HTN Flashcards
if at the first visit, a clients BP is high normal, how often should their BP be recheck
yearly
for patients with a normal BP, how often should their BP be rechecked
yearly
for patients with high BP actively modifying health behaviors, how often should they follow up
3-6 months
how often should you follow up with a patient receiving antihypertensive? when would this change?
every 1-2 months until 2 consecutive visits are at or below target then every 3-6 months
what is the cut off to diagnose HTN for OBPM
> /= 140/90
what is the cut off to diagnose HTN for ABPM or HBPM
> /= 135/85
what standard testing should be preformed for all HTN patients
urinalysis, blood chem (K, Na, Cr), FBG or A1C, lipids, 12 lead
when would you order an echocardiogram in a HTN patient
if you are concerned about LVH or coronary artery disease like those with evidence of HF
what symptoms might suggest a secondary cause
sudden onset age >55 or <33
abdominal bruit
resistant to 3 drugs
increased Cr 30% with ACEI or ARB
pulmonary edema with HTN
what is pheocromocytoma and when might you suspect is
adrenal gland tumor
Adrenal mass
labile or unexplained BP
HTN with anasethia or other meds
associated headaches, palpitations, sweating
when might you start a statin without presence of DLD for HTN patients
HTN patients with at least 3 cardiovascular risk factors or established atherosclerotic disease
what are the main classes of medication used to treat HTN
ACEI
ARB
CCB
thiazide like diuretics
without any other indications, at what threshold should HTN medication be started for those without target organ damage or other risk factors and those with?
without: >/=160/100
With: >/= 140/90
when is a beta blocker an appropriate first line monotherapy
patients younger than 60 with uncomplicated HTN and no other compelling factors
what medication should not be started in black patients
ACEI
what are adrenal causes of secondary hypertension
primary hyperaldosteronism
cushing syndrom
tumors (pheocrhomocytomas)
paroxysmal HTN, headaches, palpitations, and sweating are signs of what?
pheochromocytomas
what are renal causes of HTN
renal artery stenosis
diabetic nephropathy
glomerulonephritis
polycystic kidney disease
a young individual with HTN and signs of decreased renal perfusion may have what?
renal artery stenosis
unilateral or bilateral renal artery stenosis mya cause CKD?
Bilateral
what anti hypertensive should not be given to patients with bilateral renal artery stenosis
ACE-I
what is an aortic cause of secondary HTN
coarctation of aorta
isolated systolic HTN in elderly
what are metabolic causes of secondary HTN
hyperthyroidism and hypothyroidism
what medications may cause HTN
estrogen
cocaine
MAOIs with tyramine foods like cheese and wine
what would your fundoscopic exam reveal with hypertensive retinopathies
dot and flame shaped hemorrhages
AV nicking
silver and copper wiring
what are the main cardiac complications of HTN
LVH
atherosclerosis leading to CAD
aortic dissection
true or false: properly managed HTN provides the greatest benefit in reducing risk of stroke
true
what are the renal complications of HTN
renal failure
what is the difference between HTN urgency and emergency
both with BP <180/120 but no evidence of end organ damage with urgency
what are the neurological findings of acute end organ damage
headache
altered LOC
seizure
papilledema
stroke
what are the cardiac manifestations of acute end organ damage
MI
pulmonar edema
aortic dissection
what are the renal manifestations of acute end organ damage
increased BUN or Cr
hematuria
microalbuminuria
what are the 4 main classes of HTN medication
ACE-I
ARBs
Thiazide diuretics
long active CCB
what classes of medication should be used to treat HTN with HF
ACE-I or ARBs
Thiazide diuretics
Aldosterone antagonists
beta blockers
Although any class can be used for HTN with diabetes, which class is protective against diabetic nephropathy
ACE-I or ARBs
what medication should be avoided in patients with asthma
ACE-I
hydrochlorothiazide is what class of medication
thiazide diuretic
ramipril is what class of medication
ACE-I
candesartan is what class of medication
ARB
Amlodipine is what class of medication
CCB
what labs should be monitored for patients on ACE-I
Electrolytes (K)
Cr and GFR
BUN
what are risk factors for HTN
DM
CKD
poor diet
sedentary behavior
is ASA recommended for primary prevention in HTN management
no
what is goal BP for patient with HTN and DM
<130/80
