HTN Flashcards
definitions of hypertension?
Normal:
Systolic <80
Prehypertension
Systolic 120-139 OR Diastolic 80-89
Stage 1 hypertension
Systolic 140-159 OR Diastolic 90-99
Stage 2 hypertension
Systolic ≥160 OR diastolic ≥100*
**Calculation of seated blood pressure is based on the mean of two or more readings on two separate office visits.
contributing factors to developing HTN?
Genetic predisposition Abdominal Obesity Salt intake Alcohol intake Age
HTN is a risk factor for?
Stroke Myocardial Infarction Heart Failure ESRD Atrial Fibrillation Aortic Dissection PVD
why do most young people develop HTN?
due to increased peripheral resistance and vasospasm (on the elvel of small arterioles see spasms due to increased symp output)
- the heart has to work harder to push blood against the resistance
- both systolic and diastolic will be elevated b/c problem is in periphery in small arteerioles
why do most older people have HTN?
develop HTN usually due to aging of arteries. Aorta becomes stiff and larger aa. are stiff - this results in high stystolic BP and normal or low diastolic HTN
what defines cardio exercise
minimum of 30 minutes, most day of the week - HR elevation to at least 70% maximal (max = 220-age)
initial HTN tx for non-black populations?
ACEI’s, ARBs, CCBs, Thiazide diuretics
HTN tx for black population?
CCBs, Thiazide diuretics
see increased weight gain over 2 mos. of 30 lbs, h/a, increased thirst, mm. weakness, high glucose levels, HTN, striae
= secondary hypertension
Cushings disease: increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary. This is most often as a result of a pituitary adenoma or due to excess production of hypothalamus CRH (Corticotropin releasing hormone) that stimulates the synthesis of cortisol by the adrenal glands.
sx: weight gain high blood pressure poor short-term memory irritability excess hair growth (women) red, ruddy face extra fat around neck moon face fatigue red stretch marks
test: do dexamethasone suppression test or 24 hours urine collection for cortisol
when to suspect secondary HTN?
Compelling finding on initial evaluation
Hard to control HTN (either new onset or well controlled HTN becoming hard to control)
Atypical age of diagnosis (less than 30)
Absence predisposing factors
what to use for ddx of renovascular HTN?
Captopril Test DSA MRI – angiography Arteriography Renal vein renin ratio
two main causes for renal artery stenosis?
- atherosclerosis:
- more common in older males above 50 years
- 33% bilateral
- very progressive
- assoc. w/ tobacco, lipids, diabetes - fibromuscular dysplasia: nonatherosclerotic non-inflammatory vascular disease that causes abnormal growth w/in the wall of an artery
- more common in females under age 40
60% are bilateral
- not as progressive and less associated w/ risk factors
- good response to angioplasty
what to be careful to prescribe to someone w/ renal aa. stenosis?
ACEI’s and ARBs - will decrease perfusion pressure and kidney may become ischemic
- avoid in pt. w/ one kidney, or bilateral stenosis
unilateral renal artery stenosis?
decreased IV volume
more renin mediated
- BP usually falls w/ ACEIs
bilateral renal stenosis and single kidney?
increased IV volume
- renin mediation varied
- ACE response is unpredictable, may worsen HTN
c/o anxiety, tremors, weight loss, exopthalmos, HTN present
Grave’s disease: hyperthyroidism
Hyperthyroidism in Graves’ disease is confirmed by measuring elevated blood levels of free (unbound) T3 and T4.
thyroid-stimulating hormone (TSH, usually low in Graves’ disease due to negative feedback from the elevated T3 and T4)
What tx to use? Betablockers, nonselective (propanolol) - help with tremors, BP and anxiety
HTN emergency/crisis?
can occur at any BP - but involves acute damage to at least one organ: acute or chronic
cardiovascular:
MI (A), Angina (A), Aortic dissection (A), Aneurysmal dilatation of large vessels (C), LVH (C),CHF (A)
Renal:
Hematuria (C), Proteinuria (C), ARF (A)
CNS: Cerebral edema (A), Altered mental status (A), Bleed (A), Stroke (A) or TIA (A)
Opthalmologic?
Retinal hemorrhages or exudates (A or C), Papilledema (A)
A-V nicking (C)
primary hyperaldosteronism
- Located in adrenal gland without exogenous stimulus.
- Elevated aldosterone and low renin levels < Potassium
Types Aldosterone producing adenoma Idiopathic Hyperaldosteronism Bilateral adrenal hyperplasia Aldosterone producing Ca Aldosterone producing renin-responsive adenoma Ectopic aldosterone producing tumor Dexamathasone suppressible hyperaldosteronism
secondary hyperaldo
Elevated aldosterone and elevated renin levels
Causes are: 1. Diuretics 2. CHF 3. Cirrhosis 4. Ascites 5. Nephrosis 6. Others
medication to treat hyperaldosteronism?
spironolactone = ARB
causes of secondary HTN?
Sleep apena Drug induced causes Chronic kidney disease Primary aldosteronism Renovascular disease Steroid therapy or Cushing’s syndrome Pheochromocytoma Coarctation of the aorta Thyroid disease Parathyroid disease Pain induced
coarctation of aorta
1) Narrowing of medial layer of aorta.
2) Commonly at ligamentum arteriosum.
ddx or coarctation?
- Differences in upper and lower extremities
- Blood Pressure
systolic hypertension in an infant
20mm hg between arms - Heart Sounds – if isolated a systolic ejection murmur in the aortic outlet and between scapulae.
- Radiology –
Cardiomegaly
Rib notching
- pril
ACEI’s
