HTN Flashcards
% of adults that will experience HTN in their life
90%
% of adults that have HTN
1/3
M vs F:
- At young age, who is more likely to have HTN?
- At older age, who is more likely to have HTN?
Young: M>F
Older: F>M
Hallmark of HTN
Systemic peripheral vascular resistance
How is HTN diagnosed?
Avg of 2+ elevated readings at 2+ visits
Pre-HTN range
120-139 / 80-89
Stage 1 HTN range
140-159 / 90-99
Stage 2 HTN range
160+ / 100+
___% of pts with BP of 120-139 / 80-89 will develop HTN in ___ years?
50% in 4 years
Why do you need to be careful about aggressively treating HTN in elderly?
Increased risk of hypoTN –> falls
When to treat a pt under 60? (AHA says under 80)
140/90
When to treat a pt over 60? (AHA says over 80)
150/90
How to treat black pt vs non-black pt?
Black: thiazide or CCB
Non-black: thiazide, ACEI, or ARB
Primary Essential HTN etiology + sx
- Idiopathic
- Usually asympt or mild HA, tachy
Sx of chronic uncontrolled primary essential HTN
Retinopathy, papilledema, LVH, S4 (poor ventricular compliance)
How to treat primary essential HTN
- lifestyle changes for 6 months
2. treat w/ 2 meds >140
HTN Urgency definition
- Severe asympt HTN >180/120
- No evidence of organ dysfx (eyes, kidneys, brain, heart)
How to treat HTN urgency
Lower BP to 160/90 then you can d/c pt
HTN Emergency definition
> 180/120 w/ evidence of impending organ dysfx
- CV: acute MI, LV dysfx, unstable angina, aortic dissection
- Encephalopathy
- Acute renal insuff
- Retinopathy, papilledema
How to treat HTN emergency
Lower BP by no more than 25% in minutes, continue lowering over next 1-2 hrs (or body will not be able to perfuse).
Goal BP = 160/90
Secondary HTN definition
<30 y/o
New onset >50 y/o becomes refractory to tx
Causes of Secondary HTN
- Renal parenchymal disease (most common)
- Renal artery stenosis
- Primary hyperaldosteronism
- Cushing’s
- Pheochromocytoma
- Preeclampsia/ eclampsia
Renal parenchymal disease
Disturbance in urine filtration + formation
- Caused by DM or lupus nephritis
Renal artery stenosis
New onset HTN refractory to 3+ drugs
- Young: fibromusc dysplasia
- Older: atherosclerosis
Primary hyperaldosteronism
Hypokalemia, refractory HTN’
- Caused by idiopathic adrenal hyperplasia or aldosteronomas
- D/c all meds, reintroduce meds one at a time
Cushing’s
Excess cortisol + aldosterone
- Caused by pituitary adenoma, adrenal secretion, ACTH secreting tumor, or exogenous use
- Dexamethasone suppression, 24 hr urine, or late night salivary cortisol
Pheochromocytoma
Catecholamine secreting tumor in adrenal medulla
- 24 hr urine
Preeclampsia/ eclampsia
Proteinuria and edema (seizures=eclampsia)
- Early delivery, bed rest, or hospitalization
