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NUNP 532 Pharmacology > HTN Guidelines > Flashcards

HTN Guidelines Flashcards

1
Q

What is the proper patient position for BP reading?

A

Sitting position, back supported, arm bare and supported at heart level, legs uncrossed and feet flat on the floor

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2
Q

How should the cuff be positioned for BP reading? How do you know the right size of cuff?

A

Middle of cuff at heart level, lower edge of cuff 3 cm above elbow crease

Cuff bladder width should be close to 40% of arm circumference and length should cover 80-100% of arm circumference

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3
Q

T/F: Resistant hypertension is defined as BP above target despite 2 or more BP lowering drugs at optimal doses.

A

False, Resistant hypertension is BP above target despite 3 or more BP lowering drugs at optimal doses

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4
Q

Which three class of drugs would likely be prescribed for resistant hypertension?

A

usually a diuretic, RAAS blocker and Ca Channel blocker

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5
Q

What is the purpose of out-of –office BP measurements?

A

To rule out white-coat hypertension

Also to diagnose suspected masked hypertension

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6
Q

Single-pill combination (SPC) are recommended where possible, why?

A

To improve treatment efficacy, adherence and tolerability

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7
Q

AOBP. What does it stand for and how is it done?

A

Automated Office BP. Automated device takes a series of BP measurements without the provider or others present. Patient is left unattended in a private area while 3-6 readings are taken. First reading discarded, others averaged.

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8
Q

OBPM. What does it stand for and how is it done?

A

Office blood pressure measurement. BP measured using upper arm device with provider in the room.

Electronic or oscillometric devices are preferred to auscultatory devices

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9
Q

ABPM. What does it stand for and how is it done?

A

Ambulatory BP monitoring. Using a validated oscillometric device worn for 24 hours. BPs taken at 20-30 minute intervals

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10
Q

HBPM. What does it stand for and how is it done?

A

Home BP monitoring. Self-monitoring, patient measures BP for 7 days, twice in the morning and twice in the evening

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11
Q

Which method of BP monitoring is preferred for in-office measurement?

A

AOBP – Automated office BP

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12
Q

Which method of BP monitoring is preferred for diagnosis?

A

ABPM – Ambulatory BP monitoring

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13
Q

BP should be taken in both arms on at least one visit, if one arm has consistently higher pressure, which arm should be used for BP measurement?

A

The arm with higher BP should be used

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14
Q

How long should a patient rest before BP is measured?

A

Should rest comfortably for 5 minutes prior to BP measurement

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15
Q

What is the threshold for diagnosis of hypertension using OBPM?

A

SBP greater than or equal to 140

And/or

DBP greater than or equal to 90

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16
Q

What group of patients has a different threshold for diagnosis of hypertension? What is the threshold?

A

Patients with Diabetes

SBP greater than or equal to 130

And/or

DBP greater than or equal to 80

17
Q

What is the threshold for diagnosis of hypertension using HBPM?

A

Using home BP monitoring, the threshold changes to

SBP greater than or equal to 135

And/or

DBP greater than or equal to 85

18
Q

What is the threshold for diagnosis of hypertension using ABPM?

A

Using ambulatory BP monitoring, the threshold changes to

Mean 24 hour
SBP greater than or equal to 130

And/or

DBP greater than or equal to 80

OR

Mean daytime

SBP greater than or equal to 135

And/or

DBP greater than or equal to 85

19
Q

When would you do a seated vs. Standing BP

A

Seated used to determine and monitor treatment decisions

Standing used to examine for postural hypotension, which may modify treatment

20
Q

Do you recall how to auscultate a BP?

A

Inflate to 30mmHg above loss of radial pulse

Listen over brachial artery

Deflate slowly

Systolic = appearance of first Korotkoff sound

Diastolic = point when sounds disappear

21
Q

An office BP of ___/___ or greater allows for immediate diagnosis of HTN

A

180/110

22
Q

What preliminary investigations are indicated for patients with hypertension?

