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Cardio Week 2 > HTN-Clinical Overview > Flashcards

HTN-Clinical Overview Flashcards

1
Q

What is the eqn for BP (aka AP)?

A

CO x TPR or

(SV x HR) x TPR

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2
Q

What things determine SV?

A

preload

contractility

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3
Q

What things determine HR?

A

ANS

conduction system

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4
Q

What things determine TPR?

A
  • Neurohumoral factors

- local auto regulation (pH, hypoxia, etc.)

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5
Q

What is a normal BP?

A

less than 120 over 80 based on the least risk of CV complications from studies

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6
Q

What is preHTN?

A

120-139

80-89

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7
Q

What is stage 1 HTN?

A

140-159

90-99

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8
Q

What is stage 2 HTN?

A

160+

100+

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9
Q

JNC 8 HTN treatment goals?

A

initiate over 150/90 for 60+ and 140/90 for those with chronic kidney disease or diabetes

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10
Q

What things could increase preload (and thus SV and thus CO and thus AP)?

A

increased fluid volume or venous constriction

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11
Q

What things could increase contractility (and thus SV and thus CO and thus AP)?

A

sympathetic activity stimulation

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12
Q

T or F. Most patients with uncomplicated HTN have a normal CO

A

T.

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13
Q

What are some behavioral/dietary causes of essential HTN?

A
  • increased salt intake
  • alcohol
  • obesity
  • sleep apnea
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14
Q

HTN is a major risk factor for what diseases?

A
  • CV disease
  • stroke
  • end-stage renal disease
  • ischemic heart disease
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15
Q

Goals of evaluating hypertensive patients.

A

1) Obtain an accurate assessment of BP
2) Assess the significance of the BP
3) What is the cause?

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16
Q

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

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

17
Q

T or F. Caffeine and tobacco should be avoided for 30+ minutes before a BP reading

A

T.

18
Q

What things may elevate BP acutely?

A
  • nervousness, stress, anxiety
  • drugs (cocaine), alcohol, caffeine, nicotine
  • pain
  • white coats
19
Q

How do you assess the significance of the BP?

A

by stratifying CV risk and looking for target organ damage

20
Q

For the most part, headaches are not directly related to HTN in a person who chronically suffers from it.

A

For the most part, headaches are not directly related to HTN in a person who chronically suffers from it.

21
Q

What are some problems in the vasculature caused by HTN?

A

atherosclerosis
aneurysm
aortic dissections

22
Q

What are some problems in the kidneys caused by HTN?

A

hematuria

proteinema

23
Q

What are some problems in the heart caused by HTN?

A
  • pulmonary edema
  • MI
  • left ventricular hypertrophy
24
Q

What are some problems in the brain caused by HTN?

A
  • Hemorrhage/infarction
  • seizures
  • vascular dementia
25
Q

What are some problems in the eye caused by HTN?

A
  • Hemorrhage

- papilloedema

26
Q

T or F. Reducing SBP from 180 to 140
reduces CV disease risk by about 25% (RRR), regardless of baseline
risk

A

T. The absolute risk reduction, however, is proportional to the
baseline risk.

Therefore, subgroups
with the most additional risk
factors benefit the most

27
Q

Secondary HTN is more likely in patients with the following characteristics:

A
  • Age of onset of HTN 50 years
  • Target organ damage at presentation
  • Presence of features indicative of specific secondary causes:
28
Q

What are some features indicative of specific secondary causes of HTN?

A
  • 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

29
Q

What is the recommended first line drug for nonblack patients with essential HTN?

A

ACEIs, ARBs, CCBs, or diuretics

30
Q

What is the recommended first line drug for black patients with essential HTN?

A

CCBs, or diuretics

31
Q

What is the recommended first line drug for nonblack patients with HTN secondary to diabetes?

A

ACEIs, ARBs, CCBs, or diuretics

32
Q

What is the recommended first line drug for black patients with HTN secondary to diabetes?

A

CCBs, or diuretics

33
Q

What is the recommended first line drug for nonblack patients with HTN secondary to chronic kidney disease?

A

ACEIs, ARBs

34
Q

What is the recommended first line drug for black patients with HTN secondary to chronic kidney disease?

A

ACEIs, ARBs

35
Q

How should hypertensive emergency be treated?

A

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.

36
Q

Why is the previously described approach to treating hypertensive emergency the preferred one?

A

This is to avoid compromising
perfusion by reducing BP below the lowered threshold
established by autoregulation in response to longstanding
hypertension.

Cardio Week 2 (11 decks)

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