Hypertension Flashcards
type of hypertension whose etiology is unknown and accounts for 95% of all cases
primary hypertension
type of hypertension that has a definable cause and is usually associated with an underlying, treatable cause
secondary hypertension
which type of hypertension can be “cured”
secondary hypertension
what is considered elevated BP?
120-129/<80
what is stage I hypertension?
130-139/80-89
what is stage II hypertension?
> 140/>90
what does uncontrolled hypertension lead to?
heart failure
the pathogenesis of primary hypertension is sometimes _____
genetic
what are the 3 biggest risk factors associated with primary hypertension?
- obesity
- family history
- race
what can be a patient use to help me diagnose them with hypertension?
ambulatory BP monitoring
what kinds of patients are perfect for ambulatory BP monitoring?
- white coat hypertension + no end organ damage
- episodic hypertension
- hypotension symptoms while on HTN meds
a mean daytime BP >_____ systolic or > _____ diastolic is HTN
130;80
a patient who presents with a hypertensive urgency BP >_____ systolic or > _____ diastolic is HTN
180; 120
a patient with an initial BP > ____ systolic or > _____ diastolic and with known end-organ damage is HTN
160; 100
how often should a patient with normal BP be screened?
q 2 years
how often should a patient with BP of 120-139 systolic or 80-89 diastolic (prehypertension) be screened?
yearly
what is the physical exam like for a patient with suspected hypertension?
normal
what is metabolic syndrome?
hypertension, hyperlipidemia, and diabetes
what should I look for to diagnose hypertension, especially in patients with diabetes or renal disease?
microalbuminuria
what is the BP goal in patients 65 or older?
125-130/80
what is the BP goal in patients 65 or younger?
130-139/90
what is the BP goal for patients of all ages, that have diabetes, but no CKD?
125-130/80
what is the BP goal for patients of all ages, that have CKD, +/- diabetes
125-130/80
what 2 medications can I give a black patient with hypertension?
- thiazide diuretic
- calcium channel blocker
what 2 medications can I give any race that has hypertension and CKD?
- ACEI
- Angiotensin receptor blocker
how do thiazide diuretics decrease BP?
remove excess fluid from body
what are 3 thiazide diuretics?
- chlorthalidone
- hydrochlorothiazide
- indapamide
what are 2 ACE inhibitors?
1, benazepril
2. captopril
what are 2 angiotensin II receptor blockers (ARBs)?
- telmisartan
- losartan
name a dihydropyridine calcium channel blocker
amlodipine
name a nondihydropyridine calcium channel blocker
verapamil
which 2 treatments should not be given to a pregnant patient for hypertension?
- ACE
- ARB
what 4 medications are safe to give a pregnant patient for hypertension?
- labetalol
- hydralazine
- nifedipine ER
- methyldopa
which 2 hypertension treatments should not be combined?
ACEI and ARB
what kind of exercise produces small reductions in BP regardless of body mass, ethnic group, or age
aerobic
in patients over 50 years, what is a risk factor for cardiovascular disease?
SBP greater than 140
what is the usual nature of onset in patients with secondary hypertension?
abrupt
what is the most common cause on secondary hypertension?
chronic kidney disease
what is the 2nd most common cause of secondary hypertension?
primary hyperaldosteronism
what are 4 things to check when screening for renovascular disease?
- GFR
- renal US
- elevated serum creatinine
- abnormal UA
rare catecholamine-secreting tumor on the adrenal medulla that presents with triad of headache, palpitations, and sweating
pheochromocytoma
what should we check for in a 24hr urine sample to screen for pheochromocytoma? (2)
- metanephrines
- catecholamines
what should I check for in a 24hr urine sample to screen for hyperaldosteronism? (2)
- unexplained hypokalemia
- serum aldosterone : renin ratio
what test should I do to screen for cushing’s syndrome to see an increase of cortisol?
dexamethasone suppression test
what test confirms coarctation of the aorta?
CT angiography
hypertension in the upper extremities, hypotension in the lower extremities, and differing BP between the arms indicates …
coarctation of aorta
what would I check to screen for hypothyroidism?
TSH
what would I check to screen for hyperparathyroidism? (2)
- serum PTH
- calcium
what is the most common form of secondary hypertension?
renal parenchymal disease
renal artery stenosis that is usually due to atherosclerosis or fibromuscular dysplasia
renovascular disease
rare congenital narrowing of the proximal aorta near the origin of the left subclavian artery which may lead to hypertension
coarctation of aorta
what is commonly seen on a CXR in a patient with coarctation of the aorta?
rib notching
rare, excessive mineralocorticoid secretion of aldosterone from adrenal adenoma or bilateral hyperplasia
primary hyperaldosteronism
rare, renin-secreting tumors that causes hypertension, that is mediated by increased Na+ retention due to excess aldosterone
secondary hyperaldosteronism
rare cause of hypertension mediated by excess glucocorticoids (cortisol) that leads to increased B.V and renin production
cushing’s syndrome
thyroid problem that is associated with systolic hypertension
hyperthyroidism
thyroid problem that is associated with diastolic hypertension
hypothyroidism
the number of calories you burn as your body performs basic life-sustaining functions
basal metabolic rate
what increases HR, which in turn affects cardiac output?
increased basalmetabolic rate
how does hypothyroidism increase BP?
fluid retention
at what age should I start screening patients for hypertension?
18 years
what 4 things should I test to screen a patient for secondary hypertension?
- potassium
- calcium
- creatinine
- UA
what 2 causes of secondary hypertension can cause hypertension to persist even after treatment?
- coarctation of aorta
- hyperparathyroidism
what are the 2 main causes of hypertensive crisis?
- uncontrolled primary hypertension
- secondary hypertension
severely elevated BP without acute symptoms (often asymptomatic) or clinically-evident end-organ damage
hypertensive urgency
severely elevated BP with evidence of impending or progressive targe organ damage
hypertensive emergency
what are 5 evidence of impending or progressive target organ damage in a hypertensive crisis?
- headache/vision changes
- n/v
- chest pain
- cerebral infarction
- acute pulmonary edema
what 4 tests NEED to be ordered in a hypertensive crisis?
- electrolytes
- renal function
- UA
- ECG
what radiology should be ordered in a hypertensive crisis with suspected pulmonary edema or aortic aneurysm?
CXR
what radiology should be ordered in a hypertensive crisis with headache, AMS, or other neurological symptoms?
CT scan
therapeutic goals in a hypertensive crisis is prompt reduction of MAP by _____% and DBP below _____
20-25; 100
what is something that patients with true hypertensive emergency require?
invasive BP monitoring (radial arterial line)
