Hypertension Flashcards
-Equations for cardiac output, stroke volume and ejection fraction?
- CO=SVxHR
- SV=EDV-ESV
- EF=(SV/EDV)100
- What is the leading cause of CV disease worldwide?
- What percentage of adults in the US are affected by HTN?
- HTN
- 30%
- Which gender is more likely to have HTN under age 45?
- Between 45 and 64?
- Over 64?
- Men
- Both about equal
- Women
- How do you assess for hypertension in an office setting?
- When should ambulatory measurement of BP be done?
- Why are patient self-checks of use?
- Two readings 5 minutes apart, sitting with feet flat on ground and confirmed in the opposite arm
- Assessment of white coat hypertension
- Provides info on response to treatment and improves adherence to meds
-Which studies should be done to evaluate a patient for/with HTN?
-CBC, BMP, TSH, UA, EKG, lipid panel, echocardiogram, maybe stress testing
- According the the JNC 7 what are the limits for normal blood pressure?
- Prehypertension?
- Stage 1 hypertension?
- Stage 2 hypertension?
- What is hypertensive urgency?
- Hypertensive emergency?
- What med do you give for a hypertensive emergency?
SBP DBP
- =160 or >=100
- Acute elevations with risk of end organ damage >=180 and >=120
- HTN with acute impairment of one or more organ systems that can cause irreversibel organ damage, >=180 and >=120
- IV notroprusside
-How do you do a diagnostic eval for HTN in a patient?
-Assess risk factors and comorbidities
Reveal identifiable causes of HTN
Assess presence of target organ damage
History and Physical examination
Obtain labs including: UA, blood glucose, HCt, . lipid panel, Serum K and CR and calcium.
Optional: testing urinary albumin/creatinine ratio
Obtain EKG
What are the major risk factors for atherosclerotic cardiovascular disease (ASCVD)?
Hypertension
Obesity (BMI > 30)
Dyslipidemia
Diabetes Mellitus (1 or 2)
Tobacco Use
Sedentary Lifestyle (and lack of exercise)
Microalbuminuria (GFR < 60 mL/min)
Family history of premature ASCVD . (M < 55, F < 65)- What is the first line treatment for prehypertension?
- What are considered lifestyle modifications?
- Which types of patients should be using lifestyle modification?
- What is the dash diet?
- What are the recommended serving sizes of alcohol?
- Lifestyle mods
- Weight reduction (BMI
- What is the first line treatment for stage one HTN?
- Stage 2 HTN?
- Lifestyle mods and a thiazide diuretic (but may consider ACE-I,ARB, BB, CCB or combo)
- Lifestyle mods, combo drug therapy (a thiazide diuretic and ACE-I, or ARB, or BB, or CCB)
- What is primary hypertension?
- What is secondary HTN?
- What are some potential identifiable causes?
-No identifiable cause of HTN, also called essential HTN (most adults have this)
-HTN which stems from some identifiable cause
-Sleep Apnea
Drug Induced / Related
Chronic Kidney Disease
Primary Aldosteronism
Renovascular Disease
Cushing’s Syndrome or Steroid therapy
Pheochromocytoma
Coarctation of the Aorta
Thyroid / Parathyroid disease
- What are some potential complications of HTN?
- How does hypertension lead to cardiomyopathy?
- What are some signs of hypertensive cardiomyopathy?
- Cardiomyopathy, retinopathy, CHF, CAD, Arrythmias, CVA/stroke, dementia, arteriosclerosis, atherosclerosis, hypertensive nephropathy
- Hypertrophy of the LV and RV that in later stages cause weakness leading to CHF
- Cough, weakness, fatigue, weight gain, dyspnea with exertion and paroxysmal nocturnal dyspnea
- What are the acute effects of hypertensive retinopathy?
- Chronic effects?
- What is malignant hypertension?
- What are the optic complication of malignant HTN?
- Results of vasospasm and inability to autoregulate perfusion (Stage 1 may not be detected by patient)
- Caused by arteriosclerosis and predisposes patients to vision loss from vascular occlusion and microaneurysms. Also hemorrhages are possible (Stage 1-4)
- Very high BP that comes on suddenly and quickly (DBP is usually over 130mm Hg)
- Ischemic optic neuropathy, retinal artery occlusion, retinal vein oclusion
- What is the difference between arteriosclerosis and atherosclerosis?
- What are complications of atherosclerosis?
- Arteriosclerosis involves the narrowing and/or hardening of the arteries. Atherosclerosis is a type of arteriosclerosis that involves plaque within the arterial wall.
- The lesions can rupture causing thrombotic events such as MI or CVA.
- How does HTN cause nephropathy?
- How long does it take for this to occur?
- What are the symptoms?
- Hypertensive nephropathy (or hypertensive nephrosclerosis) occurs when hyaline accumulates on the wall of small arteries and then arterioles, thickening the walls of arteries and narrowing the lumen. This causes ischemia and then tubular atrophy, interstitial fibrosis and glomerular fibrosis
- 5-10 years of uncontrolled HTN
- Frequent urination, foamy urination and edema (with heavy proteinuria), temporal hematuria, changes in urine color (usually dark brown)
