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Medicine II > HTN > Flashcards

HTN Flashcards

1
Q

Increased angiotensin II activity and mineralocorticoid excess is defined as essential or secondary HTN

A

essential

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2
Q

According to ACC/AHA 2017

what criteria is the for HTN is a 24hr mean BP > than ….

A

24 hr mean >125/75

say time average >130/80
avg. of at least 2

night (asleep) mean >110/65

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3
Q

most common cause of secondary HTN is

A

renal artery stenosis

kidney issues are the first thing you should always think about

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4
Q

what complications do you worry abut in a pt with HTN

A

premature cardiovascular dz

CVA intracranial HTN
retinopathy

chronic renal insufficiency

PVD

hypertension emergencies

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5
Q

goal # of Tx of HTN for people who have DM and CKD i

A

130/80

for people who have DM and CKD if you would want <140/90

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6
Q

what is primary CVD prevention tx

A

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

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7
Q

what do you want to check before you put a pt on a diuretic

A

creatinIn and BMP

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8
Q

what medication is associated with a dry cough?

what would be the next step if the pt were to develop a cough?

A

Ace-inhibitors

swithc them to an ARB

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9
Q

1st line for HTN mngmt of AA pts

A

Calcium channel blockers

or thiazides

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10
Q

what would you want to use to manage HTN in a pt with asthma and why

A

calcium channel blocker

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11
Q

which two HTN tx should not be used together

A

ACEI with Beta blocker

OR

diuretic with CCB

same MOA

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12
Q

what tx would you use for HTN in a pt with

diabetic nephropathy or nondiabetic chronic kidney disease complicated by proteinuria.

A

ACE inhibitor or ARB

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13
Q

plasma renin activity (PRA)

what is it and how can it be used to guide management

A

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

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14
Q

post MI (indicated by Q waves) how would we want to tx hypertension

A

ACEI

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15
Q

what is the definition of hypertensive urgency

A

Severe hypertension in asymptomatic patients

SBP ≥180 mmHg
DBP ≥120 mmHg

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16
Q

what is the tx goal for hypertensive emergency

A

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

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17
Q

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

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

18
Q

what is the genetic links we see in HTN

A

2x as likely in subjects who have a HTN parent

genetic factors account for @ 30% of incidence

19
Q

renal causes of secondary hypertension

A

chronic renal disease
renal artery stenosis
vascular,

20
Q

pheochromocytomas

A

Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia

21
Q

hypothyroid changes that can lead to HTN

A

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

22
Q

Cushing’s syndrome

A

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);

23
Q

prevention of end organ disease in a pt with HTN should include what regular exams/screening in addition to medicaiton

A

yearly EKG, urine microalbumin, ophthalmology exam; check for bruits, distal pulses, ask about ED, HA, vision changes, etc

24
Q

The risk of CVD beginning at ______doubles with each increment of________

A

risk beginning at 115/75 mmHg

doubles with each increase of
20/10 mmHg

25
Q

when would you treat HTN with medication

A

> 135/80

26
Q

according to the JN8 what is the BP goal for pts 60 and over

A

<150/90

27
Q

according to JNC what should the BP goal be for general population less than 60

A

<140/90

28
Q

according to JNC what should the BP goal be for general population greater than 60

A

<150/90

29
Q

what should you do with a pt that comes in with <30 yrs old with DBP >90mmHg

A

should be treated

30
Q

what did Tana give as a baseline for BP goals

A

<130/80 mmHg for most patients, <140/90 mmHg for patients >75 y/

31
Q

when would you initiate two agents at the same time ?

A

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

32
Q

NCEP guidelines for adults with regards to lipid panel TC, TG, LDL and HDL

A

TC goal <200,
TG goal <150
HDL normal 40-60
LDL goal is less than 100

33
Q

NCEP guidelines for adults near normal LDL

A

100-129

34
Q

NCEP range for adults with high and very high LDL

A

high 130-159

high 160-189, very high

35
Q

according to the NCEP what is the goal LDL for pt with DM or CKD

A

<70

36
Q

how do you calculate LDL

A

Calculated LDL = TC – TG/5 – HDL

37
Q

all associated with HTN emergency

A

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

38
Q

ó Primary CVD prevention to start when you have a pt with HTN

A

ó ASA 81mg daily
ó Statin therapy
ó Smoking cessation
ó Screen for DM and OSA

39
Q

ó DM and HTN are the leading causes

A

renal fialure

40
Q

ó HTN is the leading cause of

A

stroke

41
Q

ó CAD and CVA are the leading causes of death in

A

in women over all other causes combined

Medicine II (21 decks)

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