HTN Flashcards
HTN prevalence
> 100 million people
African Americans > non-Hispanic Whites
Women > men, older than 60 years
Leading risk factor for morbidity and mortality in ppl
Systolic htn
Sustained systolic BP > 130 mm Hg
Diastolic htn
Sustained diastolic BP > 80 mm Hg
Isolated systolic hypertension
Systolic > 130 mm Hg and diastolic < 80 mm Hg
Isolated diastolic hypertension
Systolic < 130 mm Hg with diastolic > 80 mm Hg
Combined systolic and diastolichypertension
Systolic > 130 mm Hg and diastolic > 80 mm Hg
Elevated htn
120-129
<80
Stage 1 htn
130-139
80-89
stage 2 htn
> 140
90
Primary HTN (Essential) etiology
Specific etiology unclear
Primary HTN (Essential) contributing factors
SNS activity
Dysregulation of the renin-angiotensin-aldosterone system
Deficient production of endogenous vasodilators
Oxidative stress -> stiff vessels
RAAS controls…..
Extracellular fluid volume-> aldo release for na reabsprtion
Peripheral resistance-> maintain
Blood pressure
Dysregulated renin release leads to….
Elevated renin levels
Angiotensin II overproduction
Increased aldosterone
HTN
Angiotensin I cleaved into Angiotensin II by …..
chymase (human mast cell protease = bypass angiotensin cleaves to)
Acei don’t work on chymase = cant take acei
Angiotensin produced in…..
Production of angiotensin II in fat, blood vessels, heart, adrenals, and brain
Major regulators of vascular tone
Nitric oxide and endothelin
No – vasodilation
Endothelin = vasodilation or constriction
Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), and urodilatin….
Blunts RAAS…
Oxidative stress causes
Impaired endothelial function
Disruption of NP release or receptor response-> HTN
Secondary htn prevalence
Secondary HTN
5% of population
Correctable cause
Age-dependent or drug-induced
Stop drug = htn goes away
herbals that cause htn
ephedra, ginseng, ma huang
% of children with htn w/ an underlying cause
birth -12yr = 70-85, most common etiologies = renal parenchymal disease
Resistant HTN
Above goal BP despite ≥3 antihypertensive drugs of different classes
Controlled resistant HTN
Need for ≥4 drugs to achieve control
Refractory HTN
Uncontrolled BP on ≥5 drugs
Drug intolerance or pseudo-resistant HTN (0.5% of pop)
Lifestyle modifications for htn
Weight reduction
Moderation of alcohol intake
Increased aerobic exercise
Smoking cessation
Dietary potassium and calcium intake
Salt restriction
Non-black hypertensive population (w/ or w/o DM) medications
ACE inhibitors, ARBs, CCBs, or thiazide-type diuretics
ACC/AHA Guidelines for bp
Multiple BP readings for diagnosis
Nonpharmacologic interventions
Pt w/ IHD, cerebrovascular disease, CKD, or with an elevated risk of atherosclerotic CV disease treat SBP > 130 mm Hg and DBP > 80 mm Hg
Black hypertensive population w/o HF nor CKD (w/ or w/o DM) medications
Initiating treatment w/ CCBs or thiazide-type diuretic
Chronic kidney disease htn medications
ACE inhibitor or ARB
First-line antihypertensive therapy
Diuretics, CCBs, ACE inhibitors, and ARBs
Beta-blockers given for ……
CAD or tachydysrhythmias
Multi-drug therapy in resistant HTN
Interventional tx for secondary htn
Correction of renal artery stenosis
Direct arterial repair
Adrenalectomy
med tx for secondary htn
ACE-Is or in combination with diuretics
Urgent/emergent htn crises
Urgent or emergent
Progressive organ damage
Central nervous system injury from htn emergencies
Hypertensive encephalopathy,
intracerebral hemorrhage,
subarachnoid hemorrhage, and
acute stroke
PIH
Systolic pressure > 160 mm Hg and/or diastolic pressure > 110 mm Hg
require immediate intervention
can have Encephalopathy-> end organ dysfunction
First-line drug for peripartum hypertension
labetalol
Aortic dissection with htn crises treatment
β-blocker (esmolol, labetalol) plus arteriolar dilator
Medication for Rapid arterial dilation and BP reduction
sodium nitroprusside infusion
Pressure to cancel surgery
> 180 mmhg
Htn medications to DC prior to surgery
High-dose ARBs and ACE inhibitors
BP Medications to DC prior to sx
High-dose ARBs and ACE inhibitors–24 hrs
