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HTN Flashcards

1
Q

What do you do to treat Stage 1 HTN?

A
  • If ASCVD risk is <10%, just healthy lifestyle
  • If ASCVD risk >10%, both lifestyle modification and one med
  • If pt has known CVD, DM, or CKD, then lifestyle modification and one med
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2
Q

What do you do to treat Stage 2 HTN?

A

2 meds + healthy lifestyle

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3
Q

What magic number does CV risk start to increase?

A

Anything beyond 115/75

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4
Q

Criteria for diagnosing HTN 18 years and older

A
  • Avg of 2 or more BP measurements on separate days
  • Based on EITHER systolic or diastolic
  • Office BP of 130/80 or higher
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5
Q

Criteria for diagnosing HTN in children/adolescents

A
  • Avg of 2 or more BP measurements on separate days
  • Based on EITHER systolic or higher
  • BP at or above 95% for age, height, and gender
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6
Q

What’s the biggest modifiable risk factor for ASCVD?

A

HTN

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7
Q

Primary HTN

A

HTN with NO identifiable cause, NO cure, most cases

-gradual increase with slow rate of rise in BP, lifestyle factors that favor high BP, family hx of HTN

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8
Q

Secondary HTN

A

HTN with cause, correction of cause may cure the HTN, very few cases

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9
Q

NML BP
Elevated BP
Stage 1
Stage 2

A

<120/<80
120-129
130-139 OR 80-89
>140 OR >90

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10
Q

BP = …

A

CO * TPR

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11
Q

CO = …

A

SV * HR

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12
Q

How is HTN maintained

A

HTN > heart releases ANP > vasodilation and increase in Na and H2O excretion > kidney senses low pressure > release of renin > angiotensinogen to ang 1 > ACE converts ang 1 to ang 2 > aldosterone released and vasoconstriction > kidney reabsorbs Na and water > HTN

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13
Q

Secondary causes of HTN

A

Sleep apnea, RAS, CKD, hyperaldosteronism, pheochromocytoma, coarctation of aorta, hypercortisolism, hyperthyroidism

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14
Q

Most common secondary cause of HTN

A

Sleep apnea

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15
Q

What’s the mechanism for sleep apnea leading to HTN?

A

Repeated arterial desaturation sensitizes the carotid body chemoreceptors causing sustained sympathetic over-activity even during waking hours

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16
Q

Clinical signs of sleep apnea

A

Snoring, tired, observed apnea, elevated BMI, >50 yo, enlarged neck circumference, male

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17
Q

RAS causes and s/s

A
  • atherosclerosis, fibromuscular dysplasia

- renal a bruit, classic worsening renal fxn with ACEI or ARB

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18
Q

RAS mechanism for HTN

A
  • unilateral RAS causes underperfusion of JG cells > RAAS

- bilateral RAS causes renal failure and volume-dependent HTN

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19
Q

CKD cause and s/s

A
  • expanded plasma volume d/t lack of capacity to excrete Na and H2O > RAAS
  • asymptomatic edema, HTN, flank pain, and/or decreased urine output
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20
Q

Hyperaldosteronism causes

A
  • Primary: unilateral aldosterone-producing adenoma (Conn’s) and bilateral adrenal hyperplasia
  • Secondary: renin-secreting tumor, HF, cirrhosis, black licorice
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21
Q

Pheochromocytoma P’s

A
  • paroxysmal pressure
  • pain headache
  • palpitations
  • pallor
  • perspiration
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22
Q

Mechanism of increased HTN via pheo

A
  • Stimulates alpha1 receptors to increase vasoconstriction
  • Stimulates beta1 receptors to increase HR and contractility in heart and increases renin release in kidney
  • Stimulates beta2 receptors to increase smooth muscle relaxation in airways
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23
Q

Why do you also have to get phenoxybenzamine with beta-blockers?

