Hypertension Flashcards
Optimal BP
<120/80
Elevated BP
120-129/<80
Stage 1 HTN
130-139/80-89
Stage 2 HTN
> 140/90
Masket HTN
<130/80 in office, high ambulatory BP
Nocturnal HTN
> =120/70 in sleep
Treatment for BP 120-129/<80
Lifestyle, reassess in 3-6 months
Treatment of BP 130-139/80-90
ASCVD > 10% or clinical ASCVD -> Treat
Otherwise, lifestyle
Treatment of BP >140/90
Medications and lifestyle
Anti-HTNs General
Thiazide
CCB
ACE/ARB
Anti-HTN Black
1st thiazide / CCB (unless CKD)
2nd ACE/ARB
Anti-HTN CKD (>300 mg/d albuminuria)
ACE/ARB
Anti-HTN pregnancy potential
CCB
BB
Anti-HTN MI or HFrEF
BB
ACE/ARB
Anti-HTN Stable CAD
ACE/ARB
BB
CCB
BP target in DM
<140/90
<130/80 if high risk or kidney disease
Causes of resistant HTN
Excess sodium Inadequate diuretic Medication side effect Excessive ETOH Secondary HTN
Treatment of resistant HTN
Optimize diuretic
Optimize ACE/ARB with CCB
Use MRA if GFR > 30
When to screen for secondary HTN
Drug-resistant or drug-induced Abrupt onset HTN < age 30 Accelerated / malignant HTN Diastolic HTN > age 65 Unprovoked or excessive hypokalemia
Secondary causes of HTN
OSA Primary hyperaldosteronism Renal artery stenosis Cushing's disease Renal disease Thyroid disease Pheochromocytoma
Features of hyperaldosteronism
Normal to low K
High aldosterone > 15
Aldosterone / renin ratio > 20
Diagnosis of hyperaldosteronism
Stop MRA and direct renin
PRA < 1, DRC < 10
Aldosterone > 20 = diagnosis
If borderline Aldo 10-20 -> saline suppression test
Saline suppression test for hyperaldosteronism
Stop diuretics, ACE ARB 2-3 weeks
Stop MRA 4-6 weeks
Aldosterone >= 10 = adrenal adenoma or hyperplasia
Malignant hypertension definition
> 180/120
Hypertensive urgency
Malignant HTN with no-end organ damage or sx
Hypertensive emergency
Malignant HTN with organ damage or sx
BP lowering in aortic dissection
SBP <120 in 1st hour
BP lowering in eclampsia or pheochomocytoma
SBP <140 in 1st hour
BP treatment in acute ICH < 6 hours
SBP 150-220 no treatment
SBP > 220, lower with IV
BP treatment in acute ischemic stroke and lytics
<72 hours
<185/110 before lytics, maintain for 24 hours
BP treatment in acute ischemic stroke and no lytics
<72 hours
BP <220/110, no treatment for 48-72 hours
>220/110, decrease BP by 15% within 24 hours
Adrenal Insufficiency Testing
AM cortisol >11 excludes, <3 more likely
ACTH stimulation test performed to confirm
Primary hyperaldosteronism testing
ARR > 30 suggestive
Confirm with oral sodium loading test, saline infusion test, fludrocortisone suppression or captopril challenge