A

Urinalysis

Blood chemistry (K, Na, creatinine)

Fasting glucose or A1c

Serum total cholesterol, LDL, HDL, non-HDL, triglycerides, lipids

12 lead ECG

23
Q

T/F: diabetes develops in 1-3% per year of those with drug-treated HTN

A

True!

Screen adults with HTN with annual fasting plasma glucose testing

24
Q

Target organ damage (TOD) should be assessed in patients with HTN, presence of any TOD puts patient in medium-high or high risk category for therapy. What are some TOD examples?

A

Cardiovascular disease: CAD, HF, left ventricular hypertrophy

Cerebrovascular disease: aneurysms, hemorrhages, ischemic stroke, TIA, etc.

Hypertensive retinopathy

Peripheral Artery Disease

Renal disease: albuminuria, CKD

Another tool for risk assessment is the Global Cardiovascular Risk Assessment

25
Q

HTN Canada stratifies patients by risk level and threshold for treatment and BP treatment targets depend on the risk level…

For high-risk patients what is the threshold for initiation of treatment and what is the BP treatment target?

A

Threshold for treatment: SBP greater than or equal to 130

BP target: SBP<120

26
Q

For diabetic patients what is the threshold for initiation of treatment and what is the BP treatment target?

A

Threshold for treatment: SBP greater than or equal to 130, DBP greater than or equal to 80

BP target: SBP<130, DBP<80

27
Q

For medium-risk patients what is the threshold for initiation of treatment and what is the BP treatment target?

A

Threshold for treatment: SBP greater than or equal to 140, DBP greater than or equal to 90

BP target: SBP<140, DBP<90

28
Q

For low-risk patients what is the threshold for initiation of treatment and what is the BP treatment target?

A

Threshold for treatment: SBP greater than or equal to 160, DBP greater than or equal to 100

BP target: SBP<140, DBP<90

29
Q

What are some health behavior recommendations for HTN?

A

Being more physically active

Weight reduction

Moderation in alcohol intake

Healthy eating

Relaxation/stress management

Smoking cessation

30
Q

What are helpful dietary recommendations for prevention and management of HTN?

A

DASH-like diet – high in fresh fruits and vegetables, dietary fiber, non-animal protein (ex. Soy), and low-fat dairy products. Low in saturated fat and cholesterol.

To decrease BP in hypertensive pts consider increasing dietary potassium (!?)

31
Q

What is first-line therapy for HTN?

A

After health behavior management, lists all of the things as first line: thiazide/thiazide-like diuretic, ACE-I, ARB, long-acting CCB, B-Blocker, single-pill combination

** There are some more specific recommendations for first line drugs in certain situations, but even then there are often multiple choices.

Hint: ACE-I are almost always on the list of first line drugs! (except in pregnancy/lactation and isolated systolic HTN without other compelling indications)

32
Q

T/F: it is ok to prescribe your patients multiple drugs for HTN

A

True!

May require multiple drugs, especially in T2DM

Low doses of multiple drugs may be better tolerated than higher doses of fewer drugs

Aim for combination pills when able

33
Q

Which two classes of BP meds should not be combined?

A

ACE-I and ARBs

34
Q

What are some possible reasons for poor response to anti-hypertensive therapy?

A

Inaccurate BP measurement

Suboptimal treatment (dose too low or inappropriate drug combinations)

Poor adherence

Associated conditions: obesity, tobacco, excessive alcohol, OSA, chronic pain, depression

Drug interactions

Volume overload

Secondary hypertension

35
Q

What are some drug interactions that can cause poor response to HTN therapy?

A

NSAIDs

Oral contraceptives

Corticosteroids and anabolic steroids

Cocaine, amphetamines

Erythropoietin

Cyclosproine, tacrolimus

Licorice

Oral decongestant (pseudoephedrine)

Monoamine oxidase inhibitors, certain SSRIs

36
Q

How often should follow-up occur with HTN patients?

A

Every 1-2 months if uncontrolled

Once 2 consecutive visits are below target, every 3-6 months

NUNP 532 Pharmacology (26 decks)

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