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Adult/Ped Medicine 4 > HTN - Brown > Flashcards

HTN - Brown Flashcards

1
Q

Reduced Sodium Intake

Describe the management of HTN according to lifestyle modifications including recommendations and objective support.

A
  • 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
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1
Q

Prevention of HTN

5 Ways:

Describe the management of HTN according to lifestyle modifications including recommendations and objective support.

A
  1. reduction of salt intake
  2. diet rich in fruits, vegetables, low-fat dairy products, reduce saturated fat, total fat and cholesterol
  3. reduction of excess body weight
  4. regular physical exercise
  5. moderation of alcohol intake
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2
Q

HTN Retinopathy

A
  • Keith-Wagner Barker System
  • can determine the level of retinopathy caused by HBP
  • features
    • hemorrhage
    • exudates
    • papilledmia
  • HTN retinopathy has some reversibility
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2
Q

Relative Risk of HTN for CAD, CHF, CVA

A

Normal BP: 1x

140-160/90: 2x

>160/95: 4x

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2
Q

Renovascular Hypertension

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A
  • 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
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3
Q

Role of Renin in HTN

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A

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)

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5
Q

Definition of Hypertension

Describe the classification and definition of blood pressure

A

any of the following:

Systolic BP > 140 mm Hg

Diastolic BP > 90 mm Hg

taking antihypertensive medications

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5
Q

Blood Pressure Technique

A
  • 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)
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6
Q

Weight Loss HTN

Describe the management of HTN according to lifestyle modifications including recommendations and objective support.

A
  • 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
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6
Q

Pseudohypertension

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A

increased stiffness of larger arteries = artificially elevated systolic blood pressure

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8
Q

Pathophysiology of HTN

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN

A
  • 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
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9
Q

Isolated Systolic HTN

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A
  • 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
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9
Q

Renal Parenchymal Disease

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A
  • most common secondary cause
  • responsible for 20% of end stage renal disease in whites; 50% - African Americans
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10
Q

HTN High Risk Groups

A
  • Prehypertension
  • Family history
  • African-Americans
  • Overweight
  • Excess consumption of sodium
  • Physical inactivity
  • Alcohol consumption
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12
Q

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

A

patients < 60 140/90

patients > 60 150/90

diabetes or kidney disease 140/90

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13
Q

Exercise

Describe the management of HTN according to lifestyle modifications including recommendations and objective support.

A
  • regular isotonic exercise 40 min, 4x/week
  • avoid isometric exercise -may cause reflex rise
14
Q

Evaluation of Hypertension: History

Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.

A
  • 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
15
Q

DASH Diet

Describe the management of HTN according to lifestyle modifications including recommendations and objective support.

A

Dietary Approaches to Stop Hypertension

  • consume a diet rich in fruits, vegetables and low-fat dairy products
  • 8-14 mmg Hg reduction in BP
16
Q

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

A

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

17
Q

Diagnostic Tests HTN

Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.

A
  • 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

18
Q

Clinical Objectives for Diagnosing HTN

Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.

A
  • 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
19
Q

HTN in African Americans

Describe the impact hypertension has on individuals and populations.

A
  • 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
20
Q

Factors Implicated in HTN

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN

A
  • salt intake
  • obesity
  • occupation
  • alcohol intake
  • family size
  • crowding
21
Q

Types of Hypertension

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN

A
  • 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
23
Q

Secondary Causes of Hypertension

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A

Renal Diseases

  • Renal Parenchymal Disease (2-3%)
    • acute glomerulonephritis
    • polycystic disease
    • diabetic neuropathy
  • Renovascular (1%)
    • renal artery stenosis

Endocrine Disorders

  • hypo/hyperthyroidism
  • hyperparathyroidism
  • adrenal
  • exogenous hormones
  • acromegaly

Coarctaton of Aorta

Primary Hyperaldosteronism

Alcohol

  • excessive consumption

Drugs

25
Q

Lifestyle Modifications

Describe the management of HTN according to lifestyle modifications including recommendations and objective support.

A

Documented Efficacy:

  • weight loss
  • DASH diet
  • reduced sodium intake
  • reduced alcohol intake

Limited Efficacy:

  • stress management
  • potassium
  • fish oil
  • clacium
  • magnesium
26
Q

Pheochromocytoma

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A
  • rare
  • wildly episodic hypertension
  • peculiar spells: profuse sweating, tremor, palpitations, headache and other symtpoms
  • lab: single voided urine metanephrine, CT of abdomen
  • tx: surgery
27
Q

Management of HTN

A
  • Goals: BP < 140/90 (60)
  • reverse end organ manifestations
  • maintain quality of life
  • improve risk stratification for CAD
  • lifestyle modifications
28
Q

Evaluation of Hypertension: Exam

Describe the clinical presentation, history, PE, and diagnostic work-up of HTN.

A
  • vital signs:
    • bp x 3 and leg
    • pulse
    • weight
    • height
  • fundoscopic exam on all HTN patients
  • bruits:
    • carotid
    • renal
    • aortic
  • heart and lungs
  • extremities:
    • edema
    • pulse
    • signs of PVD
30
Q

White Coat HTN

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN.

A
  • many patients have higher blood pressure levels when taken in the office than when out of the office
  • may explain as much as 20% of elevated diastolic BPs in office
  • utilize home monitoring or ambulatory monitoring to further define HTN
31
Q

Describe the impact hypertension has on individuals and populations.

A
  • 78 million Americans affected - 1000 deaths/year
  • African Americans >> Caucasians
  • frequency increases with age
    • diastolic doesn’t change much after 45
  • level of BP direct risk factor for premature CV disease
  • earlier onest - greater likelihood of CV dieases
  • men >> women
32
Q

Primary Essential HTN

Summarize the pathophysiology, secondary causes, and differential diagnosis of HTN

A

increased arterial blood presssure with no definable cause

common presentation - asymptomatic

readily detectable

easily treated

often leads to lethal complications if untreated

Adult/Ped Medicine 4 (17 decks)

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