HTN Flashcards
How is HTN linked to functional decline
End organ damage such as renal function and vascular dementia. #1 cause of strokes, possible like to Alzheimers
Is there benifit to tx in people over 80yrs old
Yes, trial showl large reduction of death rate from stroke (39%), CVD (23%), HF (64%), other causes (21%).
Which vessels are resistant in systolic HTN
Large vessels
Which vessels are resistant in dystolic HTN
small vessels with HTN leading to increased resistance and even closure of small vessels
Lifestyle factors associated with HTN
Smoling, excessive ETOH, obesity
Definition of HTN (stage 1)
BP 140/90 x 3 readings
Definition of essential HTN
HTN without known cause eg environmental and genetic combination
Defefnition of secondary HTN
eg renal disease, hyperthyroid disease
pseudoHTN
brachial stiffness so that cuff cannot compress and get a correct reading
HTN hypterensive urgency
Systolic of 179 or diastolic 109 - no symptoms of end organ damange. Emergency if symptomatic IE: SOB, chestpain, headahce, visual changes, acute renal failure, altered mental status
What is appropriate cuff size
80% of upper arm circumference
Should people <90 be treated for HTN
Evidence does not support at this time
What systolic BP should be treated in <80 yrs old
< 150mmHg to target 140 - 145mmHg
Non-pharm tx
weightloss, activity, DASH diet, d/c smoking, reduce etoh
Definition of HTN (stage 2)
SBP - 160, DBP - 100
1st line pharma for stage 1 HTN
diuretics cornerstone in elderly. CCB, ACEI or ARB - or combo
1st line pharma for stage 2 HTN
at least 2 medication is BP is >20mmHg
1st line chronic kidney disease
ACEI or ARB
1st line angina
BB, CCB
Who is DASH diet contraindicated in
stage 3-4 kidney disease due to K+
COnsiderations for use of diruetics
monitor lytes, particularly K+, can increase uric acide
Why are ACEI and ARBS potenially less effective in elderly
Elderly have reudced renin-angiotension system than younger adults
Do elderly typically need more than one medication to control HTN
Yes
why are BB not 1st line in .60 yrs
unless compelling indications, increases risk of stroke
1st line medication for isolated systolic HTN
Diuretic chlorthalidone if SBP 160mmHg and disloic <90mmhg
How to tx widening pulse pressure
strong indicated for risk of stroke, HF or CVD weather pre por post tx. thiazine diuretics most effective in reducing
What does CAD do to BP
Increases systolic, decreased siasloic
Whats the link between low diastolic and MI
Low pressure impairs cornoary blood flow (should not be lower than 70mmHg). Same risk as those with DBP >90mmHg
FIrst line TX for elderly with htn, stable angina and/or prior MI
BB - hear tremoddling, consider adding long acting DPH CCB. ACE is good for left ventricular function compromise
TX goal for CHF
Reduce preload and afterload.
Which TX is preferered for CHF
Diuretics, ACE and BB
What tx for diastolic sidfunction
Reduce rate with BB or CCB to improve filling
Current guidlines for chronic renal disease
Typically ACE or ARB - medications can cause decline in GFR though
tx of BPH and HTN
ALLHAT trial showed alpha blocker dozazosin worked well
