HTN Flashcards
Primary HTN
Underlying physiologic alteration of unknown cause; 95% of cases of HTN
Secondary HTN
Resulting from a specific cause such as renal or endocrine disorders; 5% of cases
Characteristics of primary HTN
Usually of gradual onset
Usually develops between the ages of 30 and 50
Tends to remain asymptomatic for 10 to 20 yrs
Triggers include obesity, psychological stress, high-sodium intake, and alcohol intake over 1 oz/day
Causes of secondary HTN
Renal parenchymal disease Renal artery stenosis Pheochromocytoma Hyperaldosteronism Hypercortosolism MIThyroid dz Neurologic dz Meds -TZDs (thiazolidinedione) -NSAIDs -Cyclosporin
Goals of therapy
Reduce CVD and renal morbidity and mortality
Treat to BP <140/90 mmHg
-Elderly (>60 yrs) goal is <150/90
Achieve SBP goal esp in persons greater than or equal to 50 yoa
Benefits of lowering BP
35-40% stroke incidence reduction
20-25% MI reduction
50% heart failure reduction
Lifestyle modifications
Weight reduction Adopt DASH eating plan Dietary sodium reduction Physical activity Moderation of EtOH consumption
Examples of ACEIs
Banazepril
Lisionopril
Enalapril
Common side effects of ACE inhibitors
Hyperkalemia Dry cough Decrease in GFR upon initiation Angioedema- rare but serious Pregnancy category X
Organ damage that occurs with HTN
Heart -LV hypertrophy -Angina or prior MI -Prior coronary vascularization -Heart failure Brain -Stroke or TIA CKD PAD Retinopathy
CVD risk
The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors
Each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg
Nl albumin excretion
<30 mg/24 hrs
Microalbuminuria
Urine collection: 30-299 mg/24 hr
Progression: 20-40% develop overt nephropathy
Albuminuria (overt nephropathy)
Urine collection: Greater than or equal to 300 mg/24 hrs
Progression: 20% develop end stage renal disease
Examples of ARBs
Losartan
Valsartan
Candesartan
Common SEs of ARBs
Hyperkalemia
Decrease in GFR upon initiation
Do not cause cough
Angioedema is a rare but serious side effect
Can try an ARB after an ACE, but not the opposite way bc there is higher angioedema occurrence with ACEs
What are the two types of CCBs?
Dihydropyridines
Nondihydropyridines
MOA of dihydropyridines
Work in the peripheral vasculature, cause vasodilation
MOA of nondihydropyridines
Work centrally in the heart; have ionotropic and chronotropic effects
Examples of dihydropyridines
Amlodipine
Felodipine
Common side effects of dihydropyridines
Dizziness Flushing HA Gingival hyperplasia Peripheral edema
Examples of nondihydropyridines
Verapamil
Diltiazem
Common side effects of nondihydropyridines
Bradycardia
Anorexia
Nausea
Peripheral edema
Examples of thiazide diuretics
Chlothiadone
Indapamide
HCTZ
Examples of loop diuretics
Bumetanide
Furosemide
Torsemide
Examples of aldosterone agonists (diuretics)
Spironolactone
Eplerenone
Examples of K-sparing diuretics
Amiloride
Triamterene
When does loss of efficacy occur in thiazides?
When GFR <30 ml/min
Common side effects of thiazide diuretics
Hypokalemia Hypomagnesemia Hypercalcemia Hyperuricemia Sexual dysfunction
