HTN Flashcards
What is the gold standard for measuring BP
24 hour ambulatory
Describe the pathway to diagnose HTN
Office mean >180/100
If automated >135/85 or manual >140/90 or Diabetes >130/90 then get outpatient 24 hour ideally but can get home mean
If home mean >135/85 or 24 hour >130/80 then can make the diagnosis
What work up to order in new diagnosis of HTN
Lipids (TG, LDL, HDL, Chol) K Na Creatinine Urinalysis A1C ECG Urinary albumin (if diabetic) HCG
List seven secondary causes of HTN
Atherosclerosis Bruits Kidney failure Catecholamines (pheo) Diet high in salt Drugs Endocrine (THyroid, aldosterone) Etoh Sleep Apnea Stress
List six specific pieces of lifestyle advise for patients diagnosed with HTN
Eat <1800 mg of salk per day Lose 4.5 kg Drink less than 2.7 drinks per day Exxercise for 30-45 minutes 3x per week Eat the DASH diet CBT for relaxation
Last three are the best
Name four blood pressure medications you want to avoid in certain situations
Avoid Chlorthalidone in general (Increased diabets and electrolyted abnormalities)-HCTZ does have 4X chance non melanoma skin cancer but a lot of uncertainty around this and HCTZ doesn’t have those diabetes and electrolyte issues
ACE if black or pregnant
BB if >60
Alpha blocker alone
If someone appears to have resistant HTN, list 5 things to check fo
Compliance NSAIDS OCP Steroids Licorice
What is a hypertensive urgency and emergency
BP >180/110
Emergency if with end organ damage or if diastolic >130
End organ including MI, encephalopathy, LV failure, Aortic dissection
Someone comes into clinic feeling a little stressed out but otherwise well. Their BP is 190/100 and the nurse busts into your office yellin about it and saying we need to send them to the hospital. What do you do?
Calm everyone down
Not an emergency
Ask for symptoms of chest pain, confusion, blood in urine
Could do office dip to check for protein or blood in urine
Start them on a medication and follow up in a few days
Safety net around when to go into hospital
Someone comes into clinic feeling a little stressed out but otherwise well. Their BP is 190/100 and the nurse busts into your office yellin about it and saying we need to send them to the hospital. You go in and ask the patient how they feel and they said they have horrible chest pain. What do you do?
Send to ED or if you are in ED give nifedipine, hydralazine, or labetolol
List three mdications for HTN that are good if the patient is breast feeding
Labetalol
Methyldopa
Nifedipine
Which arm should you check a BP on in children
Check in R arm because if coarctation will get falsely low BP in L arm
You are in the hospital and someone comes in with super high BP and stroke symptoms. What do you do in relation to their BP
Lower if >220/210 in embolic if no thrombolytic is given
Lower if >180/100 in hemorrhagic or if thrombolytic is given
Use labetalol or hydralazine
List four secondary cuases of HTN and when and how you would investigate for each
- Fibromuscular dysplasia-If bruits, renal asymmetry
- Do MRA and CTA - Renovascular-If bruits, Increased creat by >30% on ACE or ARB, or pulmonary edema with HTN
- Do Doppler CTA or captropril enhanced radioisotope renal scan - Hyperaldosteronism-If low potassium
- Do plasma aldosterone and plasma rennin - Pheo-If Headaches, plapitations, sweating, panic attacks, pallor, HTN worse with BB
- Do MRI, 24 hour total metanephrines and M:Cr ratio (urine)
List 3 side effects of HTN medication in general
Dizziness, falls, fatigue, headaches
