HTN 1 - olenik Flashcards
what is the most significant risk factor for CVD?
HTN
what are the long term consequences of HTN?
left ventricular hypertrophy
angina
MI
coronary revascularization
HF
stroke or TIA
CKD
peripheral vascular disease
retinopathy
what is essential HTN?
elevated arterial BP with an unknown etiology
what is secondary HTN?
elevated arterial BP due to concurrent medical conditions or medications
identifiable cause
what is isolated systolic HTN?
systolic BP values are elevated
diastolic BP values are not
what is resistant HTN?
fail to attain goal BP while adherent to regimen that includes at least 3 agents at max dose (including a diuretic) or when 4+ agents are needed
what is orthostatic hypOtension?
a systolic Bp decrease of over 20 mmHg
a diastolic BP decrease of over 10 mmHg within 3 minutes of position change
AND/OR
an increase in heart rate over 20 BPM
what is the pathophysiology of essential HTN?
humoral abnormalities
neuronal mechanisms
vascular endothelial mechanisms
peripheral auto regulation defects
electrolyte distrubances
how should blood pressure be solved?
CO x TPR
how should cardiac output be solved?
HR x SV
what are modifiable HTN risk factors?
high sodium intake
obesity
low potassium intake
excessive alcohol intake
what are non-modifiable HTN risk factors?
age
ethnicity
genetic predisposition
gender
how does age and gender correlate to risk factors of HTN?
under 55: male > female
55-64: female > male
over 64: female»_space; male
why do females have a higher risk factor of HTN as they age?
during menopause, females lose the hormones that help control it better
what are substances that can increase BP?
illicit drugs
caffeine
nicotine
decongestants
amphetamines
antidepressants
atypical antipsychotics
immunosuppressants
OCs
NSAIDs
systemic steroids
oncology agents
what are the types of BP measurement techniques?
in-office
ambulatory BP monitoring (ABPM)
home BP monitoring (HBPM)
how should in-office BP readings be taken?
two readings 5 minutes apart with the patient sitting in a chair
confirmed elevated reading in opposite arm
what are the indications of ambulatory BP monitoring?
white coat and masked HTN
nighttime BP dipping
what are the indication of home BP monitoring?
white-coat and masked HTN
to evaluate the response to therapy
to improve adherence
how is normotensive classified in each setting?
no HTN in all
how is sustained HTN classified in each setting?
HTN in both
how is masked HTN classified in each setting?
office/clinic/healthcare –> no HTN
home –> HTN
how is white coat HTN classified in each setting?
office/clinic/healthcare –> HTN
home –> no HTN
what are benefits of HBPM and ABPM?
confirm diagnosis
aide in medication titration
identify white coat and masked HTN
better predictor of long-term CV outcomes
what are the cons of HBPM and ABPM?
user error
equipment cost
insurance reimbursement
what is normal BP?
under 120/80
what is elevated BP?
120-129 / under 80
what is HTN stage 1?
130-139 / 80-90
what is HTN stage 2?
+140 / +90
how should normal BP be treated?
promote a healthy lifestyle
reassess BP in 1 year
how should elevated BP be treated?
recommend non-pharm tx
reassess BP in 3-6 months
how should HTN stage 1 be treated?
pt has ASCVD risk >10% or specific comorbidity –> use non-pharm, a medication, and reassess BP in 1 month
none –> nonpharm with reassess BP in 3-6 months
how should HTN stage 2 be treated?
non-pharm interventions and 2 meds
reassess BP in 1 month
what is BP threshold for most treatment initation?
130/80
what is BP threshold for secondary stroke prevention or no clinical CVD and 10 year ASCVD risk under 10%?
140 / 90
what is goals of treatment for HTN?
decrease morbidity/mortality
reach BP targets
select agents with proven CV benefit
what is the BP goals per ACC/AHA guidelines?
under 130/80 but under 140/90 for elderly
why is the BP goal for elderly less strict?
high comorbidity burden
limited life expectancy
greater chance of a hypoglycemia risk and fall risk
what is BP goal per KDIGO guidelines?
SBP under 120 for adults with elevated BP and CKD
what were the outcomes of the SPRINT trial?
intensive treatment group had 25% lower risk of primary CV composite outcomes
27% reduced risk of death
2.8 meds required on average
increased risk of electrolyte abnormalities, hypotension, and AKI
what are the outcomes of the ACCORD trial?
intensive treatment group had no benefit in primary composite outcome
41% reduced risk of stroke
increased risk of AE
how does weight loss decrease SBP?
by 5 mmHg
how does the DASH diet decrease SBP?
by 11 mmHg
how does decreasing sodium intake decrease SBP?
by 5 to 6 mmHg
what is the recommend sodium intake levels?
under 1500 mg/day or 1000mg reduction per day
how does enhancing potassium intake decrease SBP?
by 4 to 5 mmHG
what is the recommended potassium intake per day?
3500 to 5000 mg
how does physical activity impact SBP?
decrease by 4 to 8 mmHg
how does moderate alcohol intake impact SBP?
decrease by 4 mmHg
what is the recommended alcohol intake?
2 for men
1 for women
what foods are apart of the DASH diet?
vegetables
fruits
whole grains
fat-free or low-fat dairy products
fish
poultry
beans
nuts and vegetable oils
foods rich in K, Ca, Mg, fiber, protein, and lower in sodium (1500mg/day)
what foods should be limited while on DASH diet?
high in saturated fats (fatty meals, full-fat dairy products, tropical oils)
sugar-sweetened beverages and sweets
what is pharm treatment options for HTN?
ACEi
ARBs
CCB
direct renin inhibitors
beta blockers
diuretics
alpha-1 blockers
central alpha-2 agonists
vasodilators
