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Internal Medicine pt.1 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is hypertension?

A

persistent

  • systolic 130mgHg or more
  • diastolic 80mmHg or more
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2
Q

What is a hypertensive crises?

A
  • systolic > 180

- diastolic > 120

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3
Q

What are the risk factors for primary hypertension?

A
  • positive family history
  • smoking
  • advanced age
  • inactivity
  • uncontrolled diabetes
  • race & ethnicity
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4
Q

What are the causes of secondary hypertension?

A
  • renal artery stenosis (most common
  • endocrine: hyperaldosteronism, Cushing syndrome, pheochromocytoma, acromegaly
  • oral contraceptives, decongestants, chronic steroids, TCA, NSAIDS
  • coarctation of the aorta
  • cocaine
  • obstructive sleep apnea (OSA)
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5
Q

What are the clinical features of hypertension?

A

ASYMPTOMATIC
until -> complications of end-organ damage OR hypertensive crises

  • secondary hypertension features -> of underlying disease
  • non-specific symptoms -> headache, dizziness, tinnitus, blurred vision, epistaxis, chest discomfort, palpitations, bounding pulse on palpation, nervous, fatigue, sleep disturbances
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6
Q

What are the findings of renal artery stenosis & how do we confirm its presence?

A
  • abdominal bruit
  • hypokalemia
  • asymmetric kidney size
  • duplex ultrasonography & MRA
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7
Q

What are the findings of primary aldosteronism (Conn syndrome)?

A
  • arrhythmia
  • hypokalemia
  • metabolic alkalosis
  • increase aldosterone to renin ratio
  • oral sodium loading test
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8
Q

What are the findings in pheochromocytoma?

A
  • acute episodic rise in blood pressure
  • flushing, diaphoresis
  • headache
  • increased 24-h urinary metanephrines
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9
Q

What are the findings in Cushing’s syndrome?

A
  • central obesity
  • moon face
  • increase cortisol
  • hirsutism
  • overnight 1-mg dexamethasone suppression test
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10
Q

What are the findings in aortic coarctation?

A
  • blood pressure in upper extremities higher than lower extremities
  • absent femoral pulses
  • ECHO
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11
Q

How should screening for hypertension occur?

A

Annual screening

  • > 40 years
  • any age with risk factors for primary HTN

Screening every 3 - 5 years -> everyone else

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12
Q

How should in-office BP measurement be taken?

A
  • if elevated -> repeat on other arm

- at least 2 readings on 2 separate visits

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13
Q

How are out-of-office BP measurements taken?

A
  • ambulatory blood pressure measurement

- home blood pressure monitoring

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14
Q

How do we evaluate end-organ damage?

A
  • renal function tests -> creatinine & eGFR
  • urinalysis & albumin to creatinine ration
  • ECG -> signs of hypertrophy
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15
Q

What are the indicators of secondary hypertension?

A

new-onset or uncontrolled hypertension in adults -> screen for secondary hypertension

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16
Q

How should elevated blood pressure be managed?

A

120-129/<80mmHg

- non pharmacological therapy

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17
Q

How is stage 1 hypertension managed?

A

130-139/80-90mmHg -> estimated 10-y CVD risk

  • if more than 10% -> non pharmacological therapy & BP lowering medications
  • if less than 10% -> non pharmacological
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18
Q

How is stage 2 hypertension managed?

A

> 140/90mmHg

non pharmacological therapy + BP lower medication

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19
Q

How long should non pharmacological therapy be used?

A

3 - 6 months -> if not getting better -> pharma

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20
Q

What are the first-line agents used for control of hypertension?

A
  • thiazide diuretics
  • CCBs
  • ACEI
  • ARBs
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21
Q

Which drugs do blacks respond to the most?

A

diltiazem & HCTZ

- thiazide like diuretics & CCB

22
Q

What are the second line drugs for management?

A
  • beta blockers
  • loop diuretics
  • aldosterone antagonists
  • alpha-1 blockers
23
Q

Which drugs have favorable effects on comorbidities?

A
  • BPH -> alpha blockers
  • essential tremor -> beta blocker
  • hyperthyroidism -> beta blocker
  • migrate -> beta blocker
  • osteoporosis -> thiazide diuretics
  • Raynaud phenomenon -> dihydropyridine calcium channel blocker
24
Q

What is the first-line treatment for HTN in pregnancy?

A

HYDRALAZINE

25
Q

When should sodium nitroprusside be used?

A

in hypertensive emergencies

26
Q

When should alpha-1 blockers be used in HTN management?

A

PRAZOSIN & DEXAZOSIN

  • HTN due to pheochromocytoma
  • BPH
27
Q

When should loop diuretics be used in HTN?

