HTN-Clinical Overview Flashcards
What is the eqn for BP (aka AP)?
CO x TPR or
(SV x HR) x TPR
What things determine SV?
preload
contractility
What things determine HR?
ANS
conduction system
What things determine TPR?
- Neurohumoral factors
- local auto regulation (pH, hypoxia, etc.)
What is a normal BP?
less than 120 over 80 based on the least risk of CV complications from studies
What is preHTN?
120-139
80-89
What is stage 1 HTN?
140-159
90-99
What is stage 2 HTN?
160+
100+
JNC 8 HTN treatment goals?
initiate over 150/90 for 60+ and 140/90 for those with chronic kidney disease or diabetes
What things could increase preload (and thus SV and thus CO and thus AP)?
increased fluid volume or venous constriction
What things could increase contractility (and thus SV and thus CO and thus AP)?
sympathetic activity stimulation
T or F. Most patients with uncomplicated HTN have a normal CO
T.
What are some behavioral/dietary causes of essential HTN?
- increased salt intake
- alcohol
- obesity
- sleep apnea
HTN is a major risk factor for what diseases?
- CV disease
- stroke
- end-stage renal disease
- ischemic heart disease
Goals of evaluating hypertensive patients.
1) Obtain an accurate assessment of BP
2) Assess the significance of the BP
3) What is the cause?
Which leads to more inaccurate BP readings, a large cuff on a small arm circumference or a small cuff on a larger arm circumference?
a small cuff on a larger arm circumference will overestimate BP much more than a a large cuff on a small arm circumference will underestimate it
T or F. Caffeine and tobacco should be avoided for 30+ minutes before a BP reading
T.
What things may elevate BP acutely?
- nervousness, stress, anxiety
- drugs (cocaine), alcohol, caffeine, nicotine
- pain
- white coats
How do you assess the significance of the BP?
by stratifying CV risk and looking for target organ damage
For the most part, headaches are not directly related to HTN in a person who chronically suffers from it.
For the most part, headaches are not directly related to HTN in a person who chronically suffers from it.
What are some problems in the vasculature caused by HTN?
atherosclerosis
aneurysm
aortic dissections
What are some problems in the kidneys caused by HTN?
hematuria
proteinema
What are some problems in the heart caused by HTN?
- pulmonary edema
- MI
- left ventricular hypertrophy
What are some problems in the brain caused by HTN?
- Hemorrhage/infarction
- seizures
- vascular dementia
What are some problems in the eye caused by HTN?
- Hemorrhage
- papilloedema
T or F. Reducing SBP from 180 to 140
reduces CV disease risk by about 25% (RRR), regardless of baseline
risk
T. The absolute risk reduction, however, is proportional to the
baseline risk.
Therefore, subgroups
with the most additional risk
factors benefit the most
Secondary HTN is more likely in patients with the following characteristics:
- Age of onset of HTN 50 years
- Target organ damage at presentation
- Presence of features indicative of specific secondary causes:
What are some features indicative of specific secondary causes of HTN?
- Abdominal bruit and/or extensive vascular disease (might suggest renal artery stenosis)
- Unprovoked (i.e., not on diuretic) hypokalemia (might suggest primary or secondary hyperaldosteronism)
• Labile pressures with tachycardia, sweating, and tremor (might suggest
pheochromocytoma)
• Known personal or family history of renal disease (which might suggest renal
parenchymal HTN)
• Poor response to combinations of antihypertensive agents known to be
generally effective
What is the recommended first line drug for nonblack patients with essential HTN?
ACEIs, ARBs, CCBs, or diuretics
What is the recommended first line drug for black patients with essential HTN?
CCBs, or diuretics
What is the recommended first line drug for nonblack patients with HTN secondary to diabetes?
ACEIs, ARBs, CCBs, or diuretics
What is the recommended first line drug for black patients with HTN secondary to diabetes?
CCBs, or diuretics
What is the recommended first line drug for nonblack patients with HTN secondary to chronic kidney disease?
ACEIs, ARBs
What is the recommended first line drug for black patients with HTN secondary to chronic kidney disease?
ACEIs, ARBs
How should hypertensive emergency be treated?
The important treatment principle is to treat promptly,
but not excessively.
Hypertensive emergencies require
parenteral administration of drugs that can be rapidly titrated. Reduce mean arterial pressure (MAP) no more than 25% of pretreatment level within the first two
hours. BP should then be more gradually reduced over
the next 24 hours.
Why is the previously described approach to treating hypertensive emergency the preferred one?
This is to avoid compromising
perfusion by reducing BP below the lowered threshold
established by autoregulation in response to longstanding
hypertension.
