HTN Flashcards
Who gets HTN?
- african americans
- females after 50-60 yo (d/t hormonal changes)
- sensitive to salt diet
What is HTN?
the most imp modifier risk factor for CD, stroke, HF, ESRD (diastolic and systolic d/t low perfusion HF), peripheral vascular dz
prevent HTN to prevent other dz
What are the classification of blood pressure?
Normal: <80
PreHTN: 139/90
Stage 1: 159/99
Stage 2: 160/100
What if pt is older than 80yo?
systolic up to 150
What are the classification of cxs of HTN?
1) essential/primary HTN:
- unable to ID therefore irreversible
2) secondary HTN:
- able to ID, REVERSIBLE
Examples of secondary HTN?
- chronic renal: polycysitc kidney, urinary tract obstruction, renin producing tumor
- renovascular HTN
- vascular
- endocrine: hyperaldosteronism (low K)
- adrenal: Cushing syndrome
- pregnancy
- drug and toxins: ETOH
What is arterial blood pressure?
cardiac output (SV, preload, afterload) X systemic vascular resistance (tota peripheral resistance)
What are suspected factors of HTN?
- genetics
- vascular endothelium
What types of organ damage can arise from HTN?
- cardiovascular (HF, Atheroscleortic cardiovascular dz, Left vent. hypertrophy, cardiac arrhythmias)
- CNS
- chronic renal dz
How to assess for pt’s cardiovascular risk status?
- age/gender
- family hx
- DM
- hypercholesterolemia
- smoke
- abdominal obesity
How to assess for pt’s secondary cx of HTN?
- meds/drugs
- sweating
- lack of energy (thyroid disorder)
- renal calculi (d/t hyperparathyroidsm)
- day time sleepiness (sleep apnea)
PE of HTN?
- BP on BOTH ARMS
- fundoscopic (AV NICKING, cotton wool exudates)
- peripheral pulses
- BRUITS (esp renal artery bruit = renal dz = HTN)
Labs for HTN?
- routine –> secondary cx suspicion? –> SPECIFIC studies
- UA microalbuminuria: FOR diabetes I (early indication for ESRD)
- plasma renin (hyperaldosteronism)
- UA VMA
- thyroid fxn test
Tx for HTN
- pre: lifestyle changes
- stage 1: life style changes + thiazide diuretic/ACE inhibitors; ARB beta blocker, CCB
- stage 2: life style changes + 2 drug combo
What kind of life style changes?
- wt loss
- no drinking
- more exercise
- low Na intake
- no smoking
- K, Ca, Mg
- low fat, cholesterol intake
How to tx diabetes w/ HTN?
ARB/ACE
b/c you have to protect the kidneys
but in AA: CCB or thiazide
How to tx CAD w/ HTN?
B blocker + ACE or ARB
How to tx chronic kidney dz w/ HTN?
ARB or ACE
AA: ACE
How to tx HF w/ HTN?
ARB or ACE + B blocker + spironolactone + diuretics
When do you NOT use diuretics?
- gout
- renal insufficiency
- dyslipidema
When do you NOT use B adrenergic antagonist?
- asthma
- peripheral vascular dz
When do you NOT use ACE inhibitors?
- bilateral renovascular dz
- pregnancy
When do you NOT use Angiotensin II antgonists?
- bilateral renovascular dz
- pregnancy
When do you NOT use CCB?
- heart block
- heart failure
When do you NOT use alpha adrenergic antagonists/central acting agents?
autonomic dysfunction
What should be considered in pts with resistant HTN?
- inadequate dose
- may have high Na diet
- poor compliance
- may be using other DI
- secondary HTN (need to tx underlying dz)
- white coat HTN
What to do with pts with resistant HTN?
- reassess for secondary missed cx of HTN
- referral
What are HTN emergencies?
- some pts are asymptomatic - BE ON THE LOOKOUT (>220/125)
- Tx: SLOWLY bring BP down (not suddenly) d/t organ damage (ischemia of heart, brian, kidney, placenta
- encephalopathy (severe headache, confusion, coma, PAILLEDEMA)
- cardiac decompensation: CHF, angina, MI
- nephropathy: proteinuria
- malignant HTN: encephalopathy, nephropathy, papilledema
How to tx MI w/ HTN?
Bet blocker + ACE/ARB
How to tx Stroke w/ HTN?
ACE/ARB
