HTN Flashcards
Increased angiotensin II activity and mineralocorticoid excess is defined as essential or secondary HTN
essential
According to ACC/AHA 2017
what criteria is the for HTN is a 24hr mean BP > than ….
24 hr mean >125/75
say time average >130/80
avg. of at least 2
night (asleep) mean >110/65
most common cause of secondary HTN is
renal artery stenosis
kidney issues are the first thing you should always think about
what complications do you worry abut in a pt with HTN
premature cardiovascular dz
CVA intracranial HTN
retinopathy
chronic renal insufficiency
PVD
hypertension emergencies
goal # of Tx of HTN for people who have DM and CKD i
130/80
for people who have DM and CKD if you would want <140/90
what is primary CVD prevention tx
ó ASA 81mg daily
ó Statin therapy
ó Smoking cessation
ó Screen for DM and OSA
Low dose thiazide diuretic in both younger and older patients provides better cardioprotection than an ACE inhibitor or a calcium channel blocker in patients with risk factors for coronary artery disease
what do you want to check before you put a pt on a diuretic
creatinIn and BMP
what medication is associated with a dry cough?
what would be the next step if the pt were to develop a cough?
Ace-inhibitors
swithc them to an ARB
1st line for HTN mngmt of AA pts
Calcium channel blockers
or thiazides
what would you want to use to manage HTN in a pt with asthma and why
calcium channel blocker
which two HTN tx should not be used together
ACEI with Beta blocker
OR
diuretic with CCB
same MOA
what tx would you use for HTN in a pt with
diabetic nephropathy or nondiabetic chronic kidney disease complicated by proteinuria.
ACE inhibitor or ARB
plasma renin activity (PRA)
what is it and how can it be used to guide management
Older / AA hypertensives usually have lower PRA levels than younger / white patients
Drugs that act to lower renin-angiotensin effects, such as ACE inhibitors, ARBs, would be more effective in those with higher PRA levels
post MI (indicated by Q waves) how would we want to tx hypertension
ACEI
what is the definition of hypertensive urgency
Severe hypertension in asymptomatic patients
SBP ≥180 mmHg
DBP ≥120 mmHg
what is the tx goal for hypertensive emergency
Reduce BP to ≤160/100 mmHg over hours to days with conventional oral meds
Adjust patient’s meds; if not on meds, start 2 drugs
Recheck BP and sx every 1-2 days
The following diagnostic criteria were suggested by the 2017 ACC/AHA guidelines; meeting one or more of these criteria using ABPM qualifies as hypertension
A 24-hour mean of 125/75 mmHg or above
●Daytime (awake) mean of 130/80 mmHg or above
●Nighttime (asleep) mean of 110/65 mmHg or above
what is the genetic links we see in HTN
2x as likely in subjects who have a HTN parent
genetic factors account for @ 30% of incidence
renal causes of secondary hypertension
chronic renal disease
renal artery stenosis
vascular,
pheochromocytomas
Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia
hypothyroid changes that can lead to HTN
The major cardiovascular changes that occur in hypothyroidism include a decrease in cardiac contractility, a reduction in heart rate, and an increase in peripheral vascular resistance
Cushing’s syndrome
Patients may present with the typical signs and symptoms of hypercortisolism including weight gain, obesity, hypertension, and menstrual cycle disorders. Cardiovascular disease, in particular moderate diastolic hypertension, is a major cause of morbidity and death in patients with Cushing’s syndrome.
The pathogenesis of hypertension is multifactorial and not fully understood; however, the following factors may be important: Increased peripheral vascular sensitivity to adrenergic agonists; Increased hepatic production of renin substrate (angiotensinogen);
prevention of end organ disease in a pt with HTN should include what regular exams/screening in addition to medicaiton
yearly EKG, urine microalbumin, ophthalmology exam; check for bruits, distal pulses, ask about ED, HA, vision changes, etc
The risk of CVD beginning at ______doubles with each increment of________
risk beginning at 115/75 mmHg
doubles with each increase of
20/10 mmHg
when would you treat HTN with medication
> 135/80
according to the JN8 what is the BP goal for pts 60 and over
<150/90
according to JNC what should the BP goal be for general population less than 60
<140/90
according to JNC what should the BP goal be for general population greater than 60
<150/90
what should you do with a pt that comes in with <30 yrs old with DBP >90mmHg
should be treated
what did Tana give as a baseline for BP goals
<130/80 mmHg for most patients, <140/90 mmHg for patients >75 y/
when would you initiate two agents at the same time ?
If BP is >20/10 mmHg above goal, or SBP >160 mmHg or DBP >100 mmHg, consider initiating therapy with two agents at the same time
NCEP guidelines for adults with regards to lipid panel TC, TG, LDL and HDL
TC goal <200,
TG goal <150
HDL normal 40-60
LDL goal is less than 100
NCEP guidelines for adults near normal LDL
100-129
NCEP range for adults with high and very high LDL
high 130-159
high 160-189, very high
according to the NCEP what is the goal LDL for pt with DM or CKD
<70
how do you calculate LDL
Calculated LDL = TC – TG/5 – HDL
all associated with HTN emergency
ó Seizure
ó Altered mental status
ó Headache with visual changes
ó Marked hypertension with retinal hemorrhages, exudates, or papilledema
ó May be associated with hypertensive encephalopathy
ó Decreased urinary output with rapid increase in renal failure
ó Eclampsia in pregnancy/postpartum
ó Primary CVD prevention to start when you have a pt with HTN
ó ASA 81mg daily
ó Statin therapy
ó Smoking cessation
ó Screen for DM and OSA
ó DM and HTN are the leading causes
renal fialure
ó HTN is the leading cause of
stroke
ó CAD and CVA are the leading causes of death in
in women over all other causes combined
