and % of pt with thunderlying cause.

A
  • thyroid dysfunction 5%
  • fibromuscular dysplasia
  • renal parenchymal disease

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19
Q

Most comon causes of secondary HTN in middle aged adults (40-64yr) and % of pt with thunderlying cause.

A
  • hyperaldosteronism 8-12%
  • thyroid disfunction
  • OSA
  • cushing syndrome
  • pheochromacytome

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20
Q

Most comon causes of secondary HTN in older adults (> 65 yr) and % of pt with underlying cause.

A
  • 17%
  • atherosclerotic renal artery stenosis
  • renal failure
  • hypothyroidism

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21
Q

Chronic HTN leads to remodeling of ____, ____ dysfunction, and potentially irreversible ____.

A
  • small & large arteries
  • endothelial
  • end-organ damage

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22
Q

Disseminated vasculopathy plays a major role in:

A
  • ischemic heart dz
  • LVH
  • CHF
  • CVA
  • PAD
  • aortic aneurysm
  • nephropathy

I like Coochies Cuz Pussies Are Nasty

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23
Q
  • ____ of the common carotid intimal to medial thickness and arterial pulse-wave velocity can provide an early dx of vasculopathy
A
  • Ultrasound measurement

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24
Q

____ and ____ indexes may track progression of LVH

A

Echocardiographic and electrocardiographic

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25
Q

MRI can be used to follow microangiopathic changes indicative of ____

A

cerebrovascular damage

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26
Q

what are examples of end organ damage d/t HTN?

A

Vasculopathies
Cerebrovascular Damage
Heart Disease
Nephropathy

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27
Q

what is the general therauptic goal for HTN?

A

SBP < 130
DBP < 80

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28
Q
  • ____ million people in US have untreated HTN
  • ____ million treated pts are above their BP goal
A
  • 28
  • 29

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29
Q

what is resistant HTN? what is the treatment?

A
  • above-goal BP despite 3+ antihypertensive drugs @ max dose
  • Tx usually includes a LA CCB, an ACI-I or ARB + a diuretic

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30
Q

what is controlled resistant HTN?

A

controlled BP requiring 4+medications

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31
Q

what is refractory HTN?

A
  • uncontrolled BP on 5+ drugs
  • present in 0.5% of pts

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32
Q

____ HTN (intolerance to drugs) can result from BP inaccuracies (including white-coat syndrome) or medication noncompliance

A

Pseudo-resistant

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33
Q

what are lifestyle modifications that decrease BP?

A
  • weight loss
  • ↓ETOH
  • exercise
  • smoking cessation

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34
Q

there is a continous relationship between increased ____ and ____

A

increased BMI and HTN

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35
Q

____ is an effective nonpharmacologic intervention, through direct BP reduction and synergistic enhancement of drug efficacy

A

Weight loss

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36
Q

Overweight adults should aim for ideal body weight, but can expect a 1 mmHg reduction in BP for every ____kg of weight loss

A

1mmhg reduction in BP for every 1 kg of weight loss

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37
Q

Even modest increases in physical activity areassocwith?

A

BP decrease

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38
Q

Excessive alcohol use isassociated with?

A
  • ↑HTN
  • may cause resistance toantihypertensive drugs

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39
Q

Dietary ____ and ____ intake are inversely related to HTN andcerebrovascular disease

A

potassium and calcium

sldie 12

40
Q

____ isassocw/small but consistent BP decreases

A

Salt restriction

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41
Q

the most recent ACC/AHA guidelines for BP management outlined 8 conclusions:

A
  1. Out-of-office BP’s are recommended for diagnosis and titration of antihypertensive meds
  2. Evidence supports treating pts with ischemic heart dz, cerebrovascular dz, CKD, or atherosclerotic cardiovascular dz w/ BP meds if SBP > 130 mmHg
  3. There is limited data to support treating pts w/o cardiovascular or cerebrovascular dz with nonpharmacologic therapy if SBP > 130 or DBP >80
  4. The same goals are recommended for HTN pts w/DM or CKD as for the general HTN population
  5. ACE-I’s, ARBs, CCBs, or thiazide diuretics are useful and effective in nonblack HTN pts,including those with diabetes
  6. In black adult HTN pts w/o heart failure or CKD, including those with DM, there ismoderate evidence to support initial antihypertensive therapy with a CCB or thiazidediuretic
  7. There is moderate evidence to support antihypertensive therapy with an ACE-I or ARB in those with CKD to improve kidney outcomes
  8. Nonpharmacologic interventions are important components to a comprehensive BPmanagement approach

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sorry this is so long :(

42
Q

Notably absent from 1st line therapy are ____, which are reserved for pts w/ CAD or tachydysrhythmia, or a component of multidrug tx in resistant HTN

A
  • β blockers

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43
Q

what 15 different drug classes have been approved for HTN?

A

slide 15

44
Q

Treatment of secondary HTN is often interventional, including

A
  • surgical correction of renal artery stenosis, adrenal adenoma or pheochromocytoma

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45
Q

If renal artery repair not possible, BP control may be accomplished w/ACE-I’s alone or w/ diuretics, although ACE-I’s, ARBs, and direct renin inhibitors are not recommendedin bilateral renal artery stenosis because?

