Hypertension Flashcards
HTN
HTN according to AHA
> = 130/80
HTN
Normal BP ranges according to the AHA
<120/80
HTN
high normal BP according to the AHA
120- 129/ <80
HTN
HTN stages according to the AHA
- Stage 1= 130- 139/ 80- 89
- Stage 2= >=140/90
HTN
Age specific BP targets
- <65 yrs = <130/80
- > = 65 yrs = <130/80
HTN
If SBP and DBP are in two seperate categories,
classify under the higher BP category
HTN
Isolated systolic HTN
Only SBP is high
>140/90
seen in the elderly
HTN
Causes
- essential HTN- no secondary cause
- Secondary HTN
HTN
Renal causes of HTN
All possible renal conditions can cause HTN
* Renal artery stenosis
* Diabetic nephropathy
* Chronic GN
* Adult PCKD
* Chronic glomerulo interstitial nephritis
HTN
Renal artery stenosis
- Flash pulmonary edema
- Renal bruit on examination
- USS KUB- if one Kidney is smaller than the other kidney <1.5cm
HTN
How can renal artery stenosis cause HTN
atrophied Kidney activate RAAS ( sodium retention. K excretion)
HTN
Cause of renal artery stenosis in elderly and young
- elderly- atherosclerosis
- young- fibrodysplasia
HTN
Endocrine causes of HTN
- Pheochromocytoma
- Primary hyperaldosteronism
- Cushings syndrome
- Thyroid disease
- Hyperparathyroidism
- Congenital adrenal hyperplasia
- Acromegaly
HTN
Sx of pheochromocytoma
episodic sweating, headache, palpitations
HTN
Pheochromocytoma is
an adrenaline, nor- adrenaline secreting tumor
HTN
Primary hyperaldosteronism is
Conn syndrome
HTN
K+ and Na 2+ levels in conn syndrome
Na2+ elevated
K+ reduced
HTN
Cushings syndrome
Cortisol increased
Reduced K+
HTN
Can both hyper and hypothyroidim cause HTN
YES
* Hyper usually cause systolic HTN
* Hypo usually cause diastolic HTN
HTN
3 causes of HTN with reduced K+
- Renal artery stenosis
- Conn Syndrome
- Cushing’s syndrome
HTN
CVS causes of HTN
- CoA
HTN
Drugs that can cause HTN
- OCP
- Sympathomimetics (ecstasy pills, amphetamines)
- MAOI
HTN
If the pt has DM and HTN
think about cushings
HTN
What to always check for in a patient with a renal disease
BP
HTN
Secondary HTN can occur when
- 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
HTN
Risk factors of HTN
- CVD- IHD, stroke/ TIA, PVD, HF
- CV risk factors- DM, dyslipidemia, smoking
- Psychiatric disorders
- Rheumatological disease
- COPD
- Other chronic Disease
HTN
Sx
- usually ASx
- Attacks of headache, sweating, palpitations
- Epsitaxis
- SOB
HTN
Sx of malignant HTN
- Severe headache
- Visual disturbance
- fits
- transient loss of consciousness
HTN
Complications
- CVS- IHD, HF, PVD, LVH, arrhythmia
- CNS- stroke, TIA
- Renal - uremia
- Hypertensive emergencies
HTN
Hypertensive retinopathy
divided into grade 1 to 4
HTN
Grade 1 hypertensive retinopathy
- Arteriolar thickening
- tortuousity
- increased reflectiveness
Arteries look like silver wires
HTN
Grade 2 hypertensive retinopathy
grade 1 + constriction of veins at arteriolar crossings ( arterio venous nippings)
HTN
Grade 3 Hypertensive retinopathy
Grade 2 + Evidence of retinal ischemia ( flame shaped hemorrhages and cottin wool spots)
HTN
Grade 4 Hypertensive retinopathy
Grade 3 + papilledema
HTN
Malignant HTN
BP rises rapidly ( Severe HTN)
>180/110
HTN
Histo change in malignant HTN
Fibrinoid necrosis of vessel wall
HTN
Untreated malignant HTN can cause
death from renal failure, HF, cerebral edema, hemorrhage w resultant hypertensive encephalopathy
HTN
Ix
- 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
HTN
Mx
- Lifestyle modifications
- Assess CVS risk
- Pharmacological Mx
HTN
Lifestyle modification
- To all w BP >120/80
- DASH diet
- salt reduction
- exercise
- reduce alcohol
- stop smoking
HTN
if any CVS disease exist they are classified under
high risk
HTN
If no cardiovascular disease exists they are classified under
according to WHO/ ISH CV risk classification
HTN
Who needs meds
- 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
HTN
When to start meds in pts >80 yrs
if BP >160/90
HTN
Initial therapy
- ACEI + CCB
OR - ACEI + diuretic
Start with a low dose and step up to full dose as necessary
HTN
When to consider monotherapy
IF YES TO ANY
* Low risk grade 1 HTN
* Patients >= 80 years
* Pts with fraility
HTN
Monotherapy
- ACEI/ ARB or
- DHP-CCB or
- Thiazide/ thiazide like diuretic
HTN
When to consider dual low- dose combination
NO TO ALL
* Low risk grade 1 HTN
* Patients >= 80 years
* Patients with fraility
HTN
Dual low- dose combo
- ACEI/ ARB + DHP-CCB or
- ACEI/ ARB + thiazide/ thiazide- like diuretic + DHP- CCB
