HTN Flashcards
Elevated systolic BP, diastolic BP, or both lead to what diseases
Hypertensive retinopathy
Cerebrovascular disease
Renal failure
Cardiovascular disease
primary HTN risk factors
Age Race Family History Smoking Diet (excess sodium intake) Excess alcohol intake
No a direct cause
Secondary HTN causes
Renal Disease Medication induced Thyroid/Parathyroid disease Obstructive Sleep Apnea Pheochromocytoma Coarctation of the Aorta Primary Aldosteronism Renovascular Disease Cushing’s Syndrome
Signs of secondary causes
Hypokalemia Abdominal bruit Labile pressures with tachycardia, sweating, and tremor Family history of kidney disease Serum creatinine >1.5 mg/dL LV hypertrophy determined by ECG
HTN Eval at presentation
Respiratory
rhonchi, rales
Abdomen
renal masses, renal bruits, femoral pulses
Neuro
visual disturbance, focal weakness, confusion
CVD eval HTN
Palpate brachial and femoral pulses simultaneously
Left ventricular hypertrophy
Displaced PMI
ECG evidence
S4 (presystolic) gallop due to decreased compliance of the left ventricle
Auscultate for carotid, abdominal and femoral bruits
Check extremities for edema
How does JNC 8 differ form JNC 7?
JNC 8: 140/90 for everyone including CKD and DM
ACC.AHA 2017 guide
Normal < 120/80
ELevated = 120-129/80
HNT 1 = 130-139/80-90
HNT 2 >140/90
Dx labs should include
CSC, Urinalysis, Glucose, GFR, creatininte, TSH, EKG
Know the ACA/ AHH 2017 Treatment goals
slide 37
When to start anti-HTN meds
All patients with stage 2 HTN
Patients with stage 1 HTN with 1 or more :
Established ASCVD
Type 2 DM
CKD
10-year calculated ASCVD risk of at least 10%
What are the Anti-HTN med goals
<130/80, 140/90 if low HTN 1 risk and arent on meds
Low DBP is associated with
MI and stoke
Diet modifications and their expected results
Salt restriction
Expected decrease of 5/3 mm Hg
DASH diet
Expected decrease of 6/4 mm Hg reduction
Alcohol Reduction
Expected decrease of 2-4 mm Hg reduction in SBP
Weight Loss (approx. 1 mmHg per 1 lb lost)
Exercise (4-6/3 mm Hg reduction)
Diuretics
Thiazide, Loops, Aldostreron antagonist, Potassium sparing. All Hyponatremia, and will control 50% of mild and HNT 1 (blacks, elderly, smokers)
Thiazide
Hydrochlorothiazide. Side effects: Hypokalemia Hypomagnesemia Hypercalcemia Hyponatremia Sexual dysfunction Hyperuricemia (gout) Glucose disturbance Dyslipidemia CONTRA: Hypersensative to Sulfonamides
Loop diuretic
furosamide.
ADEs; hypocalcemia, hypokalemia, hyponaturemia, hypomagnesiumia, sex dysf, gluc, lipids,
POOR AntiHTN: Kidney disease and retention
Postassium Sparing
Triamterne. weak antiHTN
ADEs: Hyperkalemia in CKD & DM. Nephrolithiasis, Renal Dysfunction.
CAUTION: combo with ACE, ARB, DRI, K supplements.
CONTRA: Hepatic disease, renal failure, hyperkalemia.
Aldosterone antagonis
Spironolactone. Side effects: Hyperkalemia Gynecomastia Strong Anti-HTN CONTRA: renal impair, DM with protenuria, hyperkalemia
Non-dihydropyridines
Calcium Channel Blocker (-dipines): More Cardio. Verapamil/Diltiazem.
ADEs: Bradycardia, Constipation, gingival hyperplasia, worse HF.
dihydropyridines
Calcium Channel Blocker (-dipines): More vasodilator. ADEs: Peripheral edema, headache, flushing
better meds for blacks and elderly
CCB, THIAZ
Ace inhibitors
-pril. AngI-AngII, Bradykinin = vasodilator, Dry cough.
