HTN intro Flashcards
Who is at risk for HTN?
- Elderly
- Blacks
- Pregnancy
- Teens now emerging (problem)
What are the factors for HTN?
- Obesity
- Lack of physical activity
- Too much salt in our diet
- Older age
- Family history of hypertension
- Chronic kidney disease
- Too much alcohol consumption
- Insufficient intake of potassium, magnesium and calcium
What is BP?
Cardiac Output x Peripheral Resistance
What is normal BP?
By the JNC-7
Systolic (mm Hg) = Less than 120
AND
Diastolic (mm Hg) = Less than 80
What is Prehypertension?
(By the JNC-7)
- What do you do for Prehypertension?
Systolic (mm Hg) = 120-139
OR
Diastolic (mm Hg) = 80-89
- No drug therapy, only lifestyle modifications
What is Stage 1 HTN?
By the JNC-7
Systolic (mm Hg) = 140-159
OR
Diastolic (mm Hg) = 90-99
What is Stage 2 HTN?
By the JNC-7
Systolic (mm Hg) = 160 or greater
OR
Diastolic (mm Hg) = 100 or greater
What are compelling Indications in HTN?
Uncontrolled Diabetes, MI, stroke, other cormorbidities etc.
What is the first thing you should do? (According to JNC-7)
lifestyle modifications
If not goal BP, after lifestyle modifications, what do you do if patient has no compelling indications? (According to JNC-7)
1.) Stage 1 Hypertension?
Thiazide-Type Diuretic for most.
May consider ACEI, ARB, Beta-blocker, CCB or
combination
2.) Stage 2 Hypertension?
2 drug combination for most.
(Usually thiazide and ACEI or ARB or beta-blocker
or CCB)
If not goal BP, after lifestyle modifications, what do you do if patient DOES HAVE compelling indications? (According to JNC-7)
Drug(s) for the Compelling Indications.
Other antihypertensive drugs (diuretics, ACEI, ARB, beta-blockers, CCB as needed
If not goal BP, after first drug interventions what do you do ? (According to JNC-7)
- Optimize Dosages or Add Additional Drugs Until Goal BP is Achieved.
- Consider Consultation with Hypertension Specialist (when on 2-3 drugs)
What is the goal BP?
< 140
What MUST be done for the antihypertensive drugs to be effective?
Must be used while doing lifestyle modifications!
According to the ESH ‘13 what are the risk factors for HTN?
- Male
- Smoker
- Age (men 55 and older, women 65 and older)
- Dyslipidemia
- Fasting plasma glucose (102- 125 mg/dL)
- Abnormal glucose tolerance test
- Obesity (BMI 30 kg/m2 or greater)
- Abdominal obesity (waist circumference men 102 cm or more; women 88 cm or more*)
- Family history of premature cardiovascular disease (men ages less than 55 years; women aged less than 65 years)
What does ESH ‘13 define as Dyslipidemia
- Total cholesterol greater than 190 mg/dL and/or
- Low-density lipoprotein cholesterol greater than 115 mg/dL and/or
- High-density lipoprotein cholesterol: men less than 40 mg/dL, women less than 46 mg/dL and/or
- Triglycerides greater than 150 mg/dL
- ) What is the optimal BP?
- ) What is the normal BP?
- ) What is the High normal BP?
(According to the ESH’13)
- ) Less than 120/Less than 80
- ) 120-129/80-84
- ) 130-139/85-89
What is Grade 1 HTN?
According to the ESH’13
140-159/90-99
What is Grade 2 HTN?
According to the ESH’13
160-179/100-109
What is Grade 3 HTN?
According to the ESH’13
180 or greater/110 or greater
What is Isolated Systolic HTN?
According to the ESH’13
140 or greater/Less than 90
What do you do for High Normal BP with NO risk factors?
According to the ESH’13
No BP intervention
What do you do for High Normal BP with risk factors?
According to the ESH’13
- Lifestyle changes
- No BP intervention
What do you do for Grade 1 HTN or Grade 2 HTN with no Risk factors?
