Htn Flashcards
PTA of the renals
5-10% people
Indicated for >75% bilateral disease
Improves BP in 60-70% usually fibromuscular.. Do not stent fibromuscular cases
BP increase in 20 mm systolic and 10 mm diastolic
Will double mortality
Coarctation
6-8% of the cases2-5x more in men Increase in turners Notching of the ribs 3 sign Stent with 20 mm gradient Restenosis ?
Pheo
Best test 24 hour urine catecholamines and metanephrines positive test 2 fold normal 10% malignant 10% extra abdominal 10% multiple MRI T2
Pheo treatment
Block alpha first phenoxy benzamine
Then beta blockers
Primary Aldo
Low plasma renin PAC/PRA 30-40 for the diagnosis PAC>10 ng/dl Treatment Spironolactone and eplerenone
Adrenergic system
Alpha1- vein constriction
Aloha2 venodation
Beta 1 increase ionotropy
Beta2 vaso dilation
Salt restriction
2-4 gm a day
Dash diet
Fruits and vegetables
Hyper tension trials
ALLHAT chlorthalidone, acei and ca blockers .. Alpha blockers were dropped due to CHF
SHEP trial low stroke rate chlorthalidone
Atenolol studies
Life study atenolol with lasartan
More strokes and death with atenolol
Ascot trial more deaths with atenolol than Norvasc
Accomplish trial
Amlodipine/ benazapril vs benazapril/hctz.. Amlodipine group did better and the study was stopped
Acei
30% increase in creatinine is ok
Reduces intra glomerular pressure
Adverse conditions
Hypovolemia and CHF bilateral renal stenosis
At2 receptor blockers
Not much better
Calcium blockers
Blacks diabetes elderly Superior stroke reduction Diastolic dysfunction Metabolically neutral BP lowering not effected by sodium or NSAIDs
Clonidine
Need bid dose
Rebound HTN
Depression
Direct vasodilators
Hydralazine
Adjuvant Lupus Does not regress LVH eDRF dependent Need to add diuretics
HTN
Hypertensive urgencies no end organ damage
Hypertensive emergencies end organ damage
Labetalol
Nipride
Nicardipine
Resistant HTN
Smoking Non compliance Salt intake Obesity Alcohol Sleep apnea Pain,NSAIDs
Pregnancy
BP should go down not up
No nipride
Labetalol , methyl dopa ca blockers
Don’t use acei and ARB also no atenolol acebutalol no hydralazine
Black patients
Over all mortality in all races is dropping
Black men more likely to have mi
Black woman more likely to have HTN