HTN part 1- Exam 1 Flashcards
What is systolic BP? What is diastolic BP? What is a normal reading?
systolic: The measurement of pressure against the arterial walls when the heart contracts and pushes out blood
diastolic: The measurement of pressure against the arterial walls when the heart is filling (between beats)
normal: LESS than 120 and LESS than 80
What are 3 severe complications that can arise from long standing HTN?
Heart disease
Neurological disease (stroke)
Renal disease
What population is most commonly affected by HTN? When does it show up? What are some common consequences?
non-Hispanic blacks and even more specifically BLACK MEN
HTN manifests earlier, is more severe, higher rates of morbidity and mortality d/t stroke, LVH, CHF, ESRD than white Americans
What is the pathogenesis behind HTN? Why is arterial BP important?
BP = cardiac output x systemic vascular resistance
Maintenance of arterial BP is necessary for organ perfusion
_______ results from complex interactions between genetic, endogenous and environmental factors aka there is no identifiable underlying cause
Name some potential causes
essential HTN
Sympathetic nervous system hyperactivity
Renin-angiotensin system activity
Defect in natriuresis
Abnormal cardiovascular or kidney development
Elevated intracellular calcium and sodium levels
What is the pathogenesis behind sympathetic nervous system HTN? What pt population? How does it present?
Acetylcholine and norepinephrine release
younger pts that present with tachycardia and elevated cardiac output
Briefly describe the RAAS system in a nutshell. Where do ACE inhibitors work?
ACE Inhibitors block the conversion of Angiotensin I to Angiotensin 2
What is the natriuresis effect?
↑ salt intake triggers ↑ in BP which promotes ↑ natriuresis to bring BP values back into normal range. Defects in this process cause HTN
aka loss of salt or lack thereof
Changes in ______ or ______ increases the risk of HTN - think aging and hardening of vessels
aortic elasticity
microvasculature
Why does cardiovascular or renal dysfunction lead to HTN?
This can also lead to damage in circulation to the brain and kidneys which would also affect our ability to control BP due to decreased fluid excretion, unmanaged hormones, etc.
Intracellular sodium is elevated in (primary/secondary) HTN. What else can it lead to?
primary HTN
can lead to increased intracellular calcium which can lead to increased vascular smooth muscle tone
What are the overall risk factors for HTN?
Obstructive sleep apnea
Excessive Alcohol Use
Cigarette Smoking
NSAID use
Obesity
Low potassium or high sodium intake
Metabolic syndrome
______ is the MC cardiovascular disorder in the US. What is the cause?
primary/essential HTN
no identifiable cause that accounts for 90-95% of HTN cases
_____ is HTN caused by another condition.
Secondary HTN
What is isolated systolic HTN defined as? What is the common pt population? What is it caused by?
A form of essential HTN when systolic BP ≥140 but diastolic BP <90
older pts
secondary to arterial stiffness and atherosclerosis
Why is stiffness of the arteries a problem in isolated systolic HTN? Which number (systolic or diastolic) is more correlated with adverse cardiovascular events?
Stiffness of arteries leads to less diastolic recoil therefore we do not see the increased pressure effect
systolic BP
What is white coat HTN defined as? What is the tx? What is the common pt population?
Persistently elevated BP (>140/90) in office but normal BP outside of a medical setting
Research suggests that so long as BP remains normal at home, treatment is unnecessary
MC in elderly pts
What is masked HTN? What is it caused by? What is the tx?
Normal BP in office but elevated BP at home
lifestyle:
Tobacco
Caffeine
Stress
If cuff is accurate, need to tx pts
What is pseudohypertension caused by? What is the tx? What is the MC pt? What do you need to order to confirm dx?
Results from calcification in peripheral vessels and causes falsely elevated BP resulting in symptomatic overtreatment
hypotension s/s
MC in elderly
take intra-aortic BP reading
What are the 3 goals of evaluating for HTN?
