HTN Flashcards
Normal BP- JNC 7
<120/80
Pre-HTN- JNC 7
120-139/ 80-89
Stage 1 HTN- JNC 7
140-159/ 90-99
Stage 2 HTN- JNC 7
> =160/ >=100
Essential HTN- Eti
95% of patient with HTN. 10-15 % white pts, 20-30% black. Men, elderly
Essential HTN- Sx
Asymptomatic for many years- HA, retinal changes, pulse abnormalities
- Eyes: av nicking, flame hemorhhages, wool spots, exudates
Essential HTN- Risk factors
Obesity, apnea, salt, alcohol, smoking, polycythemia, NSAIDs, potassium.
Essential HTN- Dx
3 high BP readings over weeks to months
Hypertension- Tx
Medications (ca channel, thiazide, ARB, ACE) & lifestyle modification
Hypertension- Initial workup
Hg, UA, creatinine, CBG, lipids, uric acid, electrolytes
2 HTN- Primary aldosteronism- Eti
Elevated plasma aldosterone with suppressed renin.
- Middle aged 40-64
- lesion: adrenal adenoma, bilateral adrenal hyperplasia.
2 HTN- Pheochromocytoma
<0.1% pts. Tumor of adrenal medulla. Excess catecholamine leads to chronic vasoconstriction and reduction in plasma volume.
Pheochromocytoma- Sx
Paroxysmal HTN, palpations, HA
Pheochromocytoma- Dx
Plasma metanephrines
2nd HTN- Renovascular disease- Eti
1-2% HTN pts. atherosclerotic stenosis Young= due to fibromuscular dysplasia.
2nd HTN- Renovascular disease- Sx
- Onset before 20, >50,
- resistant to 3+ drugs,
- renal bruits, -atherosclerotic disease of aorta
- Increase in creatinine
- pulmonary edema
2nd HTN- Renal parenchymal disease-
Most common cause of 2 HTN.
- Increased intravascular volume or activity of renin,-angiotensin-aldosterone system
- more blood forced through kidneys
2nd HTN- Coarction of aorta-
Uncommon congenital condition causing narrowing of aorta. Dx at young age
HTN- Complications
- CV disease- 1 cause of morbidity & mortality
- Cerebrovascular disease & dementia
- Kidney disease
- Aortic dissection
- Atherosclerotic complications
End/ target organ damage
Damage to major organs due to uncontrolled hypertension in circulatory system
Target organ- Heart
- Left ventricular hypertrophy
- Angina or prior MI
- Coronary revascularization (stent)
- Heart failure
Target organ- Brain
- TIA or stroke, encepholpathy
Target organ- Eyes
Retinal damage- AV nicking, cotton wool spots, flame hemorrhage, hard exudates
Isolated systolic HTN- Eti
Functional of structural changes in aorta/ large arteries. Elderly, atherosclerosis. Elevated systolic, diastolic normal.
Isolated systolic HTN- Complications
Difficult to tx- meds lower both systolic/diastolic. May cause decreased perfusion, increased risk of MI
Primary aldosteronism- Sx
Moderate to sever, difficult to control HTN
- Hypokalemia- musc weakness, fam hx
- Abn aldosterone & renin
Renal parenchymal disease- Risk factors
DM, kidney damage, nephrotoxicity
Renal parenchymal disease-Sx
Fatigue, weakness, brusing, abn urine, edema
