HTN Flashcards
Postural hypotension is defined as
20 mmHg or higher drop in systolic
OR 10 mmHg in diastolic
Essential hypertension risk factors
1- Age 2- obesity 3- family history 4- race (Black) 5- reduced nephron number 6- high Na diet 7- alcohol 8- inactivity
When do we start screening for HTN?
At 18 years old
When do we repeat the screening?
If normal;
Annually
If prehypertensive or risk factors;
Semiannually (every 6 months)
Initial lab tests for HTN
Electrolytes FBG Urinalysis CBC TSH lipid profile ECG ASCVD risk
Additional tests;
Albumin to creatinine ratio (for kidney function)
Echo (for LVH)
Highest non pharmacological intervention impact on blood pressure is
DASH diet
Recommended sodium intake
<1500 mg/day
Who should be treated with pharmacological therapy?
1- stage 2 HTN (140/90 or more)
2-stage 1 HTN (130 or 80 or more) if;
- established CVD
- T2DM
- CKD
- 65 or older
- ASCVD risk is 10 or more
Initial monotherapy for black patients
Thiazide diuretic OR calcium channel blocker
Initial monotherapy for patients with diabetic nephropathy or chronic kidney disease
ACE inhibitor OR ARB
ACE I and ARB arr compelling indications
1- heart failure
2- post MI
3- chronic kidney disease
Beta blockers compelling indications
Heart related conditions!
1- heart failure 2- post MI 3- angina 4- a. Fib 5- atrial flutter
Beta blockers have a favorable effect on what?
Hyperthyroidism (it reduces heart rate and BP)
Migrain (reduces BP)
Alpha blockers have a favorable effect on what?
MEN LIKE TO BE ALPHA MALES
So it is Benign prostatic hyperplasia
Beta blockers CONTRAindications
Bronchospastic disease
Heart block
Mythldopa contraindication
Liver disease
ACEI and ARB are contraindicated in what?
Pregnancy!
Diuretics have an adverse effect on what?
Gout, you goat!
If combination therapy is indicated, what drug classes are recommended?
ACEI or ARB with calcium channel blocker
When is INITIAL combination therapy is indecated?
When above their goal by;
- 20 mmHg systolic
Or
- 10 mmHg diastolic
If the patient is uncontrolled despite using two drugs, what is the next step?
ACEI or ARB with calcium channel blocker and diuretic
Leg swelling is caused by what drug?
Dihydropyridine calcium channel blocker (amlodipine)
If the patient is compaining of leg swelling, what do you use instead of amlodipine?
Non-dihydropyrifine calcium channel blocker ( verapamil and diltiazm)
If we can’t use thiazide diuretic, we use…
Potassium sparing diuretics
ie, spironolactone and eplerenone
Drug resistant hypertension is…
If the patient took 3 drugs at a reasonable dose and is still uncontrolled
What is the goal blood pressure of most hypertensive patients?
Less than 130/80 mmHg
