HTN Flashcards
Most common disease-related reason for visits to primary care providers
HTN
Numerical definition for HTN (Stage 1) (new standards)
Systolic: >130 mmHg
Diastolic: >80 mmHg
How should you measure a BP
Pt seated for >5 min., feet on floor, arm at heart level
No caffeine, exercise or smoking for >30 min
At least ____ measurements should be made over multiple visits and averaged to diagnose and treat HTN
2
Alternatives to office BP measurement
Home BP monitoring
Ambulatory BP monitoring
How should patients monitor BP at home?
Made after 5 min. of rest
2-3 made in morning and again in evening
7 days of consecutive measurements prior to office visits
BP measured repeatedly over 24 hours with an automated device; acquired at set intervals; average daytime, nighttime and 24-hr BPs are calculated
Ambulatory BP monitoring
(Systolic/Diastolic) blood pressure increases steadily with age
Systolic
(Systolic/Diastolic) blood pressure increases steadily until ~50 years old, then begins to decline
Diastolic
__________ have the highest prevalence of HTN
African Americans
Younger patients (<40yo) have a higher incidence of isolated (systolic/diastolic) hypertension
Diastolic
Older patients (>50yo) have a higher incidence of isolated (systolic/diastolic) hypertension
Systolic
African Americans have a _______ fold greater risk for HTN related renal disease and a _____% higher heart disease mortality
5-fold; 50% higher
It is suggested that in order to reduce coronary heart disease rates, physicians should focus on not only decreasing high BP but also…
address other risk factors (Cholesterol, DM, smoking, LVH)
Neurologic regulation of BP
a1 and b2 receptors
With increasing age, cardiac output tends to (inc./dec.) and peripheral resistance tends to (inc./dec.)
CO: decrease
PR: increase
_________ contributes to isolated systolic HTN in the elderly
Vascular stiffness
% of hypertension diagnosis that are considered essential/primary
90
Top three causes of secondary hypertension
Chronic Kidney Disease
Primary Aldosteronism
Renovascular
The pathogenesis of major consequences of HTN can be divided into what two categories
Inc. Afterload
Arterial Damage
HTN affects most vascular structures except…
veins
Organs at most risk to damage via HTN
Heart
Arteries
Brain
Kidney
Inc. afterload can result in what heart pathology
Hypertrophy
Why does the heart compensate for inc. afterload by hypertrophy and not hyperplasia?
Because these cells have very limited capacity to undergo mitosis
What causes the enlarged nuclei in ventricular hypertrophy?
increased ploidy (normal is 2N; these nuclei can be 4N, 8N or 16N)
Increased mass in the left ventricle (LVH) is manifest as what on an EKG
Greater positive voltage (taller R waves) in leftward leads (1, aVL and V6)
Greater negative voltage (deeper S waves) in rightward leads (V1-3)
Downsloping ST depressions/T wave inversions in lateral leads
Effects of chronic HTN on microvasculature
Thickened vessel wall (inc. elastin and collagen) for strength
Can progress to stenotic lumen
Most commonly used EKG criterion for LVH
S in V1 + R in V5/V6 >35mm
pathogenesis of chronic HTN on microvasculature; results in thickened walls with elastin and collagen; small arteries
Benign arteriosclerosis
pathogenesis of chronic HTN on microvasculature; results in thickened walls with collagen and plasma proteins; arterioles
Benign/Hyaline arteriolosclerosis
common cause of renal failure; benign nephrosclerosis
Chronic HTN causing stenotic lumen resulting in ischemia
Stenosis of occipital microvasculature (does/doesn’t) affect vision
Doesn’t (is useful for viewing affected vessels)
pathogenesis of severe/malignant HTN on microvasculature; results in either thickened walls with more smooth muscle cells or fibrinoid necrosis
Malignant arteriosclerosis
Malignant ateriolosclerosis
characterized by an abrupt and severe elevation in blood pressure that results in acute end-organ damage
Malignant hypertension
“onion skinning” in cases of severe HTN
Thickened wall with increased layers of smooth muscle cells
Why do you treat 140/90 mmHg in general population, but 130/80 mmHg in high-risk individuals?
Need more aggressive/proactive treatment to prevent future complications
Treatment goal for hypertensive patients (what numerical value)
<130/80 mmHg
Lifestyle interventions for those with HTN
Weight reduction DASH diet (fruits, veg., low fat milk) Reduce sodium More physical activity Moderation of alcohol
What two situations are characterized by severe elevations in BP >180/120 mmHg
- Hypertensive Emergency
2. Hypertensive Urgency
What is the evidence that it is a hypertensive emergency?
Evidence of new or worsening target organ damage
- requires immediate reduction of BP with IV drugs in ICU
What is the evidence that it is a hypertensive urgency?
No acute target organ damage
- requires drug therapy to reduce BP w/o hospitalization
What are the goals of HTN drug therapy?
- Reduction of CV and renal morbidity/mortality
2. BP <130/80 mmHg
What is the most important benefit of lowering BP?
treatment of htn with meds decreases CV risk such as stroke, MI, and HF
At each level of risk of CVD (11%, 15%, 21%), there was
similar relative risk reduction
In high risk patients, there was
greater ABSOLUTE reduction
What is the threshold for drug treatment in patients with uncomplicated HTN
BP > or = 140/90 mmHg
What is the threshold for drug treatment in HTN patients with complications or other medical conditions (CVD, Chronic kidney disease, diabetes, 10-year ASCVD risk >10%)
BP > or = 130/80 mmHg
Age, sex, race, BP, cholesterol, diabetes, tobacco use are risk factors that are counted to determine
a patient’s 10-year risk of CVD
What are the first line of treatment of hypertension?
- Thiazide diuretics
- Calcium channel blockers
- ACE inhibitors
- Angiotensin receptor blockers (ARB)
What two drugs are NOT recommended to be used in combinations?
ACE inhibitors & ARBs