HTN Flashcards
Stage 1 and 2 HTN in kids
kids <13 years
Normal: systolic and diastolic less than 90th %ile for age, sex, height
HTN: SBP, DBP, or both in 95th + %ile for age, sex, height on three separate occasions
Elevated BP: avg SBP or DBP >90th and 95th %ile (pre-hypertension)
Stage 1: BP 95th-99th %ile
Stage 2: BP >99th %ile
Stage 1 and 2 HTN in adolescents > 13 years
elevated: SBP and/or DBP >120/80 to 129/<80
HTN >130/80
Stage 1: BP >130/90 to 139/89
Stage 2: BP >140/90
Managing kids HTN / exam
Measure BP annually on all children age 3+
Elevated BP: at least 2 f/u BP measurements w/in 1-2 months of initial
If less than 95th %ile, continue to check with routine annual visits
Goal: reduce systolic or diastolic to <95th %ile
Meds given for kids HTN
Medication initiation: consult cardiology
Usually ACE or ARB, beta blocker, long acting CCB or thiazide
Start at lowest recommended dose
Type of HTN in pregnancy …
BP >140/90 <20wks, persistent >12 weeks PP
No proteinuria
Asymptomatic
Chronic HTN
Type of HTN in pregnancy …
BP >149/90 >20 wks, normal by 12 wks PP
No proteinuria
Asymptomatic
Gestational HTN
Type of HTN in pregnancy ... Mild: >149/90; Severe: >160/110, normal by 12 weeks PP Proteinuria Mild: >2g/24hr or >1+ dip Severe: >5g/24h or >3+ dip Platelets: <100,000 AST, ALT elevated LDH elevated Serum creatinine >1.2
Preeclampsia
Sx of ______
Symptoms: AMS, h/a, visual disturbances, pulmonary edema, epigastric pain, <500mL UOP/day, thrombocytopenia, hemolytic anemia
Preeclampsia
Type of HTN in pregnancy ... BP >140/90 <20 wks, persistent >12wks PP Proteinuria: New onset: protein >2g/24hrs, >20wks Sudden increase in BP Sudden increase in urine protein Low platelet count <20 wks Symptoms: same as preeclampsia
Superimposed preeclampsia
When to give pregnant woman meds for HTN?
what meds are safe
Antihypertensive if BP >160/80
Nifedipine; labetalol, methyldopa
Expectant management for expectant moms with HTN
delivery at 37 wks gestation Antenatal testing: twice weekly for preeclampsia, once weekly for gestational HTN US every 3 weeks BP assessment 2x/wk CBC, liver enzymes, creatinine 1x/wk Proteinuria each visit
Sx of severe preeclampsia:
Severe headaches that do not resolve with rest, tylenol, fluids, food; RUQ pain, visual changes, SOB
catecholamine-producing tumor of the adrenal glands; abnormal production of epinephrine and norepinephrine
Renal effects: sodium retention, increased renin secretion, reduction of hydrostatic pressure
Cardiovascular effects: peripheral vasoconstriction and increased cardiac contraction and workload 2/2 HTN
Pheochromocytomas
5 H’s: HTN, headache, hyperhidrosis (sweating), hypermetabolic state, and hyperglycemia
Labile HTN
palpitations
Pheochromocytomas
How to tx Pheochromocytomas?
Control htn (alpha blocker followed by beta blocker or alpha-beta blocker); Surgery to check for malignancy
HTN when 70-80% blockage of renal artery which activates the renin-angiotensin system.
RAS→ (Renal Artery Stenosis)
<30yo caused by fibrodysplasia (tight fibrous bands alternating with normal/thin tissue along artery)
F>M
Tx: percutaneous renal angioplasty w/ or w/o stenting
>50yo atherosclerosis more common cause. Tx: medications, stenting
PE: abdominal bruits
Diag: UA, creat, renal MRA
RAS→ (Renal Artery Stenosis)
How to tx RAS→ (Renal Artery Stenosis)
beta blockers to control HTN (NO ACEI), angioplasty, bypass surgery
→ unprovoked hypokalemia
PE: weakness, HA, fatigue, HTN, hypokalemia
Diag: aldosterone levels (before and after saline challenge); renin; CT abd/pelvis
Tx: if tumor→ sx; if bilateral hyperplasia→ potassium-sparing diuretics
Hyperaldosteronism
Creat > 1.5mg/dL
GFR < 50 mL/min
Renal Disease
Suppression of ACTH production when steroid are administered in high doses for long periods (asthma, COPD)
Steroid medications should be given in morning to avoid suppression of morning pulse of ACTH hypersecretion of glucocorticoids by the adrenal cortex, the result of an adrenal tumor or overstimulation by the anterior pituitary.
Cushing’s Syndrome
CM: HTN, glucose intolerance, and insomnia
Peds: depressed linear growth and weight gain
PE: central obesity, moon face, buffalo hump (dorsocervical fat pad), muscle wasting and weakness, hirsutism, red-purple abdominal striae (>1cm) and acne. Depression.
Diag: 24hr urine (>100mcg cortisol)
Cushing’s Syndrome
How to tx Cushing’s Syndrome
ketaconazole (competes with cortisol); pituitary tumor resection Obtain BMD (chronic glucocorticoid levels a/w osteoporotic tendencies)
Severe elevation in BP (>180/120) with evidence of new or worsening target organ damage
Send to ER
Hypertensive emergency
Severe BP elevation in otherwise stable patients without acute or impending change in target end organ damage
Can treat on outpatient basis
Hypertensive urgencies