A

FUROSEMIDE & TORSEMIDE

- in symptomatic HF

28
Q

When are beta blockers used in management of HTN?

A

METROPOLOL & LABETALOL

  • ischemic heart disease
  • HF
29
Q

What are the contraindications for CCBs?

A

patients with reduced ejection fraction (HFrEF)

  • dihydropyridines -> amlodipine, ninfedipine
  • non-dihydropyridines -> diltiazem, verapamil
30
Q

patients with isolated systolic hypertension should be given what agents?

A
  • Thiazide diuretics -> HCTZ, chlorathalidone

- dihydropyridines -> amlodipine, ninfedipine

31
Q

What are the first line agents for patients with DM, renal disease, ischemic heart disease, & HF?

A

ACEi -> lisinopril, captopril

ARBs -> losartan, candesartan

32
Q

What drugs are contraindicated in bilateral artery stenosis?

A

ACEi & ARBs

33
Q

What should the target goal be for management of HTN?

A

less than 130/80mmHg

34
Q

What should the target goal be for management of HTN?

A

less than 130/80mmHg

35
Q

How should the management be followed up?

A

reassess after giving drugs in 1 month -> BP goal is met -> reassessment in 3 - 6 months
-> if not met -> assess & optimize adherence to therapy & intensify treatment

36
Q

What are the complications of hypertension?

A 
Cardiovascular -> HF, heart attack 
Neurological -> stroke, TIA, vascular dementia 
Renal -> kidney failure 
Optic
- hypertensive retinopathy
- cotton wool spots 
- retinal hemorrhage 
- macular star (exudation into the macula)) 
- micro aneurysm 
- AV nicking
37
Q

What is the difference between hypertensive emergency & urgency?

A

EMERGENCY -> crises with with signs of end-organ damage

URGENCY -> asymptomatic or isolated non-specific symptoms & non end-organ damage

38
Q

What are the causes of hypertensive crises?

A
  • drug non-compliance or abuse
  • pheochromocytoma
  • hyperthyroidism
  • acute renal disorders
  • eclampsia/pre-eclampsia
39
Q

What are the cardiac signs of hypertensive crises?

A
  • HF exacerbation & pulmonary edema -> dyspnea & crackles
  • MI -> chest pain, diaphoresis
  • Aortic dissection -> chest pain & asymmetric pulses
40
Q

What are the neurologic signs of hypertensive crises?

A
  • hypertensive encephalopathy -> headache, vomiting, confusion, seizure, blurry vision, papilledema
  • ischemic or hemorrhagic stroke -> focal neurological deficits, altered mental status
41
Q

What are the renal signs of hypertensive crises?

A

acute hypertensive nephrosclerosis

42
Q

What are the ophthalmic signs of hypertensive crises?

A

acute hypertensive retinopathy

43
Q

What are the red flag symptoms in HTN?

A
  • dyspnea
  • chest pain
  • altered mental status
  • focal neurological symptoms
44
Q

How should hypertensive emergencies be treated?

A

1- ABCDE
2- ICU admission
3- IV agents to treat -> CCBs (nicardipine & clevidipine), nitric oxide dependent vasodilators (sodium nitroprusside & nitroglycerin), direct arterial vasodilators (hydralazine)

reduce MAP by 10-20% within the first hour to prevent coronary insufficiency -> reduce by 5-15% over the next 23 hours

45
Q

How should hypertensive urgency be treated?

A

select, reinstitute, modify oral antihypertensive therapy

46
Q

What is white coat hypertension & what is its cause?

A
  • HTN detected only in clinical settings

- caused by anxiety

47
Q

increase in systolic BP >140mmHg with diastolic BP within normal limits (<90mmgHg) is?

A

isolated systolic hypertension

  • in elderly due to decreased arterial elasticity & increased stiffness
  • secondary to increased cardiac output -> anemia, hyperthyroidism, chronic aortic regurgitation, AV fistula
48
Q

What are the features of isolated systolic hypertension & how should it be treated?

A
  • head pounding
  • rhythmic nodding
  • bobbing of the head with heartbeats
  • thiazide diuretics or dihydropyridine CCB
49
Q

What are the risks of HTN in pregnancy?

A
  • placental abruption
  • stroke
  • multiple organ failure
  • disseminated vascular coagulation
  • intrauterine growth retardation
  • preterm birth
  • intrauterine death
50
Q

What are the classifications of pregnancy hypertension?

A
  • mild: >140/90mmHg

- severe: >160/110

51
Q

What are the first lines of treatment in HTN in pregnancy?

A

Methyldopa
Labetalol
Hydralazine
Nifedipine

Internal Medicine pt.1 (33 decks)

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