Hypertension Flashcards
Module 3
What is the BP criteria for diagnosing HTN in individuals <60 years old?
> 140/90
What is the BP criteria for diagnosing HTN in individuals >60 years old?
> 150/90
Which cause of secondary HTN should be suspected in patients with hypokalemia?
Primary hyperaldosteronism
Name 5 causes of secondary HTN
Renal artery stenosis, pheochromocytoma, coarctation of aorta, Cushing’s syndrome, OSA
When symptoms of HTN are present, this indicates
Organ damage has occurred
What are exogenous differential diagnoses of HTN?
Alcohol, pregnancy, medications, drugs
What are endocrine differential diagnoses of HTN?
Primary aldosteronism, Cushing’s syndrome, hypothyroidism, hypercalcemia (secondary to parathyroidism), pheochromocytoma, acromegaly
What imaging should be done with HTN?
Renal angiography, echo
An EKG should be used to assess for ischemia or LVH which manifests as
Large S wave in V1 and large R wave in V5
What labs should be ordered when managing HTN?
Urinalysis, CBC, CMP (potassium, calcium), BUN/Cr, fasting blood glucose, lipoproteins, uric acid
Dietary sodium should be reduced to
<2300 mg/day
What are 1st line choices to treat HTN in non-AAs and AAs?
Non-AA with or without DM: thiazide-like diuretics, CCBs, ACEIs, ARBs
AA: thiazide-like diuretics or CCB
Beta-blockers are not 1st line treatment for HTN, but can be an adjunct for patients with
CAD or HF
Which non-dihydropyridines are contraindicated in patients with HFrEF?
Diltiazem and Verapamil
What labs should be monitored if patient is on diuretics, ACEIs, or ARBs?
Potassium and renal function
If HTN therapy is initiated or adjusted during a visit, when should the patient follow up?
1-4 weeks
Which 9 parenteral medications can be used in severe HTN?
Nitroprusside, Nitroglycerin, Labetalol, Esmolol, Nicardipine, Furosemide, Hydralazine, Fenoldopam, Clonidine
Labetalol and Esmolol should be avoided if possible or used with caution in patients with
HF or asthma
What can Nicardipine prevent and cause?
Prevent cerebral vasospasm
Cause ischemia
Nitroprusside is a vasodilator that has a quick duration of 1-10 mins and requires what kind of monitoring?
Monitor ICP and arterial monitoring is critical
What medication takes effect in minutes and is used for patients with HF or CAD?
Nitroglycerin
Which medication can be used in eclampsia?
Hydralazine
Which medication should be avoided in CAD and likely with dissection?
Hydralazine
Which drug takes effect in 15 mins, should be used with caution due to risk of reflex tachycardia, and is contraindicated in glaucoma?
Fenoldopam (vasodilator and diuretic)
Which medication takes effect in 5-15 mins and should be avoided in patients allergic to eggs or soy?
Clonidine
BP and HR should be measured:
In each arm twice
If Cushing’s syndrome is suspected when managing HTN, which lab test should be ordered?
24-hr urine cortisol
If pheochromocytoma is suspected when managing HTN, which lab tests should be ordered?
24-hr creatinine, catecholamines, and metanephrines
What classifies HTN as resistant to therapy, requiring a referral to an MD?
Failure of 3 full-dose, or maximally tolerated antihypertensive drugs, including a diuretic
Asian patients should be treated for HTN with
CCBs or ARBs
All patients with DM should be started with what HTN drug?
ACEIs regardless of race
All patients should be started on what HTN drug unless contraindicated?
Thiazide diuretic
For non-orthostatic patients whose blood pressure are >/= 160 systolic or 100 diastolic, what is the initial pharmacologic treatment?
2 drug therapy
What HTN drug should be considered for underlying cardiac disease or anxiety?
BBs
Which diuretic should be avoided in patients with renal dysfunction?
Thiazides
Which diuretic should be used for patients with CHF and/or renal dysfunction?
Loop
Which HTN drug is preferred for patients with renal impairment?
ACEIs