A

Only beta-blockers would give unopposed vasoconstriction since it doesn’t affect alpha receptors

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24
Q

Hypercortisolism clinical signs

A

Elevated blood sugar, HTN, central obesity with peripheral wasting, buffalo hump, moon facies

25
Q

Mechanism of hypercortisolism-induced HTN

A

Cortisol and aldosterone are almost identical in structure - glucocorticoids have a varying effect on mineralocorticoid receptors

26
Q

Cushing’s syndrome

A

Excessive cortisol

27
Q

Cushing’s disease

A

Excessive cortisol secondary to pituitary ACTH hypersecretion resulting in adrenal hypersecretion of cortisol

28
Q

Coarctation of the aorta

A

Narrowing of aorta > BP lower in legs than arms

29
Q

Hyperthyroidism mechanism of HTN

A
  • Increased expression of beta receptors resulting in increased sensitivity to catecholamines > increase contractility and HR, increase sympathetic tone to increase TPR
  • Thyroid hormones stimulate Na/K pumps in kidney > increase Na and H2O resorption
30
Q

Hyperthyroidism clinical signs

A

Palpitations, exophthalmos, weight loss, goiter

31
Q

Viscerosomatic reflexes for heart and kidney

A

Heart: T1-5, vagus
Kidney: T10-L1, S2-4

32
Q

Heart Chapman’s

A

Anterior: medial 2nd intercostal
Posterior: T2 transverse processes

33
Q

Kidney Chapman’s

A

Anterior: 1” superior and 1” lateral to umbilicus
Posterior: L1 transverse processes

34
Q

Adrenals Chapman’s

A

Anterior: 2” superior and 1” lateral to umbilicus
Posterior: T11 transverse processes

35
Q

Absolute compelling indication

A

Compelling indication is the requirement for a certain antiHTN drug class(es) for a condition

36
Q

Relative compelling indication

A

Compelling indication is suggestion for a certain antiHTN drug class(es) for a condition

37
Q

Absolute compelling contraindication

A

Requirement to NOT use a certain antiHTN drug class(es)

38
Q

Relative contraindication

A

Condition which makes a particular treatment or procedure potentially inadvisable

39
Q

Options for drugs for pregnancy

A

Methyldopa, hydralazine, vasodilators, labetolol

40
Q

relative indications for thiazide diuretics

A

Osteoporosis

41
Q

Absolute contraindications for thiazides

A

Hypokalemia

42
Q

Relative contraindications for thiazides

43
Q

Absolute indications for BB

44
Q

Relative indications for BB

A

atrial flutter/afib

45
Q

Absolute contraindications for BB

A

2nd or 3rd degree block, bradycardia

46
Q

Relative contraindications for BB

A

Fatigue, depression, aggravate asthma

47
Q

Absolute indications for ACEI/ARBs

A

CKD stage 1-3b, CVD, HF

48
Q

Absolute contraindications for ACEI/ARBs

A

pregnancy, bilateral RAS, hyperkalemia, AKI

49
Q

Relative contraindications for ACEI/ARBs

A

CKD stages 4-5

50
Q

Relative indications for CCB

A

African-American, afib/flutter (non-dihydropyridine)

51
Q

Absolute contraindications for CCB

A

2nd or 3rd degree block, bradycardia (non-dihydropyridine), systolic HF (non-dihydropyridine)

52
Q

Relative contraindications for CCB

A

Systolic HF (dihydropyridine), edema, fatigue

53
Q

Indication for aldosterone antagonises/K sparing diuretics

A

Add-on to thiazide that causes hypokalemia

54
Q

Absolute contraindications for aldosterone antagonists/Ksparing diuretics

A

Hyperkalemia

55
Q

Resistant HTN

A

Persistence of HTN despite concurrent use of adequate doses of 3 antiHTN agents from different classes (including diuretic)

56
Q

Causes of resistant HTN

A
  • Meds (alcohol, NSAID, illicit drugs, OCP, steroids, decongestants, licorice, ephedra
  • Secondary causes of HTN
57
Q

Causes of pseudo-resistant HTN

A
  • non-compliance provider is unaware of
  • improper BP measurement
  • volume overload
58
Q

First-line agents for HTN

A

Diuretics, ACEI, ARBs, renin inhibitor, CCB, BB (no longer used for initial therapy in absence of specific indication)

Heart 2 (5 decks)

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