HTN and Associated Changes Flashcards
What is HTN in terms of BP cutoffs?
BP >140/90
UNLESS:
-DM: >130/80
-80y+: >150/90
What is accelerated HTN?
Significant recent increase in BP over previous hypertensive levels associated with evidence of vascular damage on fundoscopy but without papilloedema
What is malignant hypertension?
High enough BP to cause papilloedema and other manifestations of vascular damage (retinal haemorrhages, bulging discs, mental status changes, increasing Cr).
Often BP >200/140
What is the aetiology of HTN?
- Essential /Primary HTN
- Secondary HTN
- White coat HTN
Factors predisposing to HTN?
- Male
- 30y+
- High salt diet
- Smoking
- Obesity
- Sedentary lifestyle
- Stress
- Dsylipidemia
Renal causes of secondary HTN?
- Renovascular HTN
- Renal parenchymal disease / glomerulonephritis / pyelonephritis / polycystic kidney disease
Endocrine causes of secondary HTN?
- 1” hyperaldosteronism
- Phaeochromocytoma
- Cushing’s syndrome
- Hyperthyroidism / hyperparathyroidism
- Hypercalcemia of any cause
Vascular causes of HTN?
- Coarctation of the aorta
- Renal artery stenosis
Causes of secondary HTN?
ABCDE Apnea, Aldosteronism Bruits, Bad Kidneys Coarctation, Cushings, Catecholamines, Calcemia Drugs Endocrine Disease
Ix in all pts w/ HTN?
- FBE: anemia CKD
- UEC: esp K+ (high in renal disease, low in aldosteronism)
- LFTs: fatty liver/ drug rxn
- Urine Alb:Cr ratio: evidence renal damage
- Fasting BSL
- Lipids
- ECG: CAD / hypertrophy
- Urinalysis
Lifestyle Mx HTN?
- Diet
- Moderate Exercise
- Smoking cessation
- Stress Management
- Low risk alcohol consumption
- Healthy BMI
Pharmacological Mx HTN?
-ACEi, ARB
-B blocker
-CCBs
-Diuretics
If partial response to standard monothearpy, add another first line drug in 2-3/52.
Step 1: A / C / D
Step 2: A+C / A+D
Step 3: A+C+D
What does HTN predispose to?
- CAD
- Stroke
- Cardiac hypertrophy
- CCF
- Renal failure
Is a person’s avg BP ass/w CV risk?
Yes- relationship between BP and CV risk is continuous. Above 115/75mmHg, for each 20mmHg SBP increase CV/stroke risk doubles.
How is diagnosis of HTN made?
INITIAL BP >140/90mmHg After 5 minutes seated rest 2 readings, 2mins apart. REVIEW -Additional visit 1-4/52 -24hour ambulatory measures -Home BP measures
Important features to elicit in HTN Hx?
- FHx
- PHx: CV / stroke events
- HF Sx
- Renal disease symptoms
- Smoking
- DM
- High cholesterol
Examination features in HTN?
- Pulse rate and rhythm
- BMI
- Full CV exam
- Renal bruits / masses
- Stigmata secondary causes
When should BP be treated?
SBP >180
DBP >110
normal pt, no other RFx
When should BP + risk be treated?
SBP >140
DBP >90
PLUS DM, CV / renal disease OR high CV risk
What are the high CV RFx?
- Age
- SBP
- Total:HDL cholesterol ratio
- Smoking
- DM
- End organ damage
What is the end organ damage indicative of high CV risk?
- Microalbuminuria / low eGFR (renal damage)
- LV hypertrophy (cardiac damage)
- High pulse wave velocity (stiff large arteries)
- Increase intimal-media thickness (reflects atherosclerosis).
Considerations of ACEi/ARBs as first line choice in Mx HTN?
-Preferred if
Evaluation of “resistant HTN”
Usually poor compliance.
- Consider spiro, B-blocker, centrally acting agent, a-blocker or vasodilator
- Question compliance
- Check for NSAIDs, cold remedies, antidepressants etc
- ?Secondary HTN causes