(According to the ESH’13)
- Lifestyle changes for several months
- Then add BP drugs targeting <140/90
What do you do for Grade 1 HTN with risk factors or Grade 2 HTN with 1-2 risk factors?
(According to the ESH’13)
- Lifestyle changes for several weeks
- Then add BP drugs targeting <140/90
What do you do for Grade 2 HTN with 3 or more risk factors?
According to the ESH’13
- Lifestyle changes
- BP drugs targeting <140/90
What do you do for Grade 3 HTN?
According to the ESH’13
- Lifestyle changes
- Immediate BP drugs targeting <140/90
What do you do for High Normal BP AND Organ damage, chronic kidney disease stage 3 or diabetes OR Symptomatic CVD, CKD stage 4 or greater or diabetes with OD/RFs?
(According to the ESH’13)
- Life style changes
- No BP intervention
What do you do for Grade 1 HTN or Grade 2 HTN AND Organ damage, chronic kidney disease stage 3 or diabetes OR Symptomatic CVD, CKD stage 4 or greater or diabetes with OD/RFs?
(According to the ESH’13)
- Lifestyle changes
- BP drugs targeting
What do you do for Grade 3 HTN AND Organ damage, chronic kidney disease stage 3 or diabetes OR Symptomatic CVD, CKD stage 4 or greater or diabetes with OD/RFs?
(According to the ESH’13)
- Lifestyle changes
- Immediate BP drugs targeting <140/90
What are Lifestyle modifications?
- Weight reduction
- Sodium restriction
- Reduced alcohol intake
- Stop smoking
- Reduce dietary saturated fats and cholesterol
- Maintain adequate potassium, calcium, magnesium
- Reduce stress
What meds do African Americans respond better to?
Better response to calcium channel blockers and diuretics compared with beta blockers, ACEI or ARB monotherapy
What is a good med for Pregnancy?
- methyldopa, beta blocker, and vasodilators
- Avoid ACE inhibitors and angiotensin receptor blockers
What are the contraindications of Diuretics?
- Possible contraindications: Dyslipidemia, diabetes*
- Compelling contraindications: Gout, allergy to sulfa-based diuretics
What are the contraindications of Beta Blockers?
- Possible contraindications: Asthma, COPD, dyslipidemia, severe peripheral vascular disease
- Compelling contraindications: Bronchospastic disease, second or third-degree heart block
What are the contraindications of ACEI or ARBs?
- Possible contraindications: Bilateral renal artery stenosis, renal insufficiency
- Compelling contraindications:Pregnancy, hyperkalemia
What are the contraindications of Calcium channel blockers?
- Possible contraindications: none
- Compelling contraindications: Second or third-degree heart block, heart failure
What are the contraindications of Alpha blockers?
- Possible contraindications: Postural hypotension
- Compelling contraindications: Urinary incontinence
When does the JNC 7 suggest that a two drug regimen is appropriate to use at initiation?
- Blood pressure more than 20 mm Hg systolic or 10 mm Hg systolic (DIASTOLIC?) above the treatment goal
- A two-drug regimen would include a diuretic
When is caution urged for using combination BP meds at initiation?
- Elderly patients
- Combinations mask if one agent would have been sufficient
What is HEXAMETHONIUM?
- Block the action of acetylcholine at nicotinic receptors at sympathetic and parasympathetic autonomic ganglia –> Good or bad?
- Reduce arteriolar and venomotor tone
What are side effects of HEXAMETHONIUM?
- It looks like neuro-muscular blocker so it can paralyze the muscles of respiration
- Urinary retention
- Tachcardya
- Blocks everything on parasympathetic and sympathetic side
What is Reserpine?
- Neurotransmitter reuptake blockade: Norepinephrine, Dopamine, Serotonin
- Irreversible effect
What are the adverse drug reactions of Reserpine?
- Central nervous system: Sedation, depression, nightmares, suicide
- Extrapyramidal effects, e.g. tremor
What is Guanethidine?
- Norepinephrine release inhibition: Gradual depletion of norepinephrine in nerve endings
- Drug-drug interactions
- Can’t prescribe it anymore
What are the adverse drug reactions of Guanethidine?
Hypotension; postural and post-exercise
