HTN: Special Populations

Question 1

Definition of HTN in Pregnancy

Answer 1

Women with normal BP pre-pregnancy who have:

BP 140/90 or higher AFTER 20 wks gestation

Question 2

HTN in Pregnancy monitoring

Answer 2

• Weekly BP checks and labs
• Impatient tx: stroke risk (160 or higher systolic/105 or greater diastolic, presence of renal or CVD
• Monitor for preeclampsia (>140/90 with proteinuria, vision changes, severe HA, abd pain, worsening edema)

Question 3

What to use in preggos

Answer 3

• Labetalol (cat C) PO or IV
• ER nifedipine (cat C) PO
• Methyldopa (cat B) only use for women who can’t use labetalol or nifedipine d/t significant sedation
• DONT use ACE/ARB, renin inhibitors–> teratogens

Question 4

HTN and Elderly

Answer 4

• Lowering BP is beneficial by dec CV events, HF, death
• More prone to ADRs (dizziness, lytes, inc SCr)
• Use normal meds (ACE/ARB, DHP CCB, thiazides)
• Tailor BP goal to individual patient!

Question 5

D/c anti-HTN in elderly

Answer 5

• Reporting dizziness, lightheadedness, make sure they stand up slowly
• Look for obvious BP meds to taper off unless there’s a specific need to be on (b-blocker for HFrEF)

Question 6

Peds HTN definition

Answer 6

• BP is 95th% or greater

- 130/80 or greater for 13 years or older

Question 7

Peds HTN tx

Answer 7

• Lifestyle mod first!!!!
• Still no change in 6 mo or kids w DM/kidney dz—> ACE/ARB
• Lean toward DHP-CCB for teenage girls bc ACE/ARB are teratogens

Question 8

Peds HTN goals

Answer 8

• 90th% for age

- <130/80 for 13 yrs or older

Question 9

Resistant HTN

Answer 9

• Uncontrolled HTN despite being on 3 or more drugs including a diuretic
• Only 10% “true” resistant HTN, many d/t poor adherence or inadequate regimen

Question 10

Resistant HTN Considerations

Answer 10

• Check for “pseudo resistance” (poor adherence, white cote HTN, poor monitoring)
• Check other meds that inc BP, high salt diet
• Use “core” BP lowering meds–> diuretic, ACE/ARB, CCB
• Screen for 2ndary causes of HTN (OSA, hyperaldo, RAS, hyperthyroid, etc)

Question 11

HTN Urgency

Answer 11

• > 180/100 without organ damage
• Focus on pt, not BP value
• Dropping BP too fast can trigger CVA, AMI, etc
• Check med adherence, restart BP meds, increase dose, add med
• F/u in 2 wks (no cormorbidites) or 2 days (HF, angina, CKD)

Question 12

HTN Emergency

Answer 12

• > 180/120 that causes organ damage
• Can lead to stroke, LOC/memory loss, ocular/renal damage, aortic dissection, angina/MI, pulm edema
• Admit to ICU and IV BP meds**