hypertension Flashcards
Blood Pressure Definitions:
SBP: < 120
DBP: < 80
Normal
Blood Pressure Definitions:
SBP: 120-129
DBP: < 80
Elevated
Blood Pressure Definitions:
SBP: 130-139
DBP: 80-89
Stage 1
Hypertension
Blood Pressure Definitions:
SBP: ≥140
DBP: ≥ 90
Stage 2
Hypertension
smoking, obesity, and/or excessive alcohol intake can do what to hypertension?
Exacerbate
_______ is the term applied to 95% of hypertensive patients when no
single cause can be identified.
Essential hypertension
__________ has an identifiable cause and should be suspected in patients with HTN at an early age, when first symptoms appear after 50 years old, or when there is difficulty-controlling HTN with multiple medications
Secondary Hypertension
Essential or Secondary Hypertension
usually asymptomatic
Essential hypertension
Onset of essential hypertension is usually between what ages?
25-55 y/o
Onset of Secondary hypertension is usually around or after what age?
50 y/o
To evaluate new diagnosis of HTN you’re using labs/imaging to look for?
Evidence of end organ damage or comorbidities
What are labs/testing you would order for Hypertension???
Fasting glucose CBC Chemistry TSH Lipid Panel EKG
Patients must have a elevated BP recordings on how many separate visits?
3-5
With Hypertension what non pharmacological results
Lifestyle modifications
What are the lifestyle modifications for HTN
(a) Diets rich in fruits and vegetables and low in saturated fats
(b) Weight reduction (10 kg can lower SBP 5-20 mm Hg)
(c) Reduced alcohol consumption (no more than two drinks per day)
(d) Increase in physical activity
What is the goal BP when treating HTN pts and HTN pts with DM or kidney disease?
140/90
< 130/80 in patients with diabetes or kidney disease.
What are the first line classes of meds for HTN?
Diuretics
-Hydrochlorothiazide (HCTZ): 12.5-25 mg daily maximum of 50 mg
Angiotensin Converting Enzyme Inhibitors (ACEi)
-Lisinopril 5-10 mg daily and can titrate to a maximum of 40 mg
MOA of what HTN Med?
Lower BP initially by decreasing plasma volume, but during long-term therapy, their major hemodynamic effect is reduction of peripheral vascular resistance.
Diuretics
When starting a pt on HCTZ you should get an initial chem panel then a follow up after how long? What are you evaluating for?
3 months
electrolyte abnormalities
MOA of what BP med?
inhibition of the renin angiotensin-aldosterone system, but they can also inhibit bradykinin degradation, stimulate the synthesis of vasodilating prostaglandins, and can reduce
sympathetic nervous system activity.
Angiotensin Converting Enzyme Inhibitors (ACEi)
What drug classes are commonly prescribed for HTN?
- Diuretics (First line)
- Angiotensin Converting Enzyme Inhibitors (ACEi) (First Line)
- Angiotensin Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCB)
- Alpha Blockers
MOA of what HTN Med
these agents act by causing peripheral vasodilation (it inhibits calcium from getting into the muscle cells to cause contraction).
Calcium Channel Blockers (CCB)
Your HTN patient is taking Diltiazem 180 mg Daily. What class is the med?
CCB
What are some examples of a CCB that a patient could be taking?
- Diltiazem 180 mg daily and titrate to max dose of 360 mg daily
- Amlodipine Initial dose 2.5 mg daily, titrate up to max dose of 10 mg daily.
Referral to ______ to work up accompanying cardiovascular disease or secondary hypertension if just discovering it and have had ___ readings that qualifies as HTN.
MO
3-5 readings
If your pt is well controlled on their meds, can you renew their RX?
Yes
Hypertensive Urgency is what BP?
SBP > 220 mm Hg or DBP > 125 mm Hg
Hypertensive Emergency is what BP?
DBP > 130 mm Hg,
but correlation between pressure and end organ damage is poor.
Hypertensive Urgency vs Hypertensive Emergency
There is signs of end organ damage in HTN emergency
These are signs of what?
1) Hypertensive encephalopathy (mental status changes, confusion, headache).
2) Intracranial hemorrhage
3) Ischemic stroke
4) Hypertensive nephropathy (proteinuria, hematuria, and progressive kidney dysfunction).
5) Unstable angina, AMI, CHF, or Aortic dissection
END ORGAN DAMAGE
HTN Emergency
HTN Emergency
Substantial reduction in blood pressure within how many hours to prevent serious morbidity or death
1-2
HTN EMERGENCY
Need to reduce blood pressure by what percentage within 1-2 hours? Then slowly decrease to less than ____ in 24 hours?
25%
< 160/110
HTN Urgency/Emergency
The main goal of your physical examination is to evaluate for signs of
End organ damage
With Hypertensive (Urgency or Emergency) physical examination is usually normal
Urgency
Can you use PO meds for a pt with HTN urgency?
YES
Can you use PO meds for a pt with HTN emergency?
NO use IV meds
What is the Primacy treatment for HTN urgency?
Clonidine (Alpha Blocker)
0.1 - 0.2 mg orally initially, then 0.1 mg QH
to 0.8 mg orally.
What are the first things to do for your pt with HTN emergency?
- Need to establish IV
- Give O2 if less than 94%
What is the initial med for HTN emergency?
Labetalol 20 mg IV (over 10 minutes) then 40-80 mg IV q10 min PRN, max 300 mg
Once your HTN emergency pt is stable what med do you give them?
Metoprolol 25-50 mg PO twice daily
What are the contraindications for labetalol
Asthma/COPD, bradycardia
After the first 25% you want to go slowly as excessive reductions in BP may do what and why?
may cause renal, cerebral or coronary ischemia,
because those vessels could used to seeing high perfusion pressures.
Initial Care:
Initially look for signs of what to determine Hypertensive Urgency vs Hypertensive Emergency?
END ORGAN DAMAGE
Initial Care:
If Hypertensive Urgency then start ______ medication
PO
Initial Care
If Hypertensive Emergency then start___ medication
IV
Should you Medevac a HTN emergency?
YES!
Should you MEDADVICE a Pri HTN?
yes