Assess presence of target-organ damage related to HTN
Determine the presence of other cardiovascular risk factors and disease
Evaluate for possible underlying secondary causes of HTN
**What is the criteria to dx hypertension?
A diagnosis of HTN is based on TWO or more accurately measured and seated BP readings on TWO or more different occasions (unless its an hypertensive emergency)
**What is the criteria to use home BP readings?
3 days of checking twice daily, once in the morning at least 1 hour after taking meds and once in the evening
**What are the ACC/AHA guidelines for normal/elevated/stage 1/stage 2 HTN?
What are the 2 exceptions when dx HTN?
hypertension presenting with unequivocal evidence of life-threatening end-organ damage
blood pressure is greater than 220/125 without life-threatening end organ injury
What is the textbook way to measure BP accurately?
Should be taken in both arms, two times, spaced 1-2 minutes apart at first office visit - ESPECIALLY IF WE HAVE AN ELEVATED BP READING TO START!!
use the higher value obtained
When are automated BP devices not accurate?
A. Fib
What is an important history question to ask when working a pt up for HTN?
Have you had something like this before?
Previous antihypertensive therapy and its effect on BP?
What medications are known to cause HTN? What is the major one?
**Contraceptives, NSAIDs, amphetamines, black licorice
What should the PE focus on when working a pt up for HTN?
After obtaining our initial vitals and determining HTN - our PE should focus on identifying any evidence of end organ damage
What labs should you order for HTN?
Urinalysis
BMP - need electrolytes, glucose, and BUN/Cr!
EKG
Fasting Lipid Profile
TSH
What are 4 major complications of HTN?
-Structural and functional changes in the heart and vasculature
-Increased risk of thrombosis
-Increase in morbidity and mortality
- target-organ damage that varies between person and person (TIA, stroke, retinopathy, PAD, renal failure, LVH, congenital heart disease, HF)
What is hypertensive cardiovascular dz? What are some common presentations?
Long standing HTN causes the heart to have to pump against pressure all the time (think going to the gym and lifting weights 24/7). This causes the muscle to thicken and stiffen, making it less functional
Dyspnea, edema
Palpitations, chest pain
LV heave or S4 gallop
LVH criteria on EKG
Cerebrovascular Hypertensive Disease major predisposing factor for both _____ and _____. Is it more related to SBP or DBP? Is it preventable?
ischemic and hemorrhagic stroke
SBP
can be prevented with appropriate HTN management
Cerebrovascular Hypertensive Disease also increases risk for _______ both _____ and _____ types
dementia
both vascular and Alzheimer types
hypertensive renal disease that is untreated can result in _______ and is more common complication in _____ patients. Can you reverse the damage?
nephrosclerosis
black patients
difficult to reverse damage but can be prevented
What is hypertensive retinopathy? **What are the 3 clinical pearls associated with hypertensive retinopathy? What makes it worse?
Narrowing of the retinal arteries
Development of exudates, cotton-wool spots, and retinal hemorrhages
when combined with DM
What is atherosclerosis?
Condition that causes narrowing and/or hardening of arteries
Cause by and contributes to increased B
What is an aortic aneurysm vs dissection?
aneurysm is all the layers of the blood vessel are ballooned out vs dissection is the layers of the blood vessel are falling apart/peeling away
dissection is way worse!
What is the non-pharm management of HTN? Which ones are proven to have the most impact?
**What are the ACC/AHA guidelines for HTN management for normal/elevated/stage 1/stage 2 HTN?
What is the goal BP for all pts with HTN? What is first line meds for non-black pts? black pts?
less than 130/80
non-black pts:
thiazide, ACEI/ARB or CCB
black pts:
thiazide or CCB (amlodipine is Prof Long’s fav)
Consider looking at this chart again for comorbid conditions
How often should you f/u if BP is NOT well controlled? How often do you need to order labs? When should you order an EKG?
we follow up every 4 weeks if uncontrolled!
Lab monitoring is NOT needed if BP is controlled, unless other disease processes are present
EKG could be obtained every 2-4 years depending on baseline EKG and any symptoms that present
When starting ACEI, need to order _______
need to order BMP to check electrolytes
