HTN Flashcards
The higher the BP the greater the risk of?
MI
HF
Stroke
Renal dz
Peripheral Arterial Dz major risk factors are?
HTN, DM, smoking
PAD
risk of death from CVD is associated w/
Symptomatic PAD d/t diffuse atherosclerosis, CAD and renal dz that are often present
PAD
Renovascular dz should be considered in these pts if?
BP is not controlled
Categories of HTN in Adults
Normal
Elevated
HTN Stage 1
HTN Stage 2
SBP < 120 and DBP < 80
SBP 120-129 and DBP < 80
SBP 130-139 or DBP 80-89
SBP >/= 140 or DBP >/= 90
HTN Causes & Prevention
90-95% of HTN is primary - no identifiable cause. However, there are identifiable behaviors that contribute including:
Obesity
Diets high in Na, low in fruits, veggies
Physical inactivity
Excess ETOH
Patient Evaluation
Assess Lifestyle & ID CV risk factors including?
HTN
Age
DM
Elevated chol/low HDL
GFR < 60 ml/min
family hx
microalbuminuria
BMI > 30
inactivity
tobacco
Patient Evaluation
Hx: meds
Decongestants
oral contraceptives
appetite suppressants
NSAIDs
Thyroid replacement
ETOH
drugs
Patient Evaluation
Physical Exam should include
BP
Optic fundi
BMI
waist circumference
Hear lungs auscultation
Abdomen palpation for enlarged kidneys, masses, distended bladder, & AA pulsations
LE for edema
pulses
neuro
Auscultate carotids, abd, femoral bruits
Palpate thryoid
Patient Evaluation
Basic Testing for Primary HTN
Fasting blood glucose
CBC
Lipid panel
BMP for electrolytes, sCR w/ eGFR
Thyroid - stimulating Hromone
Urinalysis
Electrocardiogram
Patient Evaluation
Optional Testing for Primary HTN
Echocardiogram
Uric acid
Urinary albumin to creatinine ratio
Conditions that should prompt a provider to evaluate for secondary HTN include?
Drug-resistant/induced HTN
Abrupt onset HTN
Onset of HTN at < 30y/o
Exacerbation of previously controlled HTN
Disproportionate TOD for degree of HTN
Accelerated/malignant HTN
Onset of diastolic HTN ini older adults (>/= 65y/o)
Unprovoked or excessive hypokalemia
Drug resistant HTN is a BP that remains uncrontrolled above goal despite?
also includes pts whose BP is controlled at or below goal but requiring?
Concurrent use of 3 antihypertensive drugs of different classes (CCB, ACEI or ARB, & diuretic)
> /= 4 antihypertensives of different classes to achieve target
Assess for presence of target organ damage including?
Heart (LVH, angina/MI, HF)
CKD
PAD
Retinopathy
Brain (stroke, dementia)
Treatment
Overall Goal?
BP goal?
Starts w/?
Stop what?
Decrease CV and renal M&M
< 130/80 mmHg for most adults
Lifestyle modification
Smoking
Lifestyle modifications to decrease HTN inlcude?
Weight loss
Healthy diet
Reduced intake of dietary sodium
Enhanced intake of dietary potassium
Physical activity
Moderation in alcohol intake
Initial Drug Choices & subsequent add-on therapy includes?
Thiazide or thiazide-type diuretics
CCB
ACEIs
ARB
Spironolactone or eplerenone - for resistant HTN
Special Populations
DM: all recommended classes of meds, including diuretics are similarly effective for prevention of?
If heavy proteinuria or advanced kidney disease use?
A combo of how many durgs is usually required to achieve BP targets?
CVD
ACEI
2 or 3 agents
Special Populations
CKD
What is the BP goal for all CKD patients not on dialysis?
SBP < 120
Secondary Agents to use?
