HTN Special Pops Flashcards

1
Q

Primary hypertension

A

– no identifiable cause

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2
Q

Secondary hypertension

A

– an underlying cause is identified

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3
Q

Goals: 1.

A

Determine if its primary or secondary.

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4
Q

Goal 2

A

If secondary, identify underlying cause

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5
Q

Goal 3

A

. Identify other co-morbid factors for CVD, or diseases associated with an increased risk for CVD

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6
Q

Normal BP under 13

A

<90th precentile

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7
Q

Elevated BP under 13

A

<90th precentitile to <95th precenitle, or 120/80 whichever is lower

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8
Q

Stage 1 under 13

A

Systolic BP >95th precentile to <95th precntile + 12 mm Hg, or 130/80 to 139/89 mmHg, (whichever is lower)

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9
Q

Stage 2 under 13

A

Systolic and diastolic BP >95th precentile +12 mmHg or >140/90 mmHg (whichever is lower)

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10
Q

Normal BP over 13

A

<120 and <80

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11
Q

Elevated BP over 13

A

120 to 129

<80

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12
Q

Stage 1 over 13

A

130/80 to 139/89

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13
Q

Stage 2 Over 13

A

> 140/90

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14
Q

Peds Initiate treatment in following examples

A
Symptomatic HTN
Stage 2 HTN
Stage 1 HTN without evidence of end-organ damage, that persists despite 6 months of non-pharm therapy
Hypertensive end-organ damage
Any stage of HTN or high BP with CKD
Any stage of HTN with DM
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15
Q

Drugs in children’s and adolecents

A
Ace inhibitors
Angiotensin-receptor blockers (ARBs)
Thiazide diuretics
Calcium channel blockers
Beta blockers
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16
Q

Choice of drug for peds

A

data comparing antihypertensive drugs in children are lacking and hence it is not possible to make an evidence-based choice
Recommendations based upon the underlying cause of HTN, concurrent disorders, and the preference and experience of the responsible provider

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17
Q

Four major hypertensive disorders that occur in pregnant women:

A

preeclampsia-eclampsia
chronic hypertension
preeclampsia-eclampsia superimposed upon chronic hypertension
gestational hypertension

18
Q

Preeclampsia-eclampsi

A

syndrome of new onset of hypertension and proteinuria or new onset of hypertension and end-organ dysfunction with or without proteinuria, most often after 20 weeks of gestation in a previously normotensive woman.

19
Q

Chronic (preexisting) hypertension

A

hypertension that antedates pregnancy, is present before the 20thweek of pregnancy, or persists longer than 12 weeks postpartum

20
Q

Preeclampsia-eclampsia superimposed upon chronic hypertension

A

diagnosed when a woman with chronic hypertension develops worsening hypertension with new onset proteinuria or other featur

21
Q

Gestational hypertension

A

elevated blood pressure first detected after 20 weeks of gestation in the absence of proteinuria or other diagnostic features of preeclampsia.

22
Q

Treatment of severe hypertension (defined as systolic BP ≥160 mmHgand/ordiastolic BP ≥110 mmHg) persisting for

A

Treatment of severe hypertension (defined as systolic BP ≥160 mmHgand/ordiastolic BP ≥110 mmHg) persisting for

23
Q

Mild (systolic 140 to 150mmHg, diastolic 80 to 100mmHg) – consider

A

symptoms and co-morbidities

24
Q

All anti-HTN cross the

A

placenta

25
Q

Methyldopa – wildly used in

A

in pregnancy women/long-term safety for fetus has been demonstrated

26
Q

Other options for HTN in pregnancy

A

Beta-blockers, calcium channel blockers, hydralazine, thiazide diuretics, clonidine.

27
Q

Drugs to avoid in pregnancy

A

ACE inhibitors, ARBs, direct renin inhibitors
Mineralocorticoid receptor antagonists
Nitroprusside

28
Q

Breastfeeding what beta blockers can be used

A

Propranolol, metoprolol, labetalol

29
Q

Breastfeedign what CCB can be used

A

Diltiazem, nifedipine, nicardipine, and verapamil

Appear to be safe during lactation

30
Q

Breast feeding what ACE can be used

A

Transferred into milk at very low levels.
Newborns may be more susceptible to the hemodynamic effects of these drugs (hypotension, oliguria and seizures)
Captopril, enalapril

31
Q

Breastfeeding what Diruetics can be used

A

HCT < 50mg/day

32
Q

Breastfeeding diuretics may reduce

A

may reduce milk volume.

HCT <150 mg/day

33
Q

Methyldop and hydralazine apear to be ___ in breastfeding

A

safe

34
Q

Geriatrics general principles

A

Lower dose to minimize SE
Lower BP over a period of weeks to up to 6 months as long as no HTN emergency or urgency
Systolic Pressure Intervention Trial (SPRINT)
Consider orthostatic hypotension

35
Q

Lower dose to minimize SE
Lower BP over a period of weeks to up to 6 months as long as no HTN emergency or urgency
Systolic Pressure Intervention Trial (SPRINT)
Consider orthostatic hypotension

A

Low-to-moderate-dose thiazide diuretics (e.g., 12.5 to 25mg/dayofchlorthalidone)
Long-acting calcium channel blockers (most often dihydropyridines)
ACE inhibitors or ARBs.
A long-acting dihydropyridine or a thiazide diuretic is generally preferred in older adult patients because of increased efficacy in blood pressure lowering

36
Q

JNC-8 – initial therapy – older adults

A

Co-morbid conditions with compelling indications (e.g., HF, MI, CKD: ACE-1 or ARB)

37
Q

Co-morbid conditions for older adults

A

Co-morbid conditions with compelling indications (e.g., HF, MI, CKD: ACE-1 or ARB)

38
Q

Addition for a second line drug for older adults

A

Addition of a second-drug
ACCOMPLISH trial - significant improvement in outcomes at the same attained blood pressure withbenazeprilplusamlodipinecompared with benazepril plushydrochlorothiazide.
Long-acting ACEinhibitor/ARB

39
Q

Resistant HTN

A

BP remains above goal despite concurrent use of three anti-hypertensive agents of three different classes.

40
Q

Resistant HTN one agent should be a

A

should be a diuretic, and all agents should be prescribed at maximum recommend dose (or maximally tolerated)

41
Q

Resistant HTN if BP controlled with

A

If BP controlled with 4 or more medications