HTN 1 Flashcards
- Elevated Systolic BP
- Elevated Diastolic BP
- Both systolic & diastolic BP elevated
- Often asymptomatic
HTN
Contraction
Systolic
Relaxation
Diastolic
- HTN is a precursor to which 4 main systemic diseases?
- What is the physiology?
- Cardiovascular disease***
- Renal failure
- Cerebrovascular disease
- Hypertensive retinopathy
Physiology: The perfusion to these organs are affected, leading to damage.
Why do women have higher rates of HTN when they turn 55 compared to when they were 45-54 y/o?
Menopause
Which race has higher incidence of HTN?
African Americans
Beginning at a BP of 115/75 mmHg, the risk for CVD doubles for each increment of what?
20/10
Which type of HTN accounts for 90-95% of all cases?
Primary (essential) HTN
Which 3 things control BP?
- Sympathetic Nervous System
- RAAS
- Plasma volume (mediated by kidneys)
What are the 5 modifiable risk factors of HTN?
- Smoking
- Diet (sodium)
- Excess ETOH
- Obesity/weight gain
- Physical inactivity
“POSED”
- Renal disease
- Medication induced
- Thyroid/Parathyroid disease
- Obstructive sleep apnea (obese patients)
- Pheochromocytoma
Causes of Secondary HTN
- Coarctation of the Aorta
- Primary Aldosteronism
- Renovascular Disease
- Cushing’s Syndrome
Causes of Secondary HTN
- HTN onset at young age
- onset of Diastolic HTN at age over 50 yrs
- Target organ damage (end organ damage)
- Poor response to generally effective therapy
You should suspect Secondary HTN
- Hypokalemia
- Abdominal bruit
- Labile pressures w/ tachycardia, sweating, and tremor
- Family hx of kidney disease
Signs of secondary HTN
- Myocardial infarction
- Angina
- Coronary revascularization
- Heart failure
Heart disease
(Target Organ Damage / End Organ Damage)
- Ischemic stroke
- Cerebral hemorrhage
- TIA
Cerebrovascular Disease
(Target Organ Damage / End Organ Damage)
- Retinopathy
- Renal Disease
- Peripheral arterial disease
Target Organ Damage / End Organ Damage
- Medications
- Illicit drug use
- Muscle weakness
- Tachycardia
- Sweating
- Tremor
- Thinning skin
- Flank pain
Secondary HTN
- Early morning headaches
- Daytime somnolence
- Loud snoring
- Erratic sleep
Signs of sleep apnea
(Secondary HTN)
- Smoking
- Diabetes
- Dyslipidemia
- Physical inactivity
(risk factors for what?)
Cardiovascular risk factors
- HA
- Transient weakness/blindness
- Loss of visual acuity
- CP
- Dyspnea
- Claudication
- Sexual dysfunction
Signs of Target Organ Damage
What are 2 additional “vital signs” of a HTN evaluation?
- BMI
- Waist circumference
What are 4 general PE findings you should assess for when evaluating HTN?
- Body fat distribution
- Skin lesions
- Muscle strength
- Alertness
- Narrowing of the arterial diameter to less than 50% of venous diameter
Grades 1 - 2 Hypertensive Retinopathy
- Copper or silver wire appearance
- Exudates 3+
- Cotton wool spots
- Hemorrhages
Grade 3 Hypertensive Retinopathy
- Flame hemorrhage
- Hard exudate
- Cotton wool spot
- Papilledema **
Grade 4 Hypertensive Retinopathy
What are 2 components of a neck exam needed to evaluate for HTN?
- Thyroid (secondary HTN)
- Carotids
2 concerning respiratory PE findings for HTN
- Rhonchi
- Rales
3 concerning abdominal PE findings for HTN
- Renal masses
- Renal bruits
- Femoral pulses
3 concerning Neuro PE findings for HTN
- Visual disturbance
- Focal weakness
- Confusion
Which 2 pulses should you palpate simultaneously when evaluating a patient who may have HTN?
- Brachial
- Femoral
- Displaced PMI
- ECG evidence
FIndings for what?
Left Ventricular Hypertrophy (HTN)
What murmur will you hear in patient w/ HTN?
S4 (presystolic gallop) due to decreased compliance of left ventricle
What 3 arteries do you need to auscultate for bruits when evaluating pt w/ HTN?
- Carotid
- Abdominal (aorta)
- Femoral
What are the screening recommendations for HTN by the USPSTF?
All adults 18+
- 18 - 39 y/o (every 3 - 5 years), w/ normal BP and no risk factors
- 40+ y/o (annually)
- At increased risk for HTN (annually)
What is required for diagnosis of HTN?
- How many readings?
- How many office visits?
Based on the average of:
- 2 (or more) properly measured, seated, BP readings
- on each of 2 (or more) office visits
SBP: <120
and
DBP: <80
Normal BP
(2017 ACC/AHA guidelines)
SBP: 120 - 129
and
DBP: <80
Elevated BP
(2017 ACC/AHA guidelines)
SBP: 130 - 139
or
DBP: 80 - 89
Stage 1 HTN
(2017 ACC/AHA guidelines)
SBP: >140 (140 or higher)
or
DBP: >90 (90 or higher)
Stage 2 HTN
(2017 ACC / AHA guidelines)
- If a patient has BPs within more than 1 category, do we diagnose the higher or lower category?
- Ex: SBP: 130 DBP: 92
- Higher (always round up)
- Stage 2 HTN
Ex: SBP: 125 DBP: 83
Stage 1 HTN
Ex: SBP: 122 DBP: 78
Elevated BP
- 20 - 25% of Stage 1 HTN
- Pt is hypertensive only in the office
White coat HTN
- 10% of patients
- Increased cardiovascular risk
- In office, pt w/ normal BP, but most of the time has high BP at home
Masked HTN
What 6 tests should you order to evaluate for HTN?
- CBC
- TSH
- EKG
- UA
- Blood chemistries (glucose, Ca, creatnine, electrolytes, GFR)
- Lipid profile
What are 3 tests you might consider ordering to evaluate for HTN?
- Urine albumin excretion
- Echocardiogram
- Sleep study
Treatment for pt w/ normal BP
less than 120/80
(according to ACC/AHA 2017)
- Promote healthy lifestyle habits
- Reassess in 1 year
Tx for pt w/ elevated BP
120-129 / less than 80
(according to ACC / AHA 2017)
- Nonpharm therapy (lifestyle changes)
- Reasses in 3 - 6 months
Tx for Pt w/ Stage 1 HTN w/ risk under 10%
130 - 139 / 80 - 90
(according to ACC / AHA 2017)
- Nonpharm therapy (lifestyle changes)
Tx for Pt w/ Stage 1 HTN w/ risk 10% or higher
130-139 / 80-90
(according to ACC / AHA 2017)
- Nonpharm therapy (lifestyle changes)
- BP lowering medication
Tx for Pt w/ Stage 2 HTN
Over 140/90
(according to ACC / AHA 2017)
- Nonpharm therapy (lifestyle changes)
- BP lowering medication
