HTN - Brown Flashcards
Reduced Sodium Intake
Describe the management of HTN according to lifestyle modifications including recommendations and objective support.
- Recommend moderate restriction:
- 2400 mg/day (2.5-5 grams)
- 6 grams of Na/Cl (normal 6-12)
- < 1500 mg is ideal
- greatest benefit in: African Americans and elderly
- read food labels
Prevention of HTN
5 Ways:
Describe the management of HTN according to lifestyle modifications including recommendations and objective support.
- reduction of salt intake
- diet rich in fruits, vegetables, low-fat dairy products, reduce saturated fat, total fat and cholesterol
- reduction of excess body weight
- regular physical exercise
- moderation of alcohol intake
HTN Retinopathy
- Keith-Wagner Barker System
- can determine the level of retinopathy caused by HBP
- features
- hemorrhage
- exudates
- papilledmia
- HTN retinopathy has some reversibility
Relative Risk of HTN for CAD, CHF, CVA
Normal BP: 1x
140-160/90: 2x
>160/95: 4x
Renovascular Hypertension
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.
- unilateral or bilateral stenosis of renal artery
- clinical clues:
- abdominal bruit
- rapid new onset of HTN
- rapid loss of renal function
- difficult to control HTN
- screening studies: MRI, CT
- confirmatory: renal arteriography
Role of Renin in HTN
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.
volume status (as related to changes in dietary sodium intake) affects the amount/rate of renin secreted
Angioteninogn —–RENIN——-> Angiotensin 1 —– ACE —-> Angiotensin 2 (vasoconstricts and increases BP)
Definition of Hypertension
Describe the classification and definition of blood pressure
any of the following:
Systolic BP > 140 mm Hg
Diastolic BP > 90 mm Hg
taking antihypertensive medications
Blood Pressure Technique
- measure after 5 minutes of rest in a seated position
- patient should refrain from smoking or ingesting caffeine 30 minutes prior to measurement
- appropriate cuff size (bladder of cuff ~ 80% of arm)
Weight Loss HTN
Describe the management of HTN according to lifestyle modifications including recommendations and objective support.
- direct linear relationship to increasing BP
- 1-2 mm Hg fall in BP seen with each kg of weight loss
- weight regain accompanied with elevated BPs
- overweight patients: 2-6x increase risk of developing HTN
Pseudohypertension
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.
increased stiffness of larger arteries = artificially elevated systolic blood pressure
Pathophysiology of HTN
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN
- cause of primary HTN unknown
- hemodynamic fault of established hypertension - INCREASED PERIPHERAL VASCULAR RESISTANCE
- renal defect in sodium excretion
- heredity
- abnormal CV or renal development
**EXACERBATING FACTORS:
- obesity
- sleep apnea
- alcohol
Isolated Systolic HTN
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.
- defined as a systolic > 160 mmHg while diastolic is < 90 mmHg
- common among older persons
- SBP is a better predictor of CV events than DBP
Renal Parenchymal Disease
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.
- most common secondary cause
- responsible for 20% of end stage renal disease in whites; 50% - African Americans
HTN High Risk Groups
- Prehypertension
- Family history
- African-Americans
- Overweight
- Excess consumption of sodium
- Physical inactivity
- Alcohol consumption
Describe the impact hypertension has on individuals and populations.
JNC 7 Goals for Specific Group Management of HTN:
patients < 60
patients > 60
diabetics or kidney disease
patients < 60 140/90
patients > 60 150/90
diabetes or kidney disease 140/90
Exercise
Describe the management of HTN according to lifestyle modifications including recommendations and objective support.
- regular isotonic exercise 40 min, 4x/week
- avoid isometric exercise -may cause reflex rise
Evaluation of Hypertension: History
Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.
- risk factors for CAD
-
social history
- diet (salt)
- alcohol
- caffeine
- smoking
- exercise
-
drugs
- OTC (anti-histamines)
- prescription
- past medical and family histories
- ROS to secreen for secondary causes
DASH Diet
Describe the management of HTN according to lifestyle modifications including recommendations and objective support.
Dietary Approaches to Stop Hypertension
- consume a diet rich in fruits, vegetables and low-fat dairy products
- 8-14 mmg Hg reduction in BP
JNC 7 - High Blood Pressure Prevention, Detection, Evaluation and Treatment Recommendations
Normal, Prehypertension, Hypertension (Stage 1 and 2)
Describe the classification and definition of blood pressure
Normal
- Systolic < 120
- Diastolic < 80
Prehypertension
- Systolic 120-139
- Diasstolic 80-89
- at risk (50% will develop HTN within 4 years)
Stage 1 Hypertension
- Systolic 140-159
- Diastolic 90-99
Stage 2 Hypertension
- Systolic > 160
- Diastolic > 100
*use the highest risk group
Diagnostic Tests HTN
Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.
- Hematocrit & Hemoglobin
- electrolytes, glucose, BUN, creatinine, cholesterol, calcium
- lipid profile
- urinalysis: dipstick and microalbumin (kidney issues)
- EKG
- As Indicated
- CXR
- TSH (esp. in patients over 50)
- 24 hr urine for protein (kidney issues)
** can identify secondary causes of hypertension
Clinical Objectives for Diagnosing HTN
Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.
- appropriate diagnosis - BP on 2 or more separate occasions
- assess for secondary causes
- determine presence of end-organ disease
- assess other coronary risk factors
- institute appopriate managment to control BP
HTN in African Americans
Describe the impact hypertension has on individuals and populations.
- develops earlier
- average BP is higher
- higher rates of stage 2 disease
- 80% higher stroke, 50% higher heart disease mortality
- screen early and often
- ? response with ACE, ARBs, BetaBlockers
Factors Implicated in HTN
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN
- salt intake
- obesity
- occupation
- alcohol intake
- family size
- crowding
Types of Hypertension
Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN
- Primary, Essential or Idiopathic (95%)
- Secondary (5%)
- look at secondary causes if the patient is young, has unusual symptoms, or doesn’t respond to conventional therapy
