HTN Flashcards
preHTN is systolic____ or diastolic____
120-139; 80-89
stage 1 HTN is systolic____ or diastolic_____
140-159; 90-99
stage 2 HTN is systolic____ or diastolic_____
> 160; >100
HTN with no known cause
primary HTN
bp that is consistently elevated by out of office measurements but does not meet the criteria in the office
masked HTN
what bp defines hypertensive urgency
diastolic >120
diastolic>120, end organ damage
hypertensive emergency
HTN can be diagnosed after how many visits?
3
take BP how many times at each visit
2
when to repeat BP within office
when have BP difference >10 b/w repeats
risk of stroke increases as bp >
110/75
what grade of HTN retinopathy: generalized retinal arteriolar narrowing
grade 1
more severe generalized narrowing, focal areas of arteriolar narrowing and AV nicking
grade 2
retinal hemorrhages, microaneurysms, hard exudates, and cotton-wool spots
grade 3
hypertensive retinopathy, grades 1-3 + optic disk swelling and macular edema
grade 4
how to screen for peripheral arterial disease
ankle-brachial index
ABI under___is specific/sensitive for PAD
under 0.9
if you can get your middle aged patient to drop SBP by 10 and DBP by 5, can reduce stroke risk by____, MI risk by___, heart failure risk by____
35-40%; 20-25%; 50%
isolated systolic HTN is more common in what age grp
elderly
why does isolated systolic HTN occur?
diminished arterial compliance
how to dx OSA
formal sleep study (polysomnography)
hypokalemia in a patiet with HTN
primary aldosteronism
best initial test for suspected primary aldosteronism
aldosterone:renin ratio
high PAC: low PRA with ratio >___, is dx for____
> 30; primary hyperaldosteronism
hig PRC:high PRA
secondary hyperaldosteronism
low PAC: low PRA
alternate mineralocorticoid stimulation
> 30% jump in Cr after started ACEi or ARBs
bilateral renovascular disease
screening for abdominal bruit?
duplex doppler ultrasonography
duplex doppler ultrasonography considered positive when
50+
f/u test for +duplex doppler ultrasonography
MR angiography or CT angiography
gold standard for dx of abd bruit
renal arteriography
string of beads appearance
fibromuscular dysplasia
what is the most common cause of HTN in preadolescent kids
renal disease
dx of renal parenchymal disease
elevated Cr, decr GFR
tx of renal parenchymal disease
aggressive tx of HTN with ACEi
2nd most common cause of HTN in kids
coarctation of aorta
h/o HTN, SOB on exertion in kids
coarctation of aorta
if >___systolc diffference, then send for____
> 20; echo
dx of pheo if low index of suspicion
24 hr urine metanephrines and catecholamines
dx of pheo if high index of suspicion
plasma for fractionated metanephrines
dx of HTN is based on elevated BP at how many visits?
3
what should you set BP goals based on? (3)
- age
- diabetes
- kidney disease
age >60 w/o DM or CAD, BP goal is under____
150/90
age under 60 w/o DM or CKD, BP goal is under____
140/90
all ages with DM or CKD, BP goal is under____
140/90
who is a candidate for lifestyle change trial as tx for HTN
BP under 160/100 with no evidence of target organ damage
1st drug to start in Af Am without CKD
thiazide or CCB
1st drug to start in non-Af Am without CKD
ACEi, ARB, thiazide, CCB
1st drug to start in person with CKD
Acei, ARB
what drug is good for an older woman with osteoporosis
thiazide
what drug is good for someone with raynauds?
CCB
what drug is good for someone with BPH?
alpha blocker
what drugs are beneficial for recurrent stroke presentation
thiazide, ACEi
when SBP >160/100, how to titrate drugs
titrate up to max dose until goal is achieved
how should PAD be managed?
ASA
maximum initial fall expected in tx of hypertensive emergencies
25%
in stroke patient, who is eligible for lytic tx
BP under 185/110
in an ischemic stroke patient, when to tx?
> 220/120
how often to f/u patients after dx
regularly until BP controlled, then every 3-4 months after dx
how often to run ancillary studies after dx
yearly
