HTN Flashcards
What is hypertension (HTN)?
Pathological elevation of arterial blood pressure
HTN is generally asymptomatic and diagnosed through repeated measurements.
What are the consequences of sustained hypertension?
- Cardiac failure
- Renal failure
- Coronary disease
- Peripheral vascular disease
- Stroke
- Dementia
Sustained HTN damages blood vessels in various organs.
What percentage of hypertension cases have no specific cause?
90%
These cases are classified as essential or primary hypertension.
List some secondary causes of hypertension.
- Renal artery constriction
- Primary aldosteronism
- Coarctation of aorta
- Pheochromocytoma
- Cushing syndrome
- Drug-induced causes
Drug-induced causes include oral contraceptives, steroids, sympathomimetics, TCA, and MAOI.
What is the JNC-8 classification of normal blood pressure?
SBP <120 mmHg and DBP <80 mmHg
This classification is from the Joint National Committee on hypertension.
What is the recommended procedure for diagnosing hypertension?
- Periodic screening for individuals over 21
- Patient should be seated quietly for at least 5 minutes
- Use appropriate cuff size
- Take BP at least twice, separated by at least 2 minutes
- Two separate visits required for accurate diagnosis
These steps help confirm chronic elevation of BP.
What lifestyle modifications can help manage hypertension?
- Smoking cessation
- Weight reduction
- Moderation of alcohol consumption
- Reduction of salt intake
- Increased physical activity
Following the DASH eating plan can also be beneficial.
What is the DASH eating plan?
A diet rich in fruits, vegetables, and low-fat dairy with reduced dietary cholesterol and fat
DASH stands for Dietary Approaches to Stop Hypertension.
What is the primary goal of antihypertensive therapy?
To reduce cardiovascular and renal morbidity and mortality
Treating to targets <140/90 mmHg is associated with decreased CVD complications.
What are the main classes of antihypertensive drugs?
- Calcium channel blockers (CCB)
- Angiotensin converting enzyme inhibitors (ACEIs)
- Angiotensin II receptor blockers (ARBs)
- Diuretics (thiazide-type)
- β-blockers (BBs)
These classes are commonly used to manage hypertension.
What is the recommended initial therapy for stage 1 hypertension?
Single antihypertensive drug
The goal is a BP of less than 140/90 mmHg.
What is the treatment approach for patients with stage 2 hypertension?
Initiate therapy with two first-line agents of different classes
This is recommended for patients with an average BP greater than 20/10 mmHg above target.
What is white-coat hypertension?
Office BP ≥ 140/90 after lifestyle modification trial, but daytime ABPM or HBPM BP < 140/90 mmHg
This condition is important to identify for accurate diagnosis.
What is the significance of monitoring antihypertensive drug outcomes?
- Assess efficacy at 4 weeks
- Add therapy from a different class if inadequate response
- Change therapy based on abnormal trends, not single measurements
Monitoring helps ensure effective management of hypertension.
What are some patient-specific considerations for antihypertensive therapy?
- Ischemic heart disease: use of vasodilators with β-blockers
- African American patients: β-blockers and ACEIs less effective as monotherapy
- Women: potential pregnancy considerations with oral contraceptives
These factors influence drug selection and management strategies.
What is resistant hypertension?
Office BP ≥ 140/90 on at least 3 antihypertensives at optimal doses
It requires confirmation and evaluation of contributing factors.
What should be done if a patient is diagnosed with resistant hypertension?
- Confirm diagnosis
- Exclude pseudoresistance
- Identify contributing factors
- Screen for secondary causes
- Assess for target organ damage
A comprehensive approach is necessary for effective management.
Fill in the blank: The lifestyle modification of weight reduction can reduce SBP by _______.
5–20 mmHg/10kg
This reduction varies depending on the individual’s weight loss.
What is the best approach for managing a patient with hypertension and acute myocardial infarction?
Add lisinopril and metoprolol
This combination is often effective for managing hypertension in post-MI patients.
What is the likely parameter for monitoring hypertension treatment safety?
Potassium level
Monitoring potassium levels is crucial, especially with certain antihypertensive medications.
