HTN - waldron Flashcards
how do you properly measure BP
have pt relax, sitting in a chair at least 5 min
patient should avoid caffeine, exercise, smoking 30 min prior to measurement
emptied bladder
neither patient or observer should talk during rest period/during measurement
clothing free area
when does screening begin for HTN
adults ages 18+ without known HTN at every visit
what is stage 1 HTN
systolic: 130-139
or
diastolic: 80-89
what is stage 2 HTN
systolic: greater than 140
or
diastolic: greater than 90
what is HTN crisis
systolic: > 180
and/or
diastolic: >120
what is the definition of primary hypertension
result of sustained increases in blood pressure secondary to increased peripheral resistance and blood volume
What is Masked Hypertension
controlled office BPs but uncontrolled BPs in out-of-office settings
risk of CVD and all-cause mortality is similar to that noted in those with sustained HTN
what is the etiology of HTN
multifactoral
genetic
ethnicity
environmental factors (stress)
dietary factors (sodium, ETOH)
obesity
aging
what are risk factors for HTN
obesity
alcohol abuse
sedentary lifestyle
tobacco use
excessive emotional stress
obstructive sleep apnea
poor diet
what is secondary HTN
elevated BP caused by another medical condition
sometimes more difficulty with control
underlining medical illness needs to be addressed
what are potential causes to secondary hypertension
Obstructive Sleep Apnea (OSA)
chronic kidney disease
primary aldosteronism
renovascular disease
cushing syndrome
what are drug related causes of HTN
NSAIDS
glucocorticoids
sympathominmetic agents
stimulants
alcohol
OCP
what are the signs and symptoms for secondary HTN
often asymptomatic
persistent or severe headache
SOB
fatigue
epitaxies
anxiety
feeling of pulsation in the neck or head
how is HTN diagnosed
History
PMHx
FamHx
medications
social hx (diet, habits)
exposures (lead)
what is the goal for diagnosing HTN
identify end-organ damage, signs of secondary HTN, reversible exacerbating factors
what are the labs to assist with dx HTN
urinalysis
CBC
fasting lipid profile
CMP
Optional: uric acid, 24hour urine creatinine and protein
what is the management for HTN
treatment goal: attain and maintain target BP
reduce cardiovascular and renal morbidity and mortality
patients < 60yo: <140/ <90
patients > 60: <150 / <90
what are the non-pharmacologic treatments for HTN
weight loss
heart-healthy diet
sodium reduction
potassium supplementation, preferably by diet
increase Physical activity
no more than 2 standard drinks per day for men and 1 for women
smoking cessation
what are the pharmaceutical therapies for HTN
Diuretics
BB
RAAS
CCB
others
what medications are indicated for antiHTN with DM
ACEi or ARBs
what medications are indicated for antiHTN with HF
ACEi, ARBs, BB, Thiazide diuretics, aldosterone antatgonists
what is the primary cause of secondary HTN
sleep apnea
what medications are indicated for antiHTN with MI
BB, ACEi (with LV dysfunction)
what medications are indicated for antiHTN with Chronic Kidney disease
ACEs, ARBs
what medications are indicated for antiHTN with isolated systolic HTN
diuretics (preferred), calcium antagonists
what type of medication is more effective at reducing strokes in AA patients
CCBs are more effective than ACEi
what HTN medications are recommended in CKD, Heart disease
ACEi/ARB
what is resistant HTN
persistent HTN despite 3+ medications - one must be a diuretic at adequate dose
what is the most common cause of resistant HTN
poor adherence to therapy
what is malignant HTN
severe HTN (BP > 180/110)
What is a Hypertensive emergency
WITH end-organ damage
dissecting aortic aneurysm
acute pulmonary edema
acute coronary syndromes (STEMI, NSTEMI, unstable angina)
renal injury
encephalopathy
stroke
eclampsia
*requires hospitalization
what is severe asymptomatic HTN
WITHOUT end-organ damage
usually chronic
outpatient management
what is hypertensive urgency
very high BP (diastolic pressure > 120-130)
acute complications are unlikely, so immediate BP reduction not required
start 2 drug oral antiHTN combination with close eval of treatment efficacy, continued outpatient
very high BP without organ damage commonly occurs in highly anxious patients or those who have had very poor sleep quality over a period of weeks
what is the treatment for hypertensive emergencies
admit to ICU
immediate short -acting BP reduction with IV drugs
- nitroglycerin, nitroprusside, labetalol, esmolol, hydralazine
how do you work up hypertensive emergencies
ECG, urinalysis, serum BUn and creatinin
chest XR
what is hypertensive encephalopathy
brain dysfunction secondary to excessively high BP
SUDDEN ONSET (most cases)
-HA, V, balance difficulties, confusion
complications include seizures, retinal hemorrhage
what are risk factors for hypertensive encephalopathy
kidney failure, abrupt medication discontinuation, pheochromocytoma, MAOI + tyramine, eclampsia
what are the causes of orthostatic hypotension
inadequate autonomic response (neurogenic)
OR
insufficient intravascular volume or circulation (non-neurogenic)
what are the risks for orthostatic hypotension
older adults (>70yo), polypharmacy, peripheral neuropathy, neurodegenerative d/o
what is the pathophysiology of orthostatic hypotension
autonomic dysfunction affecting baroreflex - no change in HR or BP
severe volume depletion - increase HR
meds
40% have no definite cause
what are the symptoms with orthostatic hypotension
in response to change in position, usually vs gravity
dizziness/lightheadedness
visual blurring
neck pain, HA
50% have systolic HTN when supine/sitting
what is the treatment for orthostatic hypotension
avoid meds related to orthostasis
modify diet
treat underlying causes
modify activity
may consider compression stockings
consider medication therapy
what are the complications of HTN
increases afterload - leads to congestive HF, increases myocardial oxygen demand
arterial damage - accelerated atherosclerosis, aneurysm, dissection, kidney disease, stroke
