HTN Flashcards
When someone has high BP, want to prevent
end organ damage
stroke, heart attack, blindness, kidney failure, heart failure
HTN is when BP is
140/90 in office multiple times
OR 135/85 at home
AOBP is a device that allows ________
you to continuously/regularly check your BP at home
Normal BP is
PreHTN BP is
120-139 mmHg SBP or DBP 80-89 mmHg
Stabe 1 HTN BP is
140 to 159 mmHg SBP or DBP 90 to 99 mmHg
Stage 2 HTN BP is
> 160 mmHg SBP or > 100 mmHg DBP
Guidelines for measuring BP
long table on slides 7-8
Prevalence is highest in
non-hispanic blacks
More LV hypertrophy, higher incidence of ____
CV events
-Reversible and treatable
Higher BP and HTN left untreated leads to a higher incidence of
ESRD (end stage renal disease)
There are cardiovascular benefits to treating
mild HTN (lowers risk of CVA and coronary heart disease)
Cause of primary HTN
over activation of SNS and RAAS via:
- NSAIDs
- too much salt intake
- family history
- smoking
- alcohol
- *Sleep apnea is a MAJOR cause of CV problems, A-Fib, HTN**
Who should be screened for secondary HTN?
- Severe or resistant HTN
(persistent HTN despite use of adequate doses of three antihypertensives from different classes) - Acute rise in BP in a patient with previously stable values
- Age under 30 in non-obese, non-African American patients with negative family history
- Malignant or accelerated HTN
- Severe HTN and evidence of end-organ damage
- Age of onset before puberty
Genetic causes of secondary HTN
- Liddle syndrome (psueodhyperaldosteronism)
- hyperaldosteronism
- HTN in pregnancy
FMD (fiber musculodysplasia)
- Cause of secondary HTN
- FMD (fiber musculodysplasia) in young women (young woman with refractory HTN, reversible cause of high BP in young women; “beads on a string” sign; sign is caused by areas of relative stenoses alternating with small aneurysms; seen in renal arteries)
95% of HTN is
essential (primary)
Refractory HTN
- Cause of secondary HTN
- Refractory hypertension was defined as BP that remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6-month follow-up period
Renovascular Disease
- Cause of secondary HTN
- Bruits (diastolic abdominal) -PAD
- ->Cr increase with ACE-I (Creat is 1.2, give ACE inhibitor, creat goes up to 2.0; suspect bilateral renal artery stenosis)
- Pulmonary edema (Flash pulmonary edema with HTN (recurrent), think renal artery stenosis)
Other factors that can cause secondary HTN
oral contraceptives, NSAIDs, stimulants (cocaine, methylphenidate), calcineurin inhibitors, antidepressants,
Pheochromocytoma
- Cause of secondary HTN
- paroxysmal (sudden burst) increase in BP
- Triad of pounding headache, palpitations, sweating
Primary aldosteronism
- Cause of secondary HTN
- unexplained HYPOkalemia, urinary protein wasting (even thought about 1/2 of pts are normkalemic)
- Tx: Sprinolactone (aldosterone inhibitor)
Cushing Syndrome
- Cause of secondary HTN
- Cushingoid facies, central obesity, proximal mm weakness, ecchymoses
- May have history of glucocorticoid use
Sleep apnea syndrome
- Cause of secondary HTN
- Usually in obese men who snore loudly when sleeping
- Daytime somnolence, fatigue, morning confusion
Coarctation of the Aorta
- Cause of secondary HTN
- HTN in arms with diminished femoral pulses and low/unreadable BP in legs
- Left brachial pulse is diminished and equal to the femoral pulse (if origin of L subclavian artery is distal to the coarctation)
- Bicuspid Aortic Valve is associated with coarcatiob
- Tx: stenting of the aorta to help alleviate congestion
- Bicuspid and aorta need MRI of brain, could have aneurism
Hypothyroidism
- Cause of secondary HTN
- s/s of hypothyroidism
- elevated serum TSH
Primary hyperparathyroidism
- Cause of secondary HTN
- elevated serum calcium
