Hypertension Flashcards
What are the goals of the recommendations for treating hypertension?
Improvement of cardiovascular health and quality of life through the prevention and treatment of risk factors.
Causes of Hypertension
More prevalent in African American men and women.
Earlier age in European Americans or Latinos.
Tends to increase with age.
More common with genetic predisposition.
Lifestyle- sedentary, stressful situations.
High sodium intake (increases peripheral vascular resistance, thus increasing BP)
Secondary Hypertension
Reversible causes (Cardiac, renal, endocrine, or medications causing vasoconstriction)
Secondary is seen <30 and >50 years of age. BP is >180/110 and significant target organ damage, hemorrhages are seen, and exudates on the funduscopic exam, renal insufficiency, LVH, accelerated or malignant therapy.
Causes of secondary hypertension
Obesity OSA Renovascular disease Chronic corticosteroid therapy Cushing's syndrome Primary aldosteronism Pheochromocytoma Coarctation of the aorta Hyperthyroid disease Parathyroid disease Excessive ETOH Drug induced: NSAIDs, licorice, oral contraceptives, erythropoietin, cocaine, amphetamines, corticosteroids, cyclosporine, herbal ephedra, smoking, chewing tobacco.
White Coat Hypertension
Transient elevation in BP in clinical setting r/t anxiety.
Important to monitor with an appropriate sized cuff. Too small, too high.
Patients should have ambulatory BP monitoring, 24 hour recording during normal daily activities that can be reviewed by the clinical. Pt may monitor over several weeks with reliable equipment and follow up with log.
Masked Hypertension
HTN that is present during routine daily life and absent in clinical setting. Important to perform ambulatory blood pressure monitoring.
Risk factors
- Smoking
- Alcohol use
- Sedentary lifestyle
- Work, physiological stressors
These patients are at higher risk for cardiovascular event, mortality and morbidity d/t missed treatment.
Malignant Hypertension
Diagnosed when patients present with severely elevated BP 180/110 and acute target organ damage.
AKA hypertensive emergency or hypertensive crisis.
If not treated with immediate parenteral antihypertensive therapy may prove fatal. Treated/reduced over the course of hours with oral and or IV medications.
Hypertensive Urgency
A significant elevation of blood pressure on it’s own.
Treated with oral medications over a 24-48 hour period to achieve stabilization.
Acute Target Organ Damage Evidence
Cerebrovascular events Papilledema, hemorrhages, or exudates on funduscopic exam. Acute MI or infarction. CHF Pulmonary edema Aortic dissection Acute renal failure or dysfunction evidenced by hematuria, proteinuria, or elevated serum creatinine. States of catecholamine excess Epistaxis Preeclampsia or eclampsia Change in mental status or neurological deficits on physical examination Dementia
When taking a history focused on hypertension risk factors include?
Age Gender Menopausal status Diet Physical activity Alcohol/caffeine use Smoking Dyslipidemia DM FMH CAD Current medications-OTC cold meds, NSAIDs, sympathomimetics
Hypertension: Physical Exam should include
Fundoscopic exam Palpation of the chest for PMI Ausculation of heart Abdominal assessment: check for masses, bruits, widened aortic diameter, enlarged kidneys. Palpation of peripheral pulses Neurological exam Fundoscopic exam
Hypertension: Objective Data to Collect
EKG
U/A
Serum Creatinine
Chest x-ray
CT head to r/o CVA (severe HA or Mental status changes)
BP in both arms, pt seated with both feet flat. Arm at heart level. Appropriate sized cuff. Two minutes apart.
Identifiable Causes of Hypertension
OSA Drug induced Chronic kidney disease Primary aldosteronism Renovascular disease Chronic steroid therapy and Cushing's syndrome Pheochromocytoma Coarctation of aorta Thyroid or parathyroid disease
Normal BP
SBP <120
DBP <80
Encourage lifestyle modifications
Prehypertension
SBP 120-139
DBP 80-90
Lifestyle modifications
No drug therapy indicated without compelling indication.
