HTN Flashcards
Age can increase your risk for CVD what are these ages?
Male >= 45 yo Women >= 55 yo
Family history can play a part in CVD risk what are these guidelines?
Family history of a premature CVD even (MI, Stent, Angioplasty….) Women
What are some risk factors for CVD?
HTN, Cigarette smoking Dyslipidemia DM CKD Antinflammatory disease
What is the leading cause of death in the US
CVD
Primary HTN includes? And this accounts for what percentage of HTN?
- Idiopathic (Spontaneously)
- Benign
- Essential
Accounts for 90% of HTNs
Secondary HTN includes?
- Renal dx
- hyperaldosteronism
- RAS
- Pheochromocytoma (Adrenal tumors)
- Preganany - Eclempsia (Seizures that occur during pregnancy)
- Thyroid
- Drugs
- Anemia
What are the classifications of blood pressure?
What the the JNC 8 dosing guidlelines?
- A) Start one drug, titrate to maximum dose and then add second drug
- B) Start one drug and then add a second drug before acheiving max dose of initial
- C) Begin with 2 drugs at the same time, either 2 separate pills or as single combo
What is the first recommendation per JNC 8 for the management of HTN?
for patients >=60
- In general population >= 60 years
- Want to initiate treatment to lower Bp when
- SBP >= 150 or DBP >=90
- Treatment goal is to lower SBP < 150 and <90 DBP
What is the second recommendation per JNC 8 with patients <60? with DBP
- Initiate pharmacologic treatment to lower bp at 90 mmHg
- Goal is to be below DBP 90
- Ages 30-59 Grade A
- 18-39
- Grade E, expert opinion
Recommendation 3 patients <60 JNC 8
Initiate pharm treament if SBP is >= 140
Grade E
Recom 4 JNC 8 >= 18 with CKD
GFR <60
Lower BP >= 140 or DBP >= 90
less than those
JNC 8 18 or older with DM
>= 140/90
General JNC 8 medication recommendation for nonback population including ones with DM
Initial Treatment?
- Thiazide diuretics
- CCB
- ACEI
- ARBs
- Grade B
Recommendation 7 black population including DM
Initial treatment
Thiazide or CCB
For general black
Moderate B
DM grade C
Recommindation 8-9
Patients >= 18 with CKD
Patient >= to 18 with CKD
Treatment should include an ACE and an ARB regardless of race or DM status
If Bp goal is not reached within a month add a second drug from the recommendations from #6
What were the key messages in JNC 7?
- For those > 50 SBP is more important than DBP as a CVD risk factor
- Starting at 115/75 risk doubles for each increment of 20/10
- Those normotensive at age 55 have a 90% lifetime risk of developing HTN
- Certain high risk conditions are compeling indications for certain drug classes
- Most patients require 2 or more antihypertensive med to achieve goal
Post MI patients initial therapy options?
- BB, ACEI, Aldosterone antagonists
Patients with high CAD risk shoudl use?
BB and CCBs mostly
Patients with DM should use what meds?
ACE and ARBs
Patients with CKD should use?
ACEI, ARBS
What is the best choice for blacks? And what is the combination used that gives there treatment a similar effect as the nonblack populations?
Diuretics and CCBs
Thiazide + ACE is best
What should pregnant patients use?
What should be avoided?
Methyldopa, hydralazine, BBs
Avoid ACEI, ARBs, Renin-I
In elderly you would treat them the same as you would any patient but you should avoid?
Vasodilators, central a2 agonists, and a-blockers
ACEIs should be avoided in patients with?
History of angioedema
Chlorthalidone is more effective than ____ and it is a?
HCTZ and is a thiazide diuretic
Not used in patients with renal insufficiency
Thiazides are best for what population?
These are synergisitic with?
Can cause?
Black population
Synergistic with ACE and BBs
Hypokalemia, Hyperlipidemia, Hyperglycemia, Hyperuricemia
Diuretics increase? what cholesterol?
LDL and TGs
Potassium ___ diuretics are often used in combination with wht?
Caution should be used in patients with what insufficiency?
Caution when using with?
HCTZ
Renal insufficiency
Caution with ACEI, ARBs and Renin-I
Loop diuretics are reserved for patients with?
Renal insufficiency
Patients with CKD, HF, DM, post-mi, recurrent stroke should use what meds?
Who has a better response white or blacks?
ACE-I
Whites are more response
ACEI inhibitor side effects?
Contraindicated in patients with?
Caution in patients with?
Cough, hyperkalemia,
Pregnancy, RAS, angioedema
Renal insufficiency
ACE inhibitors can cause?
Hyperkalemia, Rash, Cough, Postural Hypotension, Renal Artery Stenosis
ARBs should be use when?
Patients should be using ACEI but it is intolerable
Increases SCr just like ACEs
What types of patients should use CCBs?
Elderly, blacks, angina, PVD, Migraine px
Added to diuretics
Dihydropyrodines are more potent at what?
Lowering Bp and angina
What are some adverse effects of dihydropyridines? Like amlodipine
- All CCBs cause headache, dizziness, postural hypotension
- Dihydros cause
- GERD, Edema, Flushing, Reflex tachycardia
BBs should be used in patients with? what color
- Whites
- CHD
- A-fib
- Migraine
- Post-MI
- Anxious
- Tachycardia
BBs can cause what AEs and when should they be stopped?
- Fatigue
- Insomnia/weird dreams
- Depression
- Should not be stopped abruptly
Aliskirenin is a?
Renin Inhibitor
Alpha 1 blockers?
Used in patients with?
Doxazosin and Terazosin
HTN, BPH, and Lipid abnormalities
Alpha 2 agonists like methyldopa should be used in patients ewith?
Pregnant patients , add on therapy,
What drugs can exacerbate HTN?
My Bp was exacerbated when I started taking birthcontrol. I also take ibuprofen all the time and drink 32 beers a day. I chew, drink energy drinks. I just started using steroids and I copy my mom all the time, I just got a transplant and have been having a lot of nerve pain veins
- Oral contraceptives
- NSAIDs
- Caffiene, Nicotine
- Sympathomimetics
- MAO I
- Steroids
- Cyclosporine
- ETOH
- Venlafaxine
What is a HTN emergency?
Want to decrease Bp fast but gradually
positive target organ damage
IV meds
Urgencies are?
Po meds
negative target organ damage
Ambulatory setting
