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Cardiology > HTN > Flashcards

HTN Flashcards

1
Q

What are the epidemiological statistics for HTN?

A 
50% U.S. adults have HTN
most common primary care dx
90% chance of HTN if >85 yrs old 
only 2/3 aware they have HTN
only 55% ppl w/ HTN are receiving tx
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2
Q

an increase in systolic BP by 2 mmHg raises risk of stroke/MI death by what %?

A

stroke by 10%

MI by 7%

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3
Q

each increment of 20 mmHg in SBP or 10 mmHg in DBP doubles risk of what?

A

DEATH

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4
Q

what are 6 major outcomes of prolonged untreated HTN?

A
  1. ASCVD, CAD, MI, LVH
  2. CHF
  3. CVA/stroke
  4. CKD
  5. peripheral vascular disease, aortic dissection/aneurysm
  6. vision loss
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5
Q

what are fixed risk factors for HTN?

A

family hx, male, African American, age, psychosocial stress, CKD, OSA, tobacco/nicotine use, sedentary lifestyle

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6
Q

what are modifiable risk factors for HTN?

A

tobacco, DM, dyslipidemia, obesity, high sodium diet, excessive alcohol, physical inactivity

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7
Q

what are causes of primary/essential HTN?

A

no identifiable cause
genetics
sodium, obesity, DM, dyslipidemia
alcohol, smoking, lack of exercise, low potassium intake, NSAIDs, polycythemia
white coat HTN (driven by stress/anxiety)

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8
Q

what are secondary endocrine causes of HTN?

A

hyperaldosteronism, pheochromocytoma, hyperthyroidism, Cushing’s, hyperparathyroidism

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9
Q

what are secondary renal causes of HTN?

A

renal artery stenosis, polycystic kidney disease, diabetic renal disease

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10
Q

what is a secondary miscellaneous cause of HTN?

A

stress/anxiety, OSA, pregnancy, coarctation of the aorta

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11
Q

what are secondary medication causes of HTN?

A

estrogens (OC), NSAIDs, glucocorticoids, stimulants/ephedrine, alcohol, etc.

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12
Q

what is resistant HTN?

A

uncontrolled HTN despite 3 drugs (1 of which is a diuretic)

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13
Q

what should you evaluate if a pt has resistant HTN?

A

adherence, refills
white coat HTN
causes of secondary HTN

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14
Q

T or F: HTN is usually asymptomatic

A

T

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15
Q

What are rare symptoms that can arise from HTN?

A

headache, nosebleeds, palpitations, visual changes, N/V

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16
Q

what should you gather in the history of a pt w/ HTN?

A 
duration of HTN
prior tx 
intake of agents that may cause HTN
family hx
symptoms of secondary causes
symptoms of target-organ damage
risk factors
dietary hx
psychosocial 
sexual function
OSA
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17
Q

What are important aspects of the physical exam of a HTN pt?

A

general appearance, fundoscopy, neck, heart, lungs, abdomen, extremities, neurologic assessment

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18
Q

what should be noted in fundoscopic exam of HTN pt?

A

hemorrhage, papilledema, cotton wool spots, arteriorlar narrowing/nicking

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19
Q

what should be noted on neck exam of HTN pt?

A

palpation and auscultation of carotids

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20
Q

what should be noted on heart exam of HTN pt?

A

size, rhythm, sounds

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21
Q

what should be noted on lung exam of HTN pt?

A

rhonchi, rales

22
Q

what should be noted on neurologic exam of HTN pt?

A

confusion, focal weakness, visual disturbance

23
Q

what position should pt be in to correctly take BP?

A

pt should be seated, feet on floor, back supported, no crossing legs

24
Q

how to correctly take BP

A 
have pt rest 5 min before checking
support pt's arm
cuff @ mid-sternal level, empty bladder center over artery
release pressure @ 2 mmHg/second
NO TALKING 
check 2 readings 3 minutes apart
25
Q

what should pts avoid 30 min before taking BP?

A

exercise, caffeine, smoking, or Twitter

26
Q

What are the advantages of automated office BP?

A

reduces incidence of white coat HTN –> improved accuracy

27
Q

what is the gold standard for measuring BP?

A

ambulatory blood pressure monitoring

28
Q

what is ambulatory blood pressure monitoring?

A

24 hr portable device that pt wears

measures BP every 15-20 min during day and 30-60 min during night

29
Q

what are potential indications for ambulatory blood pressure monitoring?

A 
unusual variability of BP
white coat HTN
nocturnal HTN
resistant HTN
dx of HTN in pregnancy
masked HTN
30
Q

what is the definition of daytime HTN according to ACC/AHA?

A

130/80 or higher

31
Q

what are lab tests for HTN?

A 
electrolytes (including calcium)
serum creatinine
fasting BG
UA
CBC
TSH
lipid profile
electrocardiogram
calculate 10 yr athersclerotic CVD risk
if DM/CKD --> urinary albumin:creatinine
32
Q

what is the tx goal for pts w/ HTN?

A

<130/80

33
Q

what is BP 120-129/80-89 considered?

A

elevated BP, encourage lifestyle mods, no drugs

34
Q

what is BP 130-139/90-99 considered?

A

Stage I HTN, encourage lifestyle mods, single 1st line agent

35
Q

what is BP 140/100 or higher considered?

A

Stage II HTN, encourage lifestyle mods, 2 1st line agents

36
Q

how much SBP reduction is seen w/ weight loss?

A

5-20 mmHg per 10 kg wt loss

37
Q

how much SBP reduction is seen w/ DASH diet?

A

4-14 mmHg

38
Q

how much SBP reduction is seen w/ sodium restriction <2400 mg/day?

A

2-8 mmHg

39
Q

how much SBP reduction is seen w/ 150 min aerobic exercise per week?

A

5-10 mmHg

40
Q

how much SBP reduction is seen w/ limiting alcohol consumption?

A

2-5 mmHg

41
Q

what is 1st line tx for HTN?

A

thiazide diuretics

42
Q

what anti-HTN meds are recommended for <50 yrs old?

A

ACE-I, ARB

43
Q

what anti-HTN meds are recommended for 60+ yrs old?

A

Calcium channel blockers (amlodipine), thiazide

44
Q

what anti-HTN meds are recommended for black pts?

A

Calcium channel blockers (amlodipine), thiazide

45
Q

what anti-HTN meds are recommended for non-black DM pts?

A

ACE-1, ARB

46
Q

what anti-HTN meds are recommended for CKD?

A

ACE-1, ARB

47
Q

what are indications for ACE inhibitors/ARBs?

A

Heart failure, post-MI, CKD

48
Q

what are indications for beta blockers?

A

heart failure, post-MI, angina, a fib/flutter

49
Q

what are indications for diuretics?

A

heart failure

50
Q

what are indications for aldosterone antagonists?

A

heart failure, post-MI

51
Q

what are ACE inhibitors contraindicated in?

A

angioedema, pregnancy

52
Q

what are beta blockers contraindicated in?

A

bronchospastic disease, 2nd/3rd degree heart block

Cardiology (6 decks)

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