GOOD in patients w/: CKD, DM, HF, post-MI.
ADEs: Cough, hyperkalemia, Angioedema, Acute renal failure.
CONTRA: Pregs, angioedema, renal arterial stenosis.
ARBS
-sartan. Angiotension block. vasodilate.
GOOD in Pts w/: CKD, DM, HF.
ADEs: Hyperkalemia, Angioedema, Acute renal failure.
CONTRA: Preg, renal artery strenosis.
Direct Renin Inhibitor
Aliskiren. Inhibits Renin.
ADEs: Hyperkalemia, Renal impared, Hypersentativity, Angioedema.
Combo: dont combine with ACE or ARB
CONTRA: Preg, ACE, or ARB
Beta blockers
olol- Block adrenoreceptos and catecholamines = decrease CO, PVR, and Renin.
CONTRA: AV block, cardiogenic shock, HF, Hypotension. COPD, Astham, DM, Depression.
Avoid abrupt cessation = death after MI/HF
ADEs: exersize intolerance, fatigue, bradycardia, sex dysf. depressoin, airway blocked, PVR
Atenolol. Metoprolol, Nabivolol
Cardio selective BB,
Propranolol, Nadolol, Labetolol, Carvedilol
Non-cardio selective BB
Central Alpha agonist
Clonidine, Methyldopa. Stim alpha = reduce sympathetics.
Avoid abrupt stop = rebound HTN.
GOOD for pregs.
ADEs: Anticholinergic, Bradycardia, Orthohypo, Dizzy, Rebound HTN.
Methyldopa
Alpha agonist, decrease sympathetics. Good in Pregs. ADEs: Hepatitis, Hemolitic anemia, fever.
Contra = liver disease
Alpha blockers
-zosin. Peripheral smooth muscle relax = decease PVR & BP.
No monotherapy
Good in Mild-moderate HTN.
ADEs: HF, BPH, Orthohypo, reflex tachy, dizzi
When starting HTN meds, you must
reassess at 1 month, increase dose, add 2nd drug, refer. Monitor serum K and creatinine.
AHA/ACC first line drugs
THIAZ, CCB, ACE, ARB
Goal of Patients with stable ischemic heart disease
BP<130/80
Use BB, ACE, ARB.
IF no good + Angina. Add CCB, dihydro
IF no good w/o Angina. Add CCB - dihydro, OR THIAZ, OR Spironolactone
Goal of Patients with DM
BP<130/80.
All classes useful. With albuminuria = ACE or ARB
Goal of Patient with CKD
BP<130/80.
W/o albunimuria = 1st line (THZ, ACE, ARB, CCB)
W/ Albuminuria = ACE, if cant then ARB
Goal of Preg Patient
Methyldopa, Nifedipine, Labetalol
NO ACE, ARB, DRI
Poor prognosis indicators
CVD - High pulse pressure, men>55, Women>65, smoke, lipids, glucose, abnl GTT, DM, Fx CVD, abdominal obesity, LVH Cerebralvascular disease - carotid wall thickening/plaques, Kidney - low GFR, albumenuria, Retinopathy Vascular Disease, ABI>.9
What is resistant HTN
max dose on 3 drugs + thiaz . Reassess secondary HTN/Specialist
HTN emergency
> 180/120. Urgent if asymptomatic (non-adherence to meds, eats salt)
Emergency HTN - end organ damage
End organ damage
Cerebrovascular: -encephalopathy, brain infarct, hemorrage. Cardiac - Dissection, LV failure, MI Renal - Acute glomerulonephritis
Overall goal of End organ failure
gradual reduction to <160/100
- too fast = MI, Cerebral ischimia, infacrt
No sublingual nifedipine
resting reduces HTN by
10-20mm
Emergency HTN should go to
ICU, and reduce 25% of HTN per hour to 160/100
