HTN Flashcards
What is normal BP?
<80 diastolic
What is the BP for prehypertension?
120-139 systolic, 80-89 diastolic
What is the BP for Stage 1 HTN?
140-159 systolic, 90-99 diastolic
What is the BP for Stage 2 HTN?
> 160 systolic, >100 diastolic
According to JNC, what are the major cardiovascular dz risk factors?
- HTN, DM, dyslipidemia
- tobacco use
- obesity, physical inactivity
- age (>55 men, >65 women)
- familial hx of premature CVD (MI or sudden death)
What are some causes of HTN?
- sleep apnea
- drug induced
- chronic kidney dz
- renovascualr dz
- pheochromocytoma
- coarctation of the aorta
- thyroid or parathyroid dz
What are some medications that may increase BP?
- NSAIDs
- cocaine, amphetamines
- sympathomimetics (decongestants)
- oral contraceptives
- corticosteroids
- erythropoietin
- cyclosporine, tacrolimus (anti-rejection meds)
What are some examples of target organ damage from CVD?
- heart: LVH, angina, prior MI, heart failure
- brain: TIA or stroke
- nephropathy
- peripheral arterial dz
- retinopathy
What is the BP goal for a pt over 60?
<150/90
What is the BP goal for a pt under 60?
<140/90
What is the BP goal for a pt over 18 with chronic kidney dz?
<140/90
What is the BP goal for a pt over 18 with DM?
<140/90
What lifestyle changes are recommended to reduce cardiovascular risk?
- heart healthy diet: veggies, fruits, whole grains, limited sodium
- regular exercise
- achieve and maintain healthy weight
- avoid tobacco
Decreasing BP by 5-6 mmHg leads to what reduction in stroke and CHD?
- Stroke: 42% reduction
- CHD: 14% reduction
What anti-HTN treatment is recommended for general nonblack, including those with DM?
- thiazide diuretic
- CCB
- ACE-I
- ARB
What anti-HTN treatment is recommended for general black, including those with DM?
- thiazide diuretic
- CCB
What anti-HTN treatment is recommended for anyone >18 with chronic kidney dz?
ACE-I or ARB
What is the main goal of HTN treatment?
attain and maintain goal BP
What 2 types of anti-HTN meds should NOT be used together in the same patient?
ACE-I and ARB
If goal BP is not reached within one month of treatment, what should you do?
- increase the dose of the initial drug
- OR add a second drug
What 4 things might cause resistant HTN?
- improper BP measurement
- volume overload (excess Na, volume retention from kidney dz, inadequate diuretic therapy)
- medication (nonadherence, inadequate dose, drug interactions)
- associated conditions (obesity, excess EtOH, secondary HTN)
What types of interventions might improve adherence for HTN treatment?
- identify problems w/ drug tolerance and switch
- address increased urination with diuretics
- use generics or combo products to decrease cost
- educate pt about importance of BP control
What is considered a hypertensive urgency?
DBP > 130 but no target organ damage
What is considered a hypertensive emergency?
DBP > 130 and target organ damage present
What is the goal of treatment in a hypertensive urgency?
- reduce DBP to 100 within 24 hours
- can use oral agents
What is the goal of treatment in a hypertensive emergency?
- reduce DBP to 110 within 30 minutes then to 100 within 12-24 hours
- requires IV drug therapy
MOA of Thiazide Diuretics
Work at distal tubule to:
- increase Na excretion
- decrease plasma volume and cardiac output
- decrease extracellular fluid volume
- some decrease peripheral resistance over time
MOA of K+ Sparing Diuretics
- weak effects at collecting duct and distal tubule
- conserve potassium
- spironolactone is an aldosterone antagonist
MOA of Loop Diuretics
- more potent diuretic effects at loop of Henle
- more effective than thiazides in heart failure
Adverse Effects of Thiazide Diuretics
- hypokalemia, hypomagnesemia
- hyperglycemia, hyperuricemia
- effective in renal insufficiency
- may cause mild cholesterol and TG increase
AE of K+ Sparing Diuretics
- used mainly in combo with thiazides to offset K+ loss
- may cause hyperkalemia
- gynecomastia in aldosterone antagonists like spironolactone
AE of Loop Diuretics
-more potent effects than thiazides on K+ and Mg2+ loss, overdiuresis and metabolic alkalosis
MOA of ACE-I
- block formation of angiotensin II, which is a vasoconstrictor
- decrease aldosterone (decreases Na retention)
- increase bradykinin (vasodilation)
MOA or Angiotensin II Receptor Blockers
- cause vasodilation
- decrease Na+ retention
MOA of Direct Renin Inhibitors
- vasodilation
- decrease Na+ retention
AE of ACE-I
- may cause hyperkalemia
- cough, HoTN, rash, angioedema
- may cause acute renal failure
- CI in pregnancy
AE or ARBs
- hyperkalemia
- HoTN, angioedema
AE of Direct Renin Inhibitors
- diarrhea
- cough, angioedema
- do not use during pregnancy
MOA of Calcium Channel Blockers as a Class
- block intracellular reflux of Ca = prevent vascular smooth muscle contraction
- vascular smooth muscle relaxation and vasodilation
Effect of Dihydropyridine CCBs on Contractility and Peripheral Vasodilation
- contract: minimal effect -
- peripheral vaso: significant effect +++
Effect of Diltiazem Non-dihydropyridine CCBs on Contractility and Peripheral Vasodilation
- contract: medium effect - -
- peripheral vaso: medium effect ++
Effect of Verapamil Non-dihydropyridine CCBs on Contractility and Peripheral Vasodilation
- contract: sig negative effect - - -
- peripheral vaso: medium effect ++
AE of CCBs
- HA, dizziness, peripheral edema
- eczema in elderly
- should be avoided in pts with HF
AE of Dihydropyridine
-may cause tachycardia
AEs of Non-Dihydropyridines
-diltiazem and verapamil slow down heart rate so avoid use in pts with bradycardia, heart block or sinus node dz
MOA of Beta Blockers
- decrease HR and cardiac output
- decrease BP
AE of Beta Blockers
- may aggravate asthma
- CI in pts w/ bradycardia, heart block, sinus node dz
- may cause fatigue, insomnia, depression, nightmares, bradycardia
What is methyldopa used for?
-HTN control in pregnancy
How does clonidine work?
-stimulate alpha 2 receptors to decrease peripheral sympathetic activity and BP
What type of HTN drugs are hydralazine and minoxidil?
direct vasodilators
