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Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

HTN

HTN according to AHA

A

> = 130/80

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2
Q

HTN

Normal BP ranges according to the AHA

A

<120/80

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3
Q

HTN

high normal BP according to the AHA

A

120- 129/ <80

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4
Q

HTN

HTN stages according to the AHA

A
  • Stage 1= 130- 139/ 80- 89
  • Stage 2= >=140/90
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5
Q

HTN

Age specific BP targets

A
  • <65 yrs = <130/80
  • > = 65 yrs = <130/80
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6
Q

HTN

If SBP and DBP are in two seperate categories,

A

classify under the higher BP category

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7
Q

HTN

Isolated systolic HTN

A

Only SBP is high
>140/90
seen in the elderly

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8
Q

HTN

Causes

A
  • essential HTN- no secondary cause
  • Secondary HTN
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9
Q

HTN

Renal causes of HTN

A

All possible renal conditions can cause HTN
* Renal artery stenosis
* Diabetic nephropathy
* Chronic GN
* Adult PCKD
* Chronic glomerulo interstitial nephritis

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10
Q

HTN

Renal artery stenosis

A
  • Flash pulmonary edema
  • Renal bruit on examination
  • USS KUB- if one Kidney is smaller than the other kidney <1.5cm
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11
Q

HTN

How can renal artery stenosis cause HTN

A

atrophied Kidney activate RAAS ( sodium retention. K excretion)

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12
Q

HTN

Cause of renal artery stenosis in elderly and young

A
  • elderly- atherosclerosis
  • young- fibrodysplasia
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13
Q

HTN

Endocrine causes of HTN

A
  • Pheochromocytoma
  • Primary hyperaldosteronism
  • Cushings syndrome
  • Thyroid disease
  • Hyperparathyroidism
  • Congenital adrenal hyperplasia
  • Acromegaly
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14
Q

HTN

Sx of pheochromocytoma

A

episodic sweating, headache, palpitations

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15
Q

HTN

Pheochromocytoma is

A

an adrenaline, nor- adrenaline secreting tumor

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16
Q

HTN

Primary hyperaldosteronism is

A

Conn syndrome

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17
Q

HTN

K+ and Na 2+ levels in conn syndrome

A

Na2+ elevated
K+ reduced

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18
Q

HTN

Cushings syndrome

A

Cortisol increased
Reduced K+

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19
Q

HTN

Can both hyper and hypothyroidim cause HTN

A

YES
* Hyper usually cause systolic HTN
* Hypo usually cause diastolic HTN

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20
Q

HTN

3 causes of HTN with reduced K+

A
  • Renal artery stenosis
  • Conn Syndrome
  • Cushing’s syndrome
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21
Q

HTN

CVS causes of HTN

A
  • CoA
22
Q

HTN

Drugs that can cause HTN

A
  • OCP
  • Sympathomimetics (ecstasy pills, amphetamines)
  • MAOI
23
Q

HTN

If the pt has DM and HTN

A

think about cushings

24
Q

HTN

What to always check for in a patient with a renal disease

A

BP

25
Q

HTN

Secondary HTN can occur when

A
  • Young onset ( <30yrs w/o any risk factors or pre-pubertal children)
  • Rapidly developing HTN
  • Severe HTN refractory to Mx
  • Worsening of HTN in a previously well- controlled patient
26
Q

HTN

Risk factors of HTN

A
  • CVD- IHD, stroke/ TIA, PVD, HF
  • CV risk factors- DM, dyslipidemia, smoking
  • Psychiatric disorders
  • Rheumatological disease
  • COPD
  • Other chronic Disease
27
Q

HTN

Sx

A
  • usually ASx
  • Attacks of headache, sweating, palpitations
  • Epsitaxis
  • SOB
28
Q

HTN

Sx of malignant HTN

A
  • Severe headache
  • Visual disturbance
  • fits
  • transient loss of consciousness
29
Q

HTN

Complications

A
  • CVS- IHD, HF, PVD, LVH, arrhythmia
  • CNS- stroke, TIA
  • Renal - uremia
  • Hypertensive emergencies
30
Q

HTN

Hypertensive retinopathy

A

divided into grade 1 to 4

31
Q

HTN

Grade 1 hypertensive retinopathy

A
  • Arteriolar thickening
  • tortuousity
  • increased reflectiveness
    Arteries look like silver wires
32
Q

HTN

Grade 2 hypertensive retinopathy

A

grade 1 + constriction of veins at arteriolar crossings ( arterio venous nippings)

33
Q

HTN

Grade 3 Hypertensive retinopathy

A

Grade 2 + Evidence of retinal ischemia ( flame shaped hemorrhages and cottin wool spots)

34
Q

HTN

Grade 4 Hypertensive retinopathy

A

Grade 3 + papilledema

35
Q

HTN

Malignant HTN

A

BP rises rapidly ( Severe HTN)
>180/110

36
Q

HTN

Histo change in malignant HTN

A

Fibrinoid necrosis of vessel wall

37
Q

HTN

Untreated malignant HTN can cause

A

death from renal failure, HF, cerebral edema, hemorrhage w resultant hypertensive encephalopathy

38
Q

HTN

Ix

A
  • To look for a cause
    1. Renal- USS abd, RFT, Renal angio
    2. Endocrine and metabolic- urinary VMA, CT scan
    3. Primary hyperaldo- SE (hypokalemia)
    4. Cushing Syndrome- Dexa suppression test
    5. Thyroid function test
    6. CVS- CoA, Xray, Echo
  • To look for complications
    1. ECG- LVH
    2. Echo- LVH
    3. Renal- BU, SE, UFR, USS Abd
39
Q

HTN

Mx

A
  • Lifestyle modifications
  • Assess CVS risk
  • Pharmacological Mx
40
Q

HTN

Lifestyle modification

A
  • To all w BP >120/80
  • DASH diet
  • salt reduction
  • exercise
  • reduce alcohol
  • stop smoking
41
Q

HTN

if any CVS disease exist they are classified under

A

high risk

42
Q

HTN

If no cardiovascular disease exists they are classified under

A

according to WHO/ ISH CV risk classification

43
Q

HTN

Who needs meds

A
  • consider pts w high normal BP w very high Cardio vascular disease risk
  • Start for grade 1 w high Cardiovascular disease risk/ hypertensive organ damage/ CKD/ not controlled with lifestyle modifications for 3- 6 months
  • Start for all with grade 2 or 3
  • Irrespective of co- morbidities >80yrs treatment threshold is 160/90
44
Q

HTN

When to start meds in pts >80 yrs

A

if BP >160/90

45
Q

HTN

Initial therapy

A
  • ACEI + CCB
    OR
  • ACEI + diuretic
    Start with a low dose and step up to full dose as necessary
46
Q

HTN

When to consider monotherapy

A

IF YES TO ANY
* Low risk grade 1 HTN
* Patients >= 80 years
* Pts with fraility

47
Q

HTN

Monotherapy

A
  • ACEI/ ARB or
  • DHP-CCB or
  • Thiazide/ thiazide like diuretic
48
Q

HTN

When to consider dual low- dose combination

A

NO TO ALL
* Low risk grade 1 HTN
* Patients >= 80 years
* Patients with fraility

49
Q

HTN

Dual low- dose combo

A
  • ACEI/ ARB + DHP-CCB or
  • ACEI/ ARB + thiazide/ thiazide- like diuretic + DHP- CCB
50
Q
A

Cardiology (7 decks)

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