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H+P (Exam 4) Hypertension > Hypertension > Flashcards

Hypertension Flashcards

1
Q

what is normal classification of HTN?

A

SBP < 120
DBP < 80

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2
Q

what are clinical consequences of chronically elevated BP assoc w?

s3

A

ischemic heart disease, stroke, renal failure, retinopathy, PVD, and overall mortality

s3

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3
Q

what is considered isolated systolic HTN?
isolated diastolic HTN?
combined sys and diastolic HTN?

s3

A
  • isolated systolic HTN - SBP >130 mm Hg and DBP <80 mm Hg
  • isolated diastolic HTN - SBP <130 mm Hg with DBP >80 mm Hg
  • combined systolic and diastolic HTN - SBP >130 mm Hg and DBP >80 mm Hg

s3

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4
Q

what are (3) genetic and lifestyle risk factors for HTN?

s4

A

obesity, alcoholism and tobacco

s4

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5
Q

what is also a risk factor for cardiovascular morbitity (in addition to SBP and DBP elevation)?
and why?

s3

A

widened pulse pressure because it correlates w/vascular remodeling and “stiffness”

s3

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6
Q

what herbals elevate BP?

s4

A

ephedra, ginseng, ma huang

s4

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7
Q

What are contributing factors for primary HTN?

s4

A
  • SNS activity
  • dysregulation of the RAAS
  • deficiency in endogenous vasodilators

Actual cause of primary HTN is unclear!

s4

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8
Q

What are (5) common causes of secondary HTN in middle-aged adults?

s4

A

hyperaldosteronism, thyroid dysfunction, OSA, Cushings, and pheochromocytoma

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9
Q

What are 2 causes for children w/ secondary HTN?

s4

A

renal parenchymal disease or coarctation of the aorta

s4

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10
Q

what are correlations seen in this image?

A
  • Top L: Correlation btw SBP and Ischemic heart dz mortality across 5 age groups
  • Top R: Correlation btw DBP and Ischemic heart dz mortality across 5 age groups
  • Bottom L:Correlation btw SBP and Stroke mortality across 5 age groups
  • Bottom R: Correlation btw DBP and stroke mortality across 5 age groups

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11
Q

what is an Anti-infective that elevates BP?

s6

A

Ketoconazole

s6

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12
Q

what are the 2 anti-inflammatory classes that elevate BP?

s6

A

NSAIDs and COX-2 inhibitors (-coxib’s)

s6

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13
Q

what 2 illicit drugs elevate BP?

A

amphetamines and cocaine

s6

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14
Q

list 3 immunosuppresive agents that may elevate BP

A

cyclosporine, sirolimus, tacrolimus

s6

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15
Q

what 2 steroids may elevate BP?

A

methylprednisolone and prednisone

s6

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16
Q

what 2 random sympathomimetics elevate BP?

s6

A

decongestant and diet pills

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17
Q

list hormones and psych meds that may elevate BP

A
  • hormones: oral contraceptives (estrogen and progesterone), androgens
  • psych: buspar, carbamazepine, lithium, clozapine, MAO-Is, SSRIs, TCAs

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18
Q

Per ACC/AHA guidelines, there is a moderate evidence to support antihypertensive therapy with which medications in those w/ CKD to improve kidney outcomes?

A

ACE-I or ARB

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19
Q

what are 3 causes of secondary HTN in older adults (>65 yo)?

s7

A

atherosclerotic renal artery stenosis, renal failure, hypothyroidism

s7

20
Q

What does chronic HTN lead to? (vascularly..)

A

remodeling of small & large arteries, endothelial dysfunction, and potentially irreversible end-organ damage

s8

21
Q

What plays a major role in ischemic heart dz, LVH, CHF, CVA, PAD, aortic aneurysm, and nephropathy?

A

Disseminated vasculopathy

s8

22
Q

what 2 ultrasound measurements can provide an early dx of vasculopathy?

A
  1. common carotid intimal to medial thickness
  2. arterial pulse-wave velocity
23
Q

what tests can track progression of LV hypertrophy?

A

Echocardiographic and electrocardiographic indexes

s8

24
Q

what imaging can be used to identify cerebrovascular damage?

A

MRI - to follow microangiopathic changes

s8

25
Q

What are the 4 examples of end-organ damage due to HTN?

A

Vasculopathy
Cerebrovascular damage
Heart disease
Nephropathy

S9

26
Q

What is the therapeutic goal for HTN treatment?

