HTN2 Flashcards
what is the 3 steps of HTN treatment algorithm in JNC8
- for adults over 18 with HTN
- Implement lifestyle interventions
- set BP goal and initiate meds based on age, diabetes and CKD
what is the JNC8 BP definition of HTN
140/90
what are some non-pharm therapies for lifestyle changes?
1 improve diet
- reduce stressors
- regular exercise
- decrease intake of food/drugs that increase BP
- smoking cessatoin
what BP reduction recommendation involves a diet rich in fruits, vegetables, and lowfat dairy products
DASH diet
what is the max amount of sodium intake in a day with a sodium reduction diet?
what is the preferred amount of sodium intake per day if possible
max in diet 2400 mg/ day
ideal = 1,500 mg/day
the dash diet is estimated to decrease BP by how much
8-14 mmHg
what reduction in SBP is estimated for every 10 kg of weight lost?
5-20
what 5 drug classes used to be recommended to reduce BP?
what was dropped in JNC8 at first line
- thiazide diuretics
- CCBs
- ACE inhibitors
- ARBs
- beta-blockers were removed as first line in JNC8
what is treatment algorithm in JNC8 based on
- age
- diabetes (comorbidity)
- CKD (comorbidity)
what trial influenced guidelines of JNC8
Antihypertensive and Lipid Lowering tx to prevent Heart Attack Trial (ALLHAT)
what was found to be drug of choice for first line therapy in ALLHAT?
Thiazide diuretics
what are the 5 key trials JNC8 used for updates
- hypertension detection and follow up program (HDFP)
- Hypertension-Stroke Cooperative
- Medical Research Council (MRC)
- Australian National Blood Pressure (ANBP)
- VA cooperative
what DBP is inarguably considered cutoff for HTN?
less than 90
If CKD or DM is present what does JNC8 give as a goal
140/90
what is the goal BP for people over 60 without CKD and diabetes
150/90
what is goal BP for people under 60 without CKD or DM
150/90
why are black patients not recommended to have an ACEI or ARB
not as effective and increase risk of stroke
If a black patient with CKD and DM has HTN what should they be treated with ?
Why?
ACEI or ARB (all races, black or white)
provided renal protective effect
what are 3 dosing strategies per JNC8
- max first medication before adding second
- or add second med before reaching max dose with first
- or start with 2 med classes separately or as fixed dose combo
what are general rules for antiHTN dosing
- reinforce med and lifestyle adherence
- 1 month trial to reach goal before changing drug therapy
- if adding new med, use it from a new class
- avoid combined use of ACE and ARB
if a patient has gout, what HTN treatment should not be used?
thiazides
how many first line HTN treatment classes can be used at once
3, then considerer later-line drugs