Loop Diuretics
Potassium sparing diuretics
Aldosterone Antagonist diuretics
Beta blockers
Beta blockers - cardioselective and vasodilatory
Beta blockers - noncardioselective
Beta blockers - intrinsic sympathomimetic activity
Beta blockers - combined alpha and beta receptor
Direct renin inhibitor
Alpha-1 beta blockers
Central Alpha2 agonists and other centrally acting drugs
Direct vasodilators
Screening for Secondary Causes of HTN should include?
Primary aldosteronism (elevated aldosterone/renin ratio)
CKD (eGFR < 60ml/min/1.73msq)
Renal Artery Stenosis (young female, known atherosclerotic disease, worsening kidney function)
Pheochromocytoma (episodic hypertension, palpitations, diaphoresis, HA)
OSA (snoring, witnessed apnea, excessive daytime sleepiness)
Thiazide diuretics (HCTZ):
Inhibits what?
1/2 life is how long?
Common SEs?
Monitor what?
distal convoluted tubule Na & Cl resoprtion
5.6-14.8hrs
hypo K, Cl, Na; Hyper Ca, uricemia, lipidemia, glycemia, hypotension, weakness, cramps
BUN/Cr @ baseline then periodically
Beta blocker MOA
competitive inhibition of catecholamine effects @ beta-adrenergic receptors leading to decreased HR and CO.
Also decreases renin levels, releases vasodilatory prostaglandins, & decrease plasma volume
2 classes of beta blockers
Cardioselective includes? primary effects?
Non-cardioselective includes? primary effects?
metoprolol, esmolol - beta 1 blocking effects causing decreased HR
Labetalol, carvedilol - beta 1 & 2, alpha blocking effects causing decreased HR & BP
Beta Blocker Side Effects include
AV block
HF
Raynaud’s
impotence
hypotension
increased triglycerides
decreased HDL - mainly w/ nonselectives
Caution in using Beta blockers with what diseases? why?
COPD, PVD, DM
@ higher doses beta 1 blockers lose their selectivity
CCB MOA
Inhibits calcium ion influx into vascular smooth muscle & myocardium, relaxing smooth muscle, decreasing PVR, dilating coronaries, prolonging AV node refractory period
Dihydropyridine CCB’s include?
Can cause?
Amlodipine, felodipine, nicardipine
LE edema, flushing, HA, Rash
NonDHP CCBs include?
Effects?
SE’s?
Dilt, verapamil
negative inotropic and chronotropic effects
dilt - nausea, HA, rash
Verapamil - hypotension, nausea, constipation, HA
Avoid CCB in which patients? d/t what?
HF d/t Increased mortality
Aldosterone receptor blocker:
example?
MOA
1/2 life
Common SE?
Monitor?
aldactone
antagonizes distal convoluted tubule aldosterone receptors (K sparing diuretic)
1.3-2hrs
Hyperkalemia
BUN/Cr, electrolytes @ baseline then periodically
ACEIs
Examples?
MOA?
Monitor?
the prils
inhibit RAS system; inhibits ACE, interfering w/ conversion of angiotensin I to II
BUN/Cr @ baseline then periodically, electrolytes, BP
ACEIs SE’s?
dry cough
edema
hypotension
dizziness
worsening renal fxn if decreased renal perfusion d/t vasodilation of efferent arteriole in kidney
hyperkalemia
Central alpha 2 agonists/centrally acting
example?
use?
SEs?
clonidine
potent antiHTN agent
Bradycardia, hypotension
ACEI considerations/Contraindications
Renal insufficiency - generally safe w/ Cr < ?
Hypotension - from?
Cough - how many will develop w/n first week - 6mos? continue if?
Hyperkalemia - w/ ?
Angioedema - rare, usually w/n but how long? but can occur @ any time.
RAS stands for?
3mg/dL
volume depletion, vasodilators, acute CHF, HD
5-20%; if able to tolerate
renal insufficiency, DM
1st wk
Renal Artery Stenosis
HTN in AAs is?
more common
more severe
develops earlier
results w/ more clinical sequelae compared to non-Hispanic Whites
HTN control rates are lower among who compared to non-Hispanic Whites & AAs?
Mexican Americans & Native Americans
