Hypertension Flashcards
HTN Crisis Criteria
BP 180/120 or more
Evidence of target organ dysfunction (headache, dysuria, dyspnea, vision changes, etc.)
HTN Risk Factors
Genetics Obesity Smoking Metabolic Syndrome High Fat Diet High Sodium Diet Inactivity Sleep Apnea Alcohol Intake Stress
Primary Hypertension
Genetic and Environmental factors
Generally idiopathic
Sodium and Potassium intake may play a role
DASH Diet
The Dietary Approaches to Stop Hypertension (DASH) study showed a relationship between lower potassium intake and hypertension. In this study, it was found that blood pressure also decreased in response to a universally recommended diet that contains generous servings of fruits, vegetables, and low-fat dairy products with reduced sodium and saturated and total fat and increased potassium
Secondary HTN
Assocaited with medical conditions such a renal arety stenosis, renal parenchymal disease, pheochromocytoma, hyperaldosteronism, coarctation of the aorta, acromegaly, Cushing syndrome, sleep apnea, and thyroid disease
Renal Artery Stenosis
RAS results in hypertension when there is a 70% to 80% blockage of a renal artery, often activating the renin-angiotensin system
Pheochromocytoma
Catecholamine producing tumor in adrenal gland causes HTN
Catecholamine levels elevated, usually have headache, hyperhidrosis, palpatation, hyperglycemia, hypermetabolic
Pheochromocytoma
Catecholamine producing tumor in adrenal gland causes HTN
Catecholamine levels elevated, usually have headache, hyperhidrosis, palpatation, hyperglycemia, hypermetabolic
Primary Hyperaldosteronism
Adrenal adenocarcinoma is often cause
Hypokalemia with HTN is suggestive
Meds that may cause HTN
Corticosteroids Anabolic Steroids Contraceptives NSAIDs SSRI / SSNRI
HTN Presentation
Often asymptomatic until very late, secondary HTN may be earlier to manifest symptoms
History / risk analysis and BP screenings essentials
BP Screening Tips
Feet on floor, patient sitting for several minutes
Cuff bladder is at least 80% of arm circumference
Cuff 1 cm above the AC
HTN Diagnosis
Generally
BP >120/80 is pre-hypertension
BP >140/90 is hypertension if less than 60 years old
BP >150/90 is hypertension if 60 or older
Must be at two different office visits, 2 weeks apart
BP Goals
Less than 130/80 (generally) for patients with comorbids
Less than 120 systolic for primary HTN with no comorbids (generally)
BP Treatment First Treatment
Lifestyle modifications is always the first step, and only treatment for prehypertension
Exercise (150 min/week with 2-3 days of resistance training)
Limit alcohol
Stop smoking
Lose weight
Reduce sodium intake, diet changes
Stress management
BP Medications
Recommendations vary on age, ethnicity, comorbids
Typical - Thiazide diuertic is first
Non-black ethnicity may also get ACE-I, ARB, CCB, or combo
Black ethnicity - May get a CCB (amlodipine) and/or the Thiazide
Diabetics should usually get a ACE-I/ARB regardless of race
Most patients with BP of 160/100 need initial two-drug therapy
BP medication follow up
Follow up in 1-4 weeks to assess effect, serum and renal panels
For renal patients, lab follow up in 5-7 days for GFR monitor
ACE-I/ARB should have a potassium and renal assessment
HTN Crisis Management
Patients without end organ dysfunction may be treated with oral labetolol or hydralazine
Usual goal of serious crisis is lower BP slowly (25% in first hour), find source.
Sodium intake recommendation
Limit to 2.3 grams per day or less. Check labels for added salt. Remember salt substitutes often have potassium!
