HTN (Exam 4) Flashcards
How Often should adults => 40 y/o be screened for HTN?
Annually
How often should adults 18-39 w/o risk factors and last BP < 130/80 should be screened for HTN??
Every 3 Years
What is the Blood pressure equation?
BP = Cardiac output x Systemic Vascular Resistance
What is Primary (essential) hypertension?
Thought to be from interaction between multiple genetic and environmental factors
How many antihypertensive medications does a patient need to be on with persistent HTN for it to be classified as Resistant HTN?
3 concurrent Antihypertensives
Think Secondary hypertension
What is secondary hypertension?
Elevated BP with a specific cause, accounts for 5% to 10 % of hypertension in adults.
What patients would you suspect secondary hypertension based on their presentation/history??
- Severe/resistant HTN
- acute rise in BP in a previously stable BP
- HTN in patient <30 w/o risk factors or FH of HTN
- Pt’s > 55 w/ New onset HTN
What is the most common cause of Secondary HTN?
Renovascular HTN
What are some causes of Renovascular HTN?
- Activation of renin-angiotensin system w/ renal artery occlusive disease
- Renal artery stenosis
-Renal dysfunction
Renal Artery Stenosis (RAS)
Suspect w/ ACEI or ARB- induced renal dysfunction
What are some possible lab findings in Renovascular HTN?
- Hypokalemia
- Renal dysfunction (BUN creatnine)
-Elevated Aldosterone
What is the gold standard imaging for Renovascular HTN?
Renal angiography
What is the preferred treatment for Unilateral Renal Artery Stenosis (RAS)?
ACE inhibitors
What is the tx for bilateral Renal Artery Stenosis RAS?
Calcium Channel Blockers are safe and effective. CCB
NO ACEI, can drop GFR
What type of hypertension can Coarctation of the aorta cause?
Secondary HTN
What is the 1st choice of imaging study to determine coarctation of the Aorta site?
Echo,
Ligumentum Arteriosum & L subclavian artery common
How do patients with hypertension usually present?
- Asymptomatic “the silent killer”
- early morning HA’s
How does hypertensive retinopathy look on exam?
- AV nicking
- Copper Wire
- Papilledema
- Hemorrhages
- Cotton wool patch
- Exudates
Can you measure BP in the thigh and wrist?
Yes
What is masked hypertension?
Normal in office high outside of office (ambulatory - 10%)
What are BP goals for all patients??
<130/80
What are first line hypertensives?
Thiazide diuretics
CCB
ACEI / ARB
In Stage 2 hypertension how many first line agents is recommended to initiate therapy?
2 different first line agents in Stage 2 hypertension
-if average BP > 20mmHg above target
What are the thiazide diuretics mechanism of action?
Initially: reduction in plasma volume and cardiac output
Later: Vasodilation leading to increased vascular resistance
Hydrochlorothiazide 12.5-25 mg PO
What is a thiazide diuretic and its dose?
Hydrochlorothiazide HCTZ
12.5-25 mg PO daily
What are potential side effects of Thiazide diuretics?
- Hyponatremia
- Hyperuricemia (gout)
What are ACEI mechanism of action?
Inhibition of Angiotensin II formation
What is an example of an initial ACEI and dose that Sean da Paulson wants us to know??
Lisinopril 10 mg PO daily
What are potential side effects of ACEI?
Hyperkalemia (BNP)
Angioedema
Chronic Dry Cough
ARF
What are ARBs mechanism of action?
Impair binding of Angiotensin II to the AT-1 receptor on cell membrane –> action of angiotensin II is inhibited.
When would you use a ARB over an ACEI
Used for pt’s with cough on ACEI
What are two ARB medications and example of initial dosing that Sean da Paulson wants us to know?
Losartan 50 mg PO daily
Valsartan 40-80 mg PO daily
What are potential Side effects of ARBs?
Hyperkalemia
What two hypertensive drugs should you never combine??
ARBs and ACEI
What is (CCB) Dihydropyridine’s mechanism of action?
Vasodilation
What is an example of a CCB Dihydropyridine and dosing that Sean da Paulson wants us to know?
Amlodipine 2.5 mg PO daily
What is (CCB) Nondihydropyridine’s mechanism of action?
Decreases Cardiac conduction and Contractility
What is an example of a CCB NonDihydropyridine and dosing that Sean da Paulson wants us to know?
Diltiazem ER 120-180 mg
What are side effects of CCB vasodilators?
Headache
Edema
What are side effects of CCB nondihydros?
Constipation
Bradycardia
HA
What are beta blockers mechanism of action?
Blockage of beta-adrenergic activity (block receptor sites for Epi and Norepi)
- Nonselective; Blocks B1 and B2
- Cardioselective; Blocks B1
What receptors do Nonselective Beta-blockers block?
B1 and B2 receptors
What receptors do Cardioselective Beta-blockers block?
B1 receptors das it mang
In which patients would you use Beta blockers for HTN control?
Pt’s w/ Hx of
- Post MI
- Heart Failure
- Afib
Dont use it to treat HTN from cocaine!
What is an example of a Beta-blocker and dosing that Sean da Paulson wants us to know?
- Metoprolol tartrate 50mg PO BID
- Metoprolol succinate 25 mg PO daily (long acting)
What are some potential side-effects from Beta blocker use?
- Increased airway resistance
- Exacerbation of PAD
When are Alpha blockers often used?
In older men w/ BPH and HTN
Not recommended for initial mono therapy
What are some side effects of alpha blockers?
Dizziness
Orthostatic Hypotension
What are alpha blockers mechanism of action?
Block A1 receptors
What is clonidine’s mechanism of action?
A2 adrenergic agonist
What is a side effect from clonidine?
Dizziness
What is hydralazine’s mechanism of action?
Direct vasodilation of arterioles
What is the initial dosing of Hydralazine in HTN pt’s?
10 mg PO QID
What are potential side effects of Hydralazine?
Dizziness
What is the mechanism of action for Aldosterone Antagonists?
Competes w/ Aldosterone for receptor sites in DISTAL RENAL TUBULE
Increases Na+ and Water excretion
When would you use Aldosterone Antagonists in patients w/ HTN?
PT’s with;
- Resistant HTN
- Heart failure w/ reduced EF
- Cirrhosis
What is an example of aldosterone antagonists and dosing that Sean da Paulson wants us to know?
- Spironolactone 25-50 mg PO daily
- Eplerenon 50mg PO daily
What is a side effect of aldosterone antagonists?
Hyperkalemia
What is the mechanism of action for Furosemide (Lasix)?
Inhibits reabsorption of sodium and chloride in kidneys
Increased excretion of water, sodium, chloride, magnesium, and calcium
What patients do you use furosemide (lasix) for HTN?
Pt’s w/
- Heart failure
- edema
- cirrhosis w/ Ascites
- Pulmonary edema
What is a potential side effect of Furosemide (lasix)
Hypokalemia
What is a Hypertensive urgency?
Severe HTN in asymptomatic patients
Systolic > 180
Diastolic > 110
NO END ORGAN DAMAGE
Does Hypertensive urgency present with End organ damage?
NOOO
Is there proven benefit to lower BP in a hypertensive urgency rapidly?
NO, its okay to lower within 24-48 hours using oral meds
What is Hypertensive Emergency?
Severe HTN with end-organ damage
Something is damaged as a result of HTN
Do you lower BP rapidly in a Hypertensive emergency?
No, too fast can cause ischemic complications
