HTN Flashcards
What would happen if the cells in the SA node slowed down their frequency of depolarization over time?
they would have sick sinus
What are Sx of sick sinus?
dizziness
fatigue
low HR (42)
common in elderly
What is a treatment for sick sinus
pacemaker
more Ca entry =
stronger contraction
(inotropy/contractility)
faster Ca entry =
faster contraction
(chronotropy/HR)
Parts of ECG to look at
ST elevation
QT prolongation
QRS
QT prolongation
What is OBPM
in the office
attended for BP reading
What is AOBP
office automated (unattended)
What is ABPM?
Ambulatory BP monitoring
What is HBPM?
home BP monitoring
What to consider when taking BP?
conditions
timing
duration
Primary HTN
chronically increased BP results from multiple factors, no single factor predominates
also commonly associated with the metabolic syndrome
Secondary HTN
HTN is caused by significant dysfunction of a single system
Treatment resistance
usually defined as lack of BP control despite a combination of 3 HTN medications, one of which being a diuretic
What is masked HTN?
home will be high
office will be normal
What is white coat HTN?
office will be high
home will be normal
CV Risk Factors Non-Modifiable
Age > 55 years
Male
Family History of Premature CV
CV Risk Factors Modifiable
sedentary lifestyle
poor dietary habits
abdominal obesity
Dysglycemia
smoking
dyslipidemia
stress hypertension
HTN urgency
Situations where BP should be reduced within hours
BP ≥180 / ≥130 AND
papilledema or other target organ changes
HTN Emergency
Situations that require immediate BP reduction
E.g. hypertensive encephalopathy, intracranial bleed, unstable angina/MI, acute heart failure
Jugular venous pressure (JVP)
indirect assessment of right atrial pressure
Edema
swelling or accumulation of fluid in a tissue
How does BP increase from NSAIDs
inhibition of renal Pg production
lowers renal perfusion
How does BP increase from steroids
mineralocorticoid effects
How does BP increase from hormonal contraceptives
triggers angiotensinogen production from liver
How does BP increase from decongestants
SNS activity
How does BP increase from alcohol
in excess only. Impairs ADH + other mechanisms likely important
Goal for HTN low risk
140/90
Threshold for HTN low risk
160/100
Goal for HTN moderate
140/90
Threshold for HTN moderate
140/90
Threshold for Diabetes mellitus
130/80
Goal for diabetes mellitus
130/80
Goal for high HTN
120
Threshold for high HTN
130
First line for uncomplicated
TZD
ACEI
ARB
long acting CCB
BB >60 years old
How long until it should see full effect?
1 month
How much will each med lower BP?
10/5
What treatment resistance HTN?
3 antiHTN drugs used in combo
one of the drugs is diuretic
non adherence is ruled out
Isolated Systolic HTN
stuff arteries do not accommodate systolic pressure
creates a high “pulse pressure” (SBP-DBP)
What to use isolated systolic HTN?
TZD
ARB
long acting DHP CCB
What is each of the diuretics best for?
TZD - best for BP reduction
Loop - best for fluid excretion
K sparring - K+ supplement
What is a common consequence of diuretic therapy?
hypokalemia
What is low K interpretation?
<3 –> always undesirable
3-3.5 -> usually treated
3.5-4 –> action may be taken
Alternatives for Low K
- general measures
switch to another diuretic
discontinue diuretic if K seriously low
add K sparring drugs
add K supplement
Hyperkalemia
increase K is also potential cause of serious harm
Patient factors associated with hyperkalemia
CrCl <60ml/min
Baseline K>4.5 mmol/L
First line for Diabetes and HTN
ACEi or ARBs
without renal - ACEi, DHP CCB or TZD
CKD with diabetes
ACEi or ARBs
CKD
ACEi
adding diuretics
HTN Pregnancy
labetalol
methyldopa
clonidine
hydralazine
Pre-eclampsia
high BP with proteinuria
after 20 weeks
Gestational HTN
high BP without proteinuria after 20 weeks
Chronic HTN and pregnancy
HTN was present before pregnancy began
What are the 3 main vasodilators classes?
Alpha blockers
DHP calcium channel blockers
smooth muscle relaxants
When combining HTN drugs list them in the two categories?
TZD or DHP CCB
BB
ARB
ACEi
When should ACEi and ARBs be used in CKD
they should be used near the end
they work better the worst the pt is
What does the HOPE trial show?
Showed that ACEi has cardio protection
What is first line for Vasodilators in uncomplicated HTN
DHP CCB
ACEi in HTN and CV disease
Most pt at high risk for CV events are put onto ACEi even if their BP is normal
What does accomplish trial show?
showed the ACEi have cough
fluid retention is dangerous
What does SPRINT trial show?
BP meds help lower the risk for life threatening events
What does RENAAL trial show?
ARB can help protect the kidney
works better on worst CKD at baseline
What does IDNT trial show?
ARB can help protect the kidney
works better on worst CKD at baseline
What to monitor for ACEi or ARBs?
Kidney function -> renal harm is possible from the drugs
lowering glomerulus pressure can be bad for the kidney too
What should happen to monitor for renal safety for ACEi and ARBs?
obtain SCr and K within 1-2 wks
should not be less than 20-25% changes
BP and edema should get better not worst
What should be monitored for all BP drugs?
Dizziness/headache/hypotension
orthostatic hypotension
Erectile Dysfunction