A

<130/<80

S10

27
Q

How many people in the US have untreated HTN? How many patients have their BP above their goal?

A

28 million people in US have untreated HTN
29 million treated pts are above their BP goal

S10

28
Q

What is resistant HTN? What is the treatment for resistant HTN?

A

Above-goal BP despite 3+ antihypertensive drugs at max dose.
Tx usually includes a LA CCB, an ACI-I or ARB + a diuretic

S10

29
Q

How would you define the controlled resistant HTN?

A

Controlled BP requiring 4+medications

S10

30
Q

What is refractory HTN? How many patients present w/ refractory HTN?

A

Uncontrolled BP on 5+ drugs, present in 0.5% of pts

S10

31
Q

What is pseudo-resistant HTN? What are the causes of pseudo-resistant HTN?

A

Intolerance to drugs that can result from BP inaccuracies (including white-coat syndrome) or medication noncompliance

S10

32
Q

What are some lifystyle modifications recommended for patients w/ HTN?

A

Weight loss,↓ETOH, exercise, and smoking cessation

There is a continuous relationship btw ↑BMI and HTN.

S11

33
Q

What is the most effective nopharmacological intervention for HTN?

A

Weight loss
(expect a 1 mmHg reduction in BP for every 1 kg of weight loss)

- weight loss can synergistically enhance the drug efficacy.

S11

34
Q

What other factors can increase or decrease the BP?

A

Increase BP:
- Increase in physical activity
- Excessive alcohol use

Decrease BP:
- Dietary potassium and calcium intake
- Salt restriction

S12

35
Q

Which drug is reserved as the 1st line therapy for pts w/ hx of CAD or tachydysrhythmia or those w/ resistant HTN?

A

β blockers

S15

36
Q

How many drug classes have been approved for HTN?

A

15

S15

37
Q

When are HTN pts hemodynamically vulnerable during anesthesia and why?

A

during induction of GA

Induction drugs produce HoTN whileDirect Laryngoscopy & intubation elicit HTN & tachycardia

S22

38
Q

Poorly controlled hypertension is often accompanied by what volume status and how can you fix it?

A

-volume deficit, especially if pt is on diuretic!
-volume loading prior to induction might provide hemodynamic stability however careful in left ventricular hypertrophy and diastilic dysfunction

22

39
Q

When considering vasoactive drugs, consider what 4 factors?

A

Pt’s age, functional reserve, medications and the planned surgery

22

40
Q

Induction causes what 3 changes in vital signs ?

Which drug may be use after induction?

A

hypotension, direct laryngoscopy and intubation elicit hypertension and tachycardia

-esmolol! and consider a pre induction a line

23

41
Q

Women with pregnancy induced hypertension show evidence of organ damage dysfunction, especially encepalopathy at which diastolic value?
In peripartum HTN, when should you intervene?

A

DBP >100

Intervene immediatly for SBP >160/ DBP >110!

23

42
Q

Hypertensive crisis is categorized either urgent or emergent, and is based on organ damage. Which organ injuries is the patient at risk for?

A

CNS injury, kidney injury , and cardiovascular insult!

Pt w/ chronic HTN may tolerate higher SBP than normal pt

23

43
Q

For rapid arterial dilation, which drug is gold standard?

which other 2 drugs have become available as well?

A

-sodium nitroprosside! fast & easily titratable
-clevidipine (CCB, short DOA ~ 1 min half life) has selevtive vasoarterial but it’s expensive!
-nicardipine (CCB, 1/2 life 30 min) less easy to titrate

24

44
Q

When treating HTN r/t aortic dissection, what can vasodilators cause?
What is the treatment goal

A

Vasodilators may cause hypotension–> end organ ischemia :(

treatment goal is lessening pulsatile force of LV conraction

25

45
Q

When treating preeclampsia and eclamsia, BB may cause what 2 things?

What 2 groups of drugs are teratogenic so contraindicarted w pregnancy?

A

uterine blood flow and they might inhibit labor!

ACE inhibitors and ARBS!
delivery is the only ultimate treatment :(

25

46
Q

When treating pheo and cocaine intoxication for, what do you watch for when giving beta blockers?

A

unopposed alpa adrenergic stimulation after BB makes HTN worse!

25

47
Q

What are the factors of Left Ventriucular Hypertension (LVH) and what does LVH cause ?

A

see chart

H+P (Exam 4) Hypertension (7 decks)

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