Hypertension Flashcards
what is normal classification of HTN?
SBP < 120
DBP < 80
s2
what are clinical consequences of chronically elevated BP assoc w?
s3
ischemic heart disease, stroke, renal failure, retinopathy, PVD, and overall mortality
s3
what is considered isolated systolic HTN?
isolated diastolic HTN?
combined sys and diastolic HTN?
s3
- 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
what are (3) genetic and lifestyle risk factors for HTN?
s4
obesity, alcoholism and tobacco
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what is also a risk factor for cardiovascular morbitity (in addition to SBP and DBP elevation)?
and why?
s3
widened pulse pressure because it correlates w/vascular remodeling and “stiffness”
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what herbals elevate BP?
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ephedra, ginseng, ma huang
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What are contributing factors for primary HTN?
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- SNS activity
- dysregulation of the RAAS
- deficiency in endogenous vasodilators
Actual cause of primary HTN is unclear!
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What are (5) common causes of secondary HTN in middle-aged adults?
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hyperaldosteronism, thyroid dysfunction, OSA, Cushings, and pheochromocytoma
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What are 2 causes for children w/ secondary HTN?
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renal parenchymal disease or coarctation of the aorta
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what are correlations seen in this image?
- 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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what is an Anti-infective that elevates BP?
s6
Ketoconazole
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what are the 2 anti-inflammatory classes that elevate BP?
s6
NSAIDs and COX-2 inhibitors (-coxib’s)
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what 2 illicit drugs elevate BP?
amphetamines and cocaine
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list 3 immunosuppresive agents that may elevate BP
cyclosporine, sirolimus, tacrolimus
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what 2 steroids may elevate BP?
methylprednisolone and prednisone
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what 2 random sympathomimetics elevate BP?
s6
decongestant and diet pills
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list hormones and psych meds that may elevate BP
- hormones: oral contraceptives (estrogen and progesterone), androgens
- psych: buspar, carbamazepine, lithium, clozapine, MAO-Is, SSRIs, TCAs
s6
Per ACC/AHA guidelines, there is a moderate evidence to support antihypertensive therapy with which medications in those w/ CKD to improve kidney outcomes?
ACE-I or ARB
S7
what are 3 causes of secondary HTN in older adults (>65 yo)?
s7
atherosclerotic renal artery stenosis, renal failure, hypothyroidism
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What does chronic HTN lead to? (vascularly..)
remodeling of small & large arteries, endothelial dysfunction, and potentially irreversible end-organ damage
s8
What plays a major role in ischemic heart dz, LVH, CHF, CVA, PAD, aortic aneurysm, and nephropathy?
Disseminated vasculopathy
s8
what 2 ultrasound measurements can provide an early dx of vasculopathy?
- common carotid intimal to medial thickness
- arterial pulse-wave velocity
what tests can track progression of LV hypertrophy?
Echocardiographic and electrocardiographic indexes
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what imaging can be used to identify cerebrovascular damage?
MRI - to follow microangiopathic changes
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What are the 4 examples of end-organ damage due to HTN?
Vasculopathy
Cerebrovascular damage
Heart disease
Nephropathy
S9
What is the therapeutic goal for HTN treatment?
<130/<80
S10
How many people in the US have untreated HTN? How many patients have their BP above their goal?
28 million people in US have untreated HTN
29 million treated pts are above their BP goal
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What is resistant HTN? What is the treatment for resistant HTN?
Above-goal BP despite 3+ antihypertensive drugs at max dose.
Tx usually includes a LA CCB, an ACI-I or ARB + a diuretic
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How would you define the controlled resistant HTN?
Controlled BP requiring 4+medications
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What is refractory HTN? How many patients present w/ refractory HTN?
Uncontrolled BP on 5+ drugs, present in 0.5% of pts
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What is pseudo-resistant HTN? What are the causes of pseudo-resistant HTN?
Intolerance to drugs that can result from BP inaccuracies (including white-coat syndrome) or medication noncompliance
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What are some lifystyle modifications recommended for patients w/ HTN?
Weight loss,↓ETOH, exercise, and smoking cessation
There is a continuous relationship btw ↑BMI and HTN.
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What is the most effective nopharmacological intervention for HTN?
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
What other factors can increase or decrease the BP?
Increase BP:
- Increase in physical activity
- Excessive alcohol use
Decrease BP:
- Dietary potassium and calcium intake
- Salt restriction
S12
Which drug is reserved as the 1st line therapy for pts w/ hx of CAD or tachydysrhythmia or those w/ resistant HTN?
β blockers
S15
How many drug classes have been approved for HTN?
15
S15
When are HTN pts hemodynamically vulnerable during anesthesia and why?
during induction of GA
Induction drugs produce HoTN whileDirect Laryngoscopy & intubation elicit HTN & tachycardia
S22
Poorly controlled hypertension is often accompanied by what volume status and how can you fix it?
-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
When considering vasoactive drugs, consider what 4 factors?
Pt’s age, functional reserve, medications and the planned surgery
22
Induction causes what 3 changes in vital signs ?
Which drug may be use after induction?
hypotension, direct laryngoscopy and intubation elicit hypertension and tachycardia
-esmolol! and consider a pre induction a line
23
Women with pregnancy induced hypertension show evidence of organ damage dysfunction, especially encepalopathy at which diastolic value?
In peripartum HTN, when should you intervene?
DBP >100
Intervene immediatly for SBP >160/ DBP >110!
23
Hypertensive crisis is categorized either urgent or emergent, and is based on organ damage. Which organ injuries is the patient at risk for?
CNS injury, kidney injury , and cardiovascular insult!
Pt w/ chronic HTN may tolerate higher SBP than normal pt
23
For rapid arterial dilation, which drug is gold standard?
which other 2 drugs have become available as well?
-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
When treating HTN r/t aortic dissection, what can vasodilators cause?
What is the treatment goal
Vasodilators may cause hypotension–> end organ ischemia :(
treatment goal is lessening pulsatile force of LV conraction
25
When treating preeclampsia and eclamsia, BB may cause what 2 things?
What 2 groups of drugs are teratogenic so contraindicarted w pregnancy?
uterine blood flow and they might inhibit labor!
ACE inhibitors and ARBS!
delivery is the only ultimate treatment :(
25
When treating pheo and cocaine intoxication for, what do you watch for when giving beta blockers?
unopposed alpa adrenergic stimulation after BB makes HTN worse!
25
What are the factors of Left Ventriucular Hypertension (LVH) and what does LVH cause ?
see chart
