Hypertension 101 Flashcards
What are the BP goals for diabetics for JNC7 and for ADA?
JNC7 <130/80 ADA < 140/80 unless you can achieve < 130/80 without undue burden
What is definition of Stage 1 and Stage 2 HTN?
Stage 1 HTN >140/90
Stage 2 HTN >160/100, if either diastolic or systolic is in range you get the diagnosis. For example, 150/110 is stage 2 HTN
Name 3 prescription medication classes that are secondary causes of HTN.
oral contraceptives - progesterone is the bad player for HTN NSAIDs Prednisone Effexor at 150mg or greater Amphetamines
Name two OTC medications that can cause HTN.
Decongestants (psuedoephedrine)
Afrin nasal spray
Name three herbals known to cause HTN.
Ma Huang, bitter orange, ephedra, also licorice
Name 6 diseases that are causes for secondary HTN.
sleep apnea, renal disease, primary aldosteronism, pheochromocytoma, Cushing’s disease, thyroid disease, hyperparathyroidism
What are the five lifestyle modifications for treatment of HTN in order of effectiveness?
Weight reduction DASH diet exercise sodium restriction moderating alcohol consumption (no more than 1 drink/ day for women no more than 2 drinks per day for men)
What is the first line treatment for stage 1 HTN without compelling indications?
Thiazides are first line. Chlorthalidone is stronger than HCTZ and all initial studies showing benefits of thiazides done with chlorthalidone, but has higher rate of electrolyte disturbance.
What should be your strategy for treatment of Stage 2 HTN?
Start two medications one of them being a thiazide
What are the diseases with compelling indications and their associated medications?
Diabetes - ACE/ARB, thiazides Heart Failure - BB, ACE/ARB, AA MI - BB, ACE/ARB AA CKD - ACE/ARB CVA - ACE, thiazides
Other than HTN what are the diseases that are favorably effected by the following medication classes: beta blockers, calcium channel blocker, thiazides and alpha blockers?
BB - tremor hyper thyroidism and migraine prophylaxis
CCB - Raynaud’s and migraine
thiazides - osteoporosis
alpha blockers - BPH
What 5 situations should you avoid ACE/ARB?
pregnancy woman of reproductive age unless also diabetic angioedema hyperkalemia, ACUTE renal failure
In what 4 situations should you avoid Beta blockers?
bronchospastic disease
depression
diabetes especially with hypoglycemia unawareness
greater than first degree heart block
In what 4 situations should you avoid thiazides?
gout
lithium use
sulfa allergy
hyponatremia
In what 2 situations should you avoid CCB?
CHF
fluid overload
In what situations should you avoid aldosterone antagonist?
Hyperkalemia, specifically K > 5
SCr >2.5
What are best agents for isolated systolic HTN
CCB and thiazides
What are the two best first choices in African Americans for HTN?
thiazides and CCB
ACE/ARB do not work as well in AA
In the absence of compelling indications what are your first three classes of medications and the strategy to use them?
Thiazides, ACE/ARB and CCB
thiazide first line, maximize one agent before adding another. Maximum dose for thiazides is 25 mg. Drug therapy is additive. start two medications for stage two. In presence of compelling indications you would maximize those medications first.
What two lab changes can occur with initiation of ACE/ARB and what should you do about them?
serum creatinine can rise up to 30% this is short lived and should normalize in 2 weeks. If creatinine rises above 30% or does not normalize should consider stopping ACE/ARB and working up for renal artery stenosis
patient’s can develop hyperkalemia which is an indication for discontinuing ACE/ARB
When should you consider referral to renal for HTN?
All patients with CKD
Maximum doses of 4 antihypertensives without good control.
How do you make the diagnosis of HTN?
BP > 140/90 on two occasions 24 hours apart using good technique
What is the initial work-up for HTN and why do you do each test?
EKG - looking for LV hypertrophy
UA looking for proteinuria as an indication for possible renal disease
CBC - ruling out polycythemia vera
metabolic panel - looking at renal function and electrolytes, electrolyte abnormalities may be indication of Cushing’s or primary aldosteronism
