HTN Flashcards
Stages of hypertension?
Pre-hypertension: 120-139/80-89
Stage one hypertension: 140 – 159/90 – 99
Stage two hypertension: greater than 160/100
Patient with hypertension. Next steps?
- Assess renal and cardiac function
- Start two drug antihypertensive regimen that includes thiazide
- Stop smoking
A secondary cause of hypertension should be suspected if?
- Age of onset before 25 or after 55
- Presenting with malignant hypertension
- Requiring three or more antihypertensives
- Suddenly uncontrolled hypertension
- Rising creatinine with use of ACE inhibitors
Renal causes of hypertension?
Renovascular
Parenchymal (glomerulonephritis , polycystic renal disease, diabetic nephropathy)
Endocrine causes of hypertension?
Primary aldosteronism, Cushing’s, pheochromocytoma, hyperthyroidism, growth hormone excess, OCP
Non-renal and non-endocrine causes of hypertension?
Coarctation of the aorta, posttransfusion, hypercalcemia, medications (sympathomimetics, glucocorticoids)
Major risk factors for cardiovascular disease?
Age, smoking, dyslipidemia, diabetes, obesity, kidney disease, family history
Target organ damage of hypertension?
Cardiomyopathy, nephropathy, retinopathy
Clues to renovascular HTN?
Flank bruits, malignant hypertension, hypertension refractory to three drug treatment, sudden worsening hypertension,
HTN tx?
Pre-hypertension: Lifestyle modifications unless pt has hypertension or diabetes (start Antihypertensive)
Stage one hypertension: Single hypertensive agent
Stage two hypertension: At least two hypertensive agents
Target blood pressure?
135/85
If patient has diabetes or renal disease 130/80
Consider what drug in all patients? Why?
Thiazide diuretics. Associated with a decrease in mortality in all types of patients (OLD -now can start in anything)
In patients with uncomplicated hypertension, use which drugs first?
Thiazide diuretics and beta blockers
First-line antihypertensives in diabetics and heart failure pts?
Problem with thiazides?
Ace inhibitors.
Thiazides can exacerbate hypoglycemia. Add thiazides if blood pressure remains uncontrolled
Potassium levels in patients with renal artery stenosis?
Low due to secondary hyperaldosteronism
Diagnostic tool for renal artery stenosis?
Captopril enhanced radio nuclide renal scan
MRI angiography, spiral CT
Patient with bilateral flank masses, flank pain, elevated blood pressure, and hematuria?
Polycystic kidney disease
Patient with hypertension hypokalemia?
Primary hyperaldosteronism
Obesity-related cause of hypertension? MoA?
Obstructive sleep apnea. Hypoxemia and hypercarbia leads to Vasoconstriction, systolic hypertension and pulmonary hypertension
Patients with HTN, widened pulse pressure and hyperdynamic precordium?
Hyperthyroidism
Patient with hypertension, truncal obesity, moon face, purple striae. Test to confirm?
Cushing’s syndrome. Dexamethasone suppression test
Patient with upper limb hypertension, cold extremities and decreased femoral pulses?
Coarctation of the aorta
Patient with hypertension, cutaneous flushing, headache, diarrhea, wheezing? Mech?
Carcinoid syndrome. Production serotonin from the chromaffin cells of the G.I. tract and the lungs
Patients with episodic hypertension, headaches, palpitations, chest pain, anxiety, nervousness?
Pheochromocytoma
Prognosis in hypertension depends on?
Cardiovascular RFs and observed and end-organ effects of the HTN
