HTN Flashcards
What are the 3 factors need to maintain adequate pressure in the cardiovascular system
- Functioning pump
- Sufficient fluid volume
- Vascular resistance
Diagnostic Studies for HTN
ECG: L Ventricular hypertrophy Decreased H&H Elevated BUN, creatinine, urine protein and glucose Serum K, Ca, and uric acid Plasma aldosterone concentration Lipid panel
After diagnosis, what is the treatment goal?
> 140/90
After diagnosis of HTN in pt with DM or CKD, what is treatment goal?
> 130/80
Nonpharmacologic therapies for HTN
DASH Exercise Weight loss Smoking cessation ETOH decrease
Initiating pharmacologic therapies for HTN in pt with DM and CKD
Initiate drug therapy immediately if BP is > 140/90 at diagnosis along with lifestyle changes
How many drugs does stage 2 (>160 systolic or >100 diastolic) its require to lower BP?
2
What are the drugs available for HTN?
Diuretics B-adrenergic antagonists Angiotensin-converting enzyme inhibitors Angiotensin II Receptor Blockers Calcium channel blockers
What drug is considered 1st line in treating Essential HTN?
Diuretics: Thiazides are consistently effective
How do diuretics work to treat HTN?
Initially reduce plasma volume & chronically reduce PVR
Potassium supplements may be needed
Who can use loop diuretics?
HTN pt with renal dysfunction
How do Beta Blockers work to treat HTN?
Decrease HR & CO
What pt population do BB work best in?
Young white adults
Reduce mortality after MI in pt with heart failure
What pt population must you be careful to use BB with when treating HTN?
Pt with pulmonary disease or DM
How do ACE-I work?
Inhibit bradykinin degradation (inflammatory mediator that vasodilate) (initiates cough)
Stimulate vasodilating prostaglandins (vasodilation)
What is the initial drug choice for HTN pt with BM & CKD
ACE-I: help preserve kidney function
What pt population will benefit from ACE-I use?
Mild-Mod HTN
Younger whites
Use when diuretics are insufficient
Reduce mortality in PT with MI and heart failure
How do ARBs work?
Block the interaction of angiotensin II on receptors
What pt population with benefit from ARBs?
Pt with DM or CKD because they help preserve kindly function
Do not increase bradykinin = no cough
What are other agents available to treat refractory HTN or other special cases?
Aldosterone receptor antagonists: combo with BB and ARBs after MI with heart failure
Alpha-blockers: BPH
Central Sympatholytics
Vasodilators
Aliskiren: renin inhibitor
How do Calcium Channel Blockers works?
Peripheral vasodilation
What pt population is CCB preferred?
Elderly & Black
Drugs used in HTN emergencies
- Nitroprusside
- Nitroglycerin (if MI present)
- B blocker
- Fenoldopam
- Hydralzine: pregnancy
- Oral agents: Clonidine
Classification of BP
Normal 160/ >100
Causes of HTN
Sleep apnea Drugs CKD Primary aldosteronism Reno vascular disease Steroid or Cushing's Pheochromocytoma Coarctation Thyroid/parathyroid disease
HTN can cause target organ damage to which organs?
Heart Brain Kidneys Peripheral arterial disease Retinopathy
What is the JNC 8 goal & therapy for >60 yo
What is the JNC 8 goal & treatment for
What is the JNC 8 goal & treatment for diabetics with HTN
What is the JNC 8 goal & treatment for CKD pt with HTN
ACE or ARB
Thiazide use for osteoporosis
Favorable
BB for arrhythmia migrant, thyrotoxicosis, and preoperative HTN
Favorable
CCB in Raynaud’s and some arrhythmias
Favorable
A-Blockers for BHP
Favorable
ACE/ARB in LVH can prevent cardiac remodeling
Favorable
