HTN Flashcards
1
Q
New Diabetes Guidelines from American Diabetes Association
A
- Less strict SBP target
- New Target–> SBP <140 SBP
- Lower target may be achieved if w/out undue burden
- Does NOT mean HTN is not important for DM
2
Q
JNC 7 Classification of HTN
A
- Normal: SBP 159 or DBP >99
3
Q
CV Mortality Risk
A
- Doubles with each 20/10 mmHg increase in BP
4
Q
BP Goals by Category
A
- Essential HTN: <140/80
5
Q
BP Measurement Techniques
A
- In office: 2 readings (average), 5 minutes apart, sitting. Confirm elevated reading in contralateral arm
- Ambulatory BP monitoring: Indicated for evaluation of ‘white-coat” HTN; Absence of 10-20% BP decrease during sleep may indicate increased CVD risk
- Home BP: Provides information on response to therapy. May help improve adherence to therapy & evaluate “white-coat.” Avoid finger/wrist cuffs.
6
Q
Home BP Measurements: Why & How
A
- Better predictor of cardiovascular risk, target organ damage
- Helps reduce “white coat” effect & determine the presence of masked HTN
- Should be a routine component of BP measurement for monitoring someone with known or suspected HTN
- Use upper arm, appropriate sized cuff, seated, in AM & PM for 1-week
7
Q
Home BP Measurement: Who & What
A
- Most patients are suitable for HBPM, except those with A-Fib or other cardiac rhythm disturbances which make automatic BP monitoring unreliable
- Need 12 readings on average to make clinical decisions
- Average usually considered normal if majority of findings are SBP <135/85
8
Q
HBPM: Protocol
A
- 5 consecutive days (minimum)
- perform 3 measurements, 5min apart, in the AM and PM
- Toss the first 2 days and the first measurement each days thereafter
- Average remaining measurements
- Average the 2nd and 3rd measurements of each triplicate set
- Bring all recordings to HCP
9
Q
Systolic Blood Pressure
A
Increases with age
10
Q
Measuring BP in Elderly
A
- An auscultatory gap is more common in elders
- Period during which sounds of the true SBP fade away and reappear at a lower pressure point
- Usually occurs with vascular disease
- Often a common reason for inaccurate BPs (underestimates SBP)
11
Q
HTN and Elders
A
- HTN affects most elders
- More likely to have organ damage
- Optimal BP in HTN pts. NOT definitely established
- Proven benefits of treating HTN in >70yrs
- Risk of adverse outcomes by age & BP vary:
- 140 increases risks
- > 69: J Curve effect; risk of adverse events increase at SBP below upper 130s and above upper 140s
12
Q
BP Goals for the Very Elderly
A
- GOAL = 79 is beneficial:
- Decreases BP (~15/6mmHg)
- Decreases fatal and non-fatal stroke by 30%
- Decreases death from stroke by 39%
- Decreases death from any cause by 21%
- Decreases death from CV cause by 23%
- Decreases rate of HF by 64%
- ** No significant difference in K, uric acid, glucose, and creatinine
13
Q
JNC 7 Treatment Algorithm Stage 1
A
1) Lifestyle modifications
14
Q
Stage I HTN (Without compelling indications)
A
- SBP 140-159 or DBP 90-99
1) Thiazide diuretic
2) May consider ACE-I, ARB, BB, CCB, or combo
15
Q
Stage II HTN (without compelling indications)
A
- SBP >159 or DBP >99
1) 2 drug combo (usually thiazide diuretic + ACE-I or ARB, BB, or CCB)
