HTN 1 Flashcards
1
Q
- Elevated Systolic BP
- Elevated Diastolic BP
- Both systolic & diastolic BP elevated
- Often asymptomatic
A
HTN
2
Q
Contraction
A
Systolic
3
Q
Relaxation
A
Diastolic
4
Q
- HTN is a precursor to which 4 main systemic diseases?
- What is the physiology?
A
- Cardiovascular disease***
- Renal failure
- Cerebrovascular disease
- Hypertensive retinopathy
Physiology: The perfusion to these organs are affected, leading to damage.
5
Q
Why do women have higher rates of HTN when they turn 55 compared to when they were 45-54 y/o?
A
Menopause
6
Q
Which race has higher incidence of HTN?
A
African Americans
7
Q
Beginning at a BP of 115/75 mmHg, the risk for CVD doubles for each increment of what?
A
20/10
8
Q
Which type of HTN accounts for 90-95% of all cases?
A
Primary (essential) HTN
9
Q
Which 3 things control BP?
A
- Sympathetic Nervous System
- RAAS
- Plasma volume (mediated by kidneys)
10
Q
What are the 5 modifiable risk factors of HTN?
A
- Smoking
- Diet (sodium)
- Excess ETOH
- Obesity/weight gain
- Physical inactivity
11
Q
- Renal disease
- Medication induced
- Thyroid/Parathyroid disease
- Obstructive sleep apnea (obese patients)
- Pheochromocytoma
A
Causes of Secondary HTN
12
Q
- Coarctation of the Aorta
- Primary Aldosteronism
- Renovascular Disease
- Cushing’s Syndrome
A
Causes of Secondary HTN
13
Q
- 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
A
You should suspect Secondary HTN
14
Q
- Hypokalemia
- Abdominal bruit
- Labile pressures w/ tachycardia, sweating, and tremor
- Family hx of kidney disease
A
Signs of secondary HTN
15
Q
- Myocardial infarction
- Angina
- Coronary revascularization
- Heart failure
A
Heart disease
(Target Organ Damage / End Organ Damage)
16
Q
- Ischemic stroke
- Cerebral hemorrhage
- TIA
A
Cerebrovascular Disease
(Target Organ Damage / End Organ Damage)
17
Q
- Retinopathy
- Renal Disease
- Peripheral arterial disease
A
Target Organ Damage / End Organ Damage
18
Q
- Medications
- Illicit drug use
- Muscle weakness
- Tachycardia
- Sweating
- Tremor
- Thinning skin
- Flank pain
A
Secondary HTN
19
Q
- Early morning headaches
- Daytime somnolence
- Loud snoring
- Erratic sleep
A
Signs of sleep apnea
(Secondary HTN)
20
Q
- Smoking
- Diabetes
- Dyslipidemia
- Physical inactivity
(risk factors for what?)
A
Cardiovascular risk factors
21
Q
- HA
- Transient weakness/blindness
- Loss of visual acuity
- CP
- Dyspnea
- Claudication
- Sexual dysfunction
A
Signs of Target Organ Damage
22
Q
What are 2 additional “vital signs” of a HTN evaluation?
A
- BMI
- Waist circumference
23
Q
What are 4 general PE findings you should assess for when evaluating HTN?
A
- Body fat distribution
- Skin lesions
- Muscle strength
- Alertness
24
Q
- Narrowing of the arterial diameter to less than 50% of venous diameter
A
Grades 1 - 2 Hypertensive Retinopathy
25
* Copper or silver wire appearance
* Exudates 3+
* Cotton wool spots
* Hemorrhages
Grade 3 Hypertensive Retinopathy
26
* Flame hemorrhage
* Hard exudate
* Cotton wool spot
* Papilledema \*\*
Grade 4 Hypertensive Retinopathy
27
What are 2 components of a neck exam needed to evaluate for HTN?
* Thyroid (secondary HTN)
* Carotids
28
2 concerning respiratory PE findings for HTN
* Rhonchi
* Rales
29
3 concerning abdominal PE findings for HTN
* Renal masses
* Renal bruits
* Femoral pulses
30
3 concerning Neuro PE findings for HTN
* Visual disturbance
* Focal weakness
* Confusion
31
Which 2 pulses should you palpate simultaneously when evaluating a patient who may have HTN?
* Brachial
* Femoral
32
* Displaced PMI
* ECG evidence
FIndings for what?
Left Ventricular Hypertrophy (HTN)
33
What murmur will you hear in patient w/ HTN?
S4 (presystolic gallop) due to decreased compliance of left ventricle
34
What 3 arteries do you need to auscultate for bruits when evaluating pt w/ HTN?
* Carotid
* Abdominal (aorta)
* Femoral
35
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)_
36
**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
37
**SBP:** \<120
and
**DBP:** \<80
**Normal BP**
| (2017 ACC/AHA guidelines)
38
**SBP:** 120 - 129
and
**DBP:** \<80
**Elevated BP**
| (2017 ACC/AHA guidelines)
39
**SBP:** 130 - 139
or
**DBP:** 80 - 89
**Stage 1 HTN**
| (2017 ACC/AHA guidelines)
40
**SBP:** \>140 (140 or higher)
or
**DBP:** \>90 (90 or higher)
**Stage 2 HTN**
| (2017 ACC / AHA guidelines)
41
* 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
42
Ex: **SBP:** 125 **DBP:** 83
Stage 1 HTN
43
Ex: **SBP:** 122 **DBP:** 78
Elevated BP
44
* 20 - 25% of Stage 1 HTN
* Pt is hypertensive only in the office
White coat HTN
45
* 10% of patients
* Increased cardiovascular risk
* In office, pt w/ normal BP, but most of the time has high BP at home
Masked HTN
46
What 6 tests should you order to evaluate for HTN?
* CBC
* TSH
* EKG
* UA
* Blood chemistries (glucose, Ca, creatnine, electrolytes, GFR)
* Lipid profile
47
What are 3 tests you might consider ordering to evaluate for HTN?
* Urine albumin excretion
* Echocardiogram
* Sleep study
48
Treatment for pt w/ **normal BP**
**less than 120/80**
(according to ACC/AHA 2017)
* Promote healthy lifestyle habits
* Reassess in 1 year
49
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
50
Tx for Pt w/ **Stage 1 HTN** w/ risk under 10%
**130 - 139 / 80 - 90**
(according to ACC / AHA 2017)
* Nonpharm therapy (lifestyle changes)
51
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
52
Tx for Pt w/ **Stage 2 HTN**
**Over 140/90**
(according to ACC / AHA 2017)
* Nonpharm therapy (lifestyle changes)
* BP lowering medication
