HTN Clinical Approaches Flashcards
What is a normal BP?
120/80
What are pre-hypertensive BPs?
121-139/81-89
What are stage I HTN BPs?
140-159/90-99
What are stage II HTN BPs?
> 160/100
What can HTN be defined as?
140/90 BP on two or more office visits, or use of anti-HTN meds
What % of American population has HTN? In whom is it more prevalent?
30%
African Americans
Prevalence rises with age
What % of Americans are pre-hypertensive?
25%
What do you do to treat a pre-HTN patient?
Lifestyle modifications
What is the cause of essential HTN?
Idiopathic
Multifactorial
Stress, Weight, Blood glucose, Smoking, Caffeine, Sedentary life
What is white coat HTN?
BP is higher at the drs office than at home
How do you confirm a diagnosis of white coat HTN?
Check their home BP monitor
-Could do ambulatory (24 hr) bp monitoring, but that may be excessive
What is malignant HTN?
Rare - BP that is 200/120 with signs and symptoms
HA, encephalopathy, papilledema, renal failure
Can occur without preexisting HTN
What is pseudohypertension?
Peripheral arteries become rigid from advanced arteriosclerosis, so the cuff needs to be at a higher pressure to compress the artery
What is Isolated Systolic HTN?
High systolic pressures with low or normal diastolic pressures.
Widened pulse pressure
Happens with aging
What is resistant HTN? What should you do?
Failure to reach BP goal in pts who are adhering to full doses or an appropriate 3 drug regimen including a diuretic
Look into a potential secondary cause for their HTN
Define Hypertensive Urgency
Severe elevation in BP (> or = 180/120) without end organ damage
Often due to patients not taking their meds
Define Hypertensive Emergency
Severe elevation in BP with end organ damage
Encephalopathy Intracerebral hemorrhage ACS LV Failure Aoritc dissection Renal crisis Microangiopathic hemolytic anemia
How do you treat a hypertensive emergency?
They need immediate lowering of BP.
Reduce their MAP by 25-30% in the first 24 hours.
What are the symptoms of HTN?
None! “Silent killer”
There often are no symptoms until they have end organ damage
What are the sequelae of HTN?
Ischemic Heart Disease Heart Failure CVA Cardiac Hypertrophy Aortic dissection Renal Failure Retinopathy
For each 10 mmHg decrease in systolic pressure, the patient has what lowered risk of heart or stoke mortality?
30% decrease in heart mortality
40% decrease in stroke mortality
Smoking Cessation
3 Steps
- Address nicotine addiction (patch, gum, Chantix)
- Address Behavior Modification (identify triggers, when they smoke, plan the day)
- Address Muscle Memory (stress ball, suckers)
What are the goals of treatment for HTN? (In specific numbers)
BP of less than 140/90 in patients less than 60yo
BP of less than 150/90 in patients older than 60
