Hypertension Flashcards
Primary HTN aka: _________________
No specific cause can be identified
These are the ________ of HTN cases
essential HTN
majority
Secondary HTN involves a ___________ cause identified
specific
For JNC 8
Patients > age 60 start treatment at ____________ and treat to under those thresholds.
Patients <60 start treatment at ____________ and treat to under those thresholds.
Treat patients with kidney disease or diabetes to less than __________
150/90
140/90
140/90
The ACC/AHA high BP guidelines
Normal: less than _____________
Elevated: Systolic _________ and diastolic less than ________
Stage 1: Systolic _________ or diastolic between ___________
Stage 2: Systolic at least __________ or diastolic at least____________
120/80
S-120-129, D- less than 80
S-130-139, D- 80-89
S- 140, D- 90
Environmental/Lifestyle factors that can impact blood pressure:
1.
2.
3
4.
5.
- obesity
- sodium intake
- alcohol
- cigarettes
- exercise
What can cause elevation of blood pressure?
1.
2.
3.
4.
vasoconstriction
increased vascular tone
increased HR
increased intravascular volume
How is the renin-angiotensin system involved in hypertension?
- renin + angiotensin = angiotensin I
(renin is secreted by juxtaglomerular cells in response to various stimuli) - angiotensin I + Ace = angiotensin II
- Angiotensin II(increased aldosterone) = vasoconstriction
What are the cardiovascular complications for hypertension?
1.
2.
3.
4.
left ventricular hypertrophy
congestive heart failure
atherosclerosis
aortic dissection
What are the cerebrovascular complications of hypertension?
1.
2.
3.
stroke
dementia
encephalopathy
-severe HTN
-impaired consciousness
-retinopathy with papilledema
-seizures
What is the renal complication for hypertension?
hypertensive nephropathy
What is the ophthalmologic complication for hypertension?
hypertensive retinopathy
Who is annual screening for essential hypertension recommended for?
1.
2.
Screening must be done properly by office blood pressure and if its elevated, confirming the diagnosis with_________________.
Adults 40 yrs+
Those who are at increased risk for high BP
-high-normal bp 130-139/85-89
-overweight/obese and AA
ambulatory blood pressure monitoring (ABPM)
The USPSTF recommends that adults aged _______ to _______ years with normal BP who do not have other risk factors should be rescreened every _______ to ________ years.
18, 39
3, 5
To assess for essential hypertension, the BP needs to be ______________ taken in both arms, at least ________ separate visits at least ___________ weeks apart. The pulse is _________ or ___________
> 140-150/90
2
1-2
normal, tachy
What is the lab work up for essential HTN?
1.
2.
3.
4.
5.
Additional workup
1.
CBC
UA
CMP
TSH
Lipid pannel
additional: EKG
What are the causes of secondary hypertension?
1.
2.
3.
4.
5
6
7
8
9.
renal parenchymal disease
renal vascular hypertension
(-renal vascular stenosis)
primary hyperaldosteronism
sleep apnea
cushings syndrome
pheochromocytoma
coarctation of the aorta
pregnancy
medication induced
____________________ is the most common cause of secondary hypertension. It includes several diseases such as ____________, ______________, ______________ and ________________. This disease causes increased _________________ volume and increased activity of the ________________
renal parenchymal disease
glomerular, tubular, polycystic kidneys, diabetic nephropathy
intravascular, RAA system
__________ is likely the cause of HTN in diabetic patients.
renal parenchymal disease
How is secondary hypertension diagnosed?
UA, renal function tests, FBS, renal u/s
Renal vascular hypertension is usually due to____________________. Mechanism is excessive renin release due to _____________________
renal artery stenosis.
decreased renal blood flow.
Renal vascular hypertension is HTN onset before the age of _________. It involves
1.
2.
3.
20
fibromuscular hyperplasia
epigastric/renal bruitis
atherosclerosis of aorta or peripheral arteries
What is the definitive diagnostic test for renal vascular hypertension?
renal arteriography
The treatment of renal vascular hypertension for young or low risk patient is _____________________. For an older patient with diffuse atherosclerosis its _____________________.
- stenosis correction via percutaneous stent placement in the renal artery
- manage medically and closely follow BP and kidney function
______________ is the most common potentially curable cause of HTN. It is excessive unregulated secretion of aldosterone from the adrenal cortex. You want to suspect this when hypertension is associated with _________________.
You want to get the following labs:
1.
2.
3.
You want to get the following imaging:
1.
2.
The treatment is ___________________
primary hyperaldosteronism
hypokalemia
Labs:
1. plasma aldosterone
2. plasma renin activity
3. plasma aldosterone/renin ratio
Imaging:
1. MRI
2. CT
removal of the adenoma