A

they can accelerate renal failure

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46
Q

Primary hyperaldosteronism can be treated w/ an aldosterone antagonist such as ____

A

spironolactone

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47
Q

Certain disease processes, such as ____, require a combined pharmacologic and surgical approach

A

pheochromocytoma

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48
Q

Preop considerations for Secondary HTN

  • Preop BP assessment is often complicated by ____
  • Pts are often instructed to pause BP meds, such as ____ on the day of surgery
A
  • anxiety (white-coat HTN)
  • ACE-I’s & diuretics

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49
Q
  • Can a single BP give an accurate picture of BP trends?
  • What are current guidlines for a diagnosis of HTN?
A
  • Assessing BP in a single moment in time does not give an accurate picture of overall BP trends
  • Current guidelines state that multiple elevated BP readings over time are necessary for a diagnosis of HTN

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50
Q

what should you do is BP is elevated?

A

a pressure on the contralateral arm should be obtained

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51
Q
  • A careful review of clinic data, homeBP’s, and a thorough history are necessaryto gain an overall picture of ____
  • ____ is not a direct prompt to delay surgery in asymptomatic pts w/oother risk factors
A
  • cardiovascular health
  • Elevated BP

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52
Q

surgery should NOT be delayed d/t transient elveated BP unless…?

A
  • patient is experiencing extreme HTN (SBP >180 or DBP >110)
  • or end-organ injury that could bereversed w/BP control

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53
Q

The cause of secondary HTN may be indicated by the symptoms:

A
  • flushing, sweating & palpitations suggestive of pheochromocytoma
  • renal bruit suggestive of renal artery stenosis
  • hypokalemia suggestive of hyperaldosteronism

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54
Q

what antihypertensive meds should you stop before surgery and which ones do you continue?

A
  • possibly stop ARBs and ACE-I’s
  • dont stop BB, clonidine or CCB’s
    • BB and clonidine can have rebound effects
    • CCBs can have increased perioperative CV events

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55
Q

Although guidelines don’t support delaying surgery for poorly controlled BP, perioperative HTN ____ as well as the incidence of ____ and ____

A
  • increases blood loss
  • MI & CVA

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56
Q

Hypertensive pts are prone to ____ d/t physiologic factors along with the BP meds on-board

A

intraop hemodynamic volatility

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57
Q

When superimposed on the organ damage from chronic HTN, even brief periods of hypotension are assoc with?

A
  • acute kidney injury
  • myocardial injury
  • and death

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58
Q

Clinicians need to consider acute intraoperative BP changes in the context of ____?

A

end-organ functional reserve

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59
Q

what can lead to LVH?

A
  • hemodynamic load
  • BP magnitude [afterload]
  • hypervolemia [preload]
  • elevated pulse wave velocity
  • age
  • sex
  • ethnic factors
  • genes [positive FH]
  • salt consumption
  • obesity
  • SNS
  • catcolamines
  • angiotesin II
  • aldosterone

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60
Q

what can LVH lead to?

A
  • reduced coronary reserve [microangiopathy]
  • impaired contractility
  • reduced LV filling
  • Afib or ventricular dystrhymias

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61
Q

what does reduced cornary rserve (microangiopathy) lead to?

A

myocardial infarction [macroangiopathy]

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62
Q

what does impaired contractility [systolic] and reduced LV filling [diastolic] cause?

A

heart failure

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63
Q

what does afib or ventricular dysrhytmias lead to?

A
  • sudden death
  • cardiac emboli

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64
Q

HTN pt are hemodynamically vulnerable to induction of ?

A

general anesthesia

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65
Q
  • Induction drugs produce ____
  • DL & intubation elicit ____ & ____
A
  • HoTN
  • HTN & tachycardia

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66
Q

A pre-induction A-line, followed by a multimodal induction that includes ____ may be beneficial

A

short acting beta blocker (Esmolol)

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67
Q

Poorly controlled HTN is often accompanied by ____, especially if the pt ison a diuretic

A

volume depletion

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68
Q

In some pts, modest volume loading prior to induction may provide better____

A
  • hemodynamic stability
  • this approach may be counterproductive in pts with LVH and diastolic dysfunction

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69
Q

vasoactive drug considerations should take into account:

A
  • pt’s age
  • functional reserve
  • medications
  • planned operation

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70
Q

____ is categorized as either urgent or emergent, b/o the presence of progressive organ damage

A

hypertensive crisiis

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71
Q

Pts w/chronic HTN tend to tolerate a higher ____ than normotensive pts

A

SBP

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72
Q

Perioperative emergencies in HTN crisis may include:

A
  • CNS injury
  • kidney injury
  • cardiovascular insult

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73
Q

Women w/ PIH may show evidence of end-organ dysfunction (in particular encephalopathy) with a DBP ____.

A

> 100

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74
Q

Current guidelines for peripartum HTN recommends immediate intervention for what BP parameters?

A

SBP >160 / DBP>110

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75
Q

In hypertension:
* BP must be titrated down slowly to avoid ____.
* ____ monitoring can facilitate this process
* ____ is a 1st line drug for peripartum HTN

A
  • overshooting
  • Aline
  • Labetalol

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76
Q

For rapid arterial dilation and BP reduction, ____ infusion isthe gold standard, as it has a fast onset and titratable

A

SNP [sodium nitropresside]

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77
Q

if SNP is not available what is a newer medication that can be used?

A

Clevidipine, a 3rd-generation dihydropyridine CCB with an ultrashort DoA (≈1-min half-life) and selective arteriolar vasodilating properties

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78
Q

in HTN crisis if SNP and clevidipine is not available what else can be used?

A

Nicardipine, a second-generation dihydropyridine CCB, but has a longer half-life (≈30 min), making it less titratable than clevidipine

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Mar: Sem 2 - Health Assessment (32 decks)

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