Hypertension Flashcards
Cardiloogy I
HTN Facts
> Most Common Reason for a visit to PCP
Most Widely recognized treatable risk factor for other comorbidities such as ( CVT, PVD, CKD, CHF, Retinopathy)
Untreated or poorly controlled, doubles the risk of CKD, CVA, PVD……..
Heart disease leading cause of death Men and Women.
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Summary: > Common Visis
> Treabable Risk Factor for other commorbidies
Unreated and poorly controlled
Leasing cause of death
HTN Epidemiology
116 million people in the US have HTN : 50 % not taking medications.
> Age 55: 90% chance of having HTN the patient is 55 yrs old : Prevalence increase with age
> 75% of those with HTN are not at goal <130/80
> Affects 20 to 30% of African Americans
> Affects 10 to 15% of Caucasians .
> Heart diseases most common cause of death word wide men and women
HTN: Primary vs
90% Do Not have a single reversible cause
Primary or Essential
Plethora of risk factors
people having HTN just because
HTN : Secondary
10% have identifiable mechanism
Remove the problem, fix the high BP
Secondary HTN
HTN: Risk Factors
> No clear cause, generally linked to genetics, poor diet, lack of exercise, obesity ( 9 factors)
Age: onset age 25 to 55
Obesity > 24.5
NSAIDs
Cigarette smoking
Alcohol use > 2 drinks a day
OSA ( sleep apnea )
Increase Na+ intake
Genetic and Environmental Factors
Metabolic Syndrome
Metabolic Syndrome
Also Call Syndrome X : have to meet 3 outo 5 criteria to dx Metabolic Syndrome:
- Abdominal Obesity
- Elevated Triglyceride ( >/= 175)
- Low HDL (below 40)
- Increase BP (130/80)
- FG >100
HTN: Clinical Manifestations
> Light -Headedness
Visual Disturbances
Headaches ( Pulsation, Suboccipital headache)
Retinal Changes ( Hypertensive Retinopathy)
Auscultate S4 ( Left Ventricle Hypertrophy) stiffness of heart that can lead to Diastolic CHF
HTN most common cause of Left Venticul Hypertrophy Leading to Diastolic CHF
HTN Complications
> Vascular damage
Heart Failure
CVA (hemorrhagic/ischemic stroke )
Renal disease
Aortic Dissection
Development of atherosclerosis
Normal BP
Less than 120 AND
Less than 80
Elevated BP
120-129 AND
Less than 80
HTN Stage I
130-139 OR
80-89
Stage 2
140 or Higher OR
90 or Higher
Hypertension Crisis
Highter 180 and /or
Highter 120 DBP
Consult cardiologist
start interventions eventhougth it’s first BP as such
HTN
> /= 130 or
/= 80
Isolated SBP
> 130 SBP or Highter
DBP <80
Isolated DBP
DBP <130
DBP >80
Mix HTN
130/80 or More
Atherosclerotic Cardiovascular Disease (ASCVD)
Risk Enhancers
> Family Hx of CAD
Persistent Elevated LDL >/=160 OR TG >/= 175
CKD
Metablic Syndrome
Inlfammatory Disease ( RA, Cirrhois, HTN)
Ethnicity ( South Asian’s )
DM
HTN Initial Work Up
Labs Diagnostics
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CBC EKG
CMP Echo
Lipid Panel Stress Test
FGM or A1C
TSH
UA ( protein?)
Uric Acid
HTN: Lifestyle Modifications : Approx SBP
> Weight Reduction (BMI 18.5 to 24.9)
Q 10 lbs: 5 to 20 mmHg
Dash diet: : 8-14 mmHg
Na+ Reduction ( less 2.4gm/day) 2 to 8 mmHG
**Physcial Activity : 4 to 9
Moderation of alcohol consumption 2drink/day
smoking cessation
Stress Reduction
HTN RX of Choice Primary Agents Non Aftrican American
Thiazides 1st then with or without
ACE Inhibitors
ARBs
CCB (dihydrophyridines )
CCB (nondihydropyridines )
Pimary for African American
Thiazides or CCB 1st
Thiazides
> 1st line
Monitor Electrolytes
Hydrochlorothiazide (HCTZ); Chlorthalidone; Metolazone ( Strong meds can cause HypoNatremia)
ACE Inhibitors
” Pril” “ you give ACE in APRIL”
> Benazepril, Captopril, Lisininopril
> Monitor Renal Function
> Cough and Angioedema
ARB : Angiotensin II Receptor Blocker
” TAN” “ARB cost $10
> Losartan, Valsartan, Azilsartan
> monitor Renal Function
CCB (dihydropyridines)
“PINE” (/ca in pine of blood”
> Amlodipine, Felodipine, Nicardipine
> Avoid patient with HF
>Cause pedal edema
CCB (nondihydropyridines)
> Diltiazem, Verapamil
Avoid in with HF
Aldosterone Antagonists Diuretics /K sparing
> Eplerenone, Aldactone
s/E: Importance of caution with men
Aldactone
> Aldosterone Antagonists Diuretics
> Potassium Sparing Diaurectis
Caution w men cause Impotance
Beta-Blocker “lol”
Noncardioselective
> Nadolol, Proranolol
Cause impotance. Bronchospastm
Do not given to patient unclesss they have CHF.
Alpha 1 Blockers
Doxazosin, prazosin, Terazosin
Orthostatic Hypotension
BPH 2nd line
Direct Renin Inhibitor
> Aliskiren
> Hyperkalemia , Renal Failure
Central Alpha 2 Agonist
Clonidine
Abrupt Withdrawal Effect
HTN Crisiis
Direct Vasodilators
Hydralizine ( cause Reflectory Tachycardia . USe BBB and Diaurects
Minoxidil ( bear grow women )
Young patient
> Increased Renin Levels
Best treated with ACE/ARB, Thiazides, BBB
> 50yrs old
> Decrease Renin levels
Best treated with diuretics and CCB
African American
> Decrease Renin Level
TX with Thiazide Diurectics; and CCB
Do not often response to ACE/ARB
CKD/DM
> ACE/ARB should be included i regimen for renal progection
Cautions with dosing in Alterly
BP =
CO x SVR
CO
HR x SV
BP =
HR x SVx SVR
HF Treaments
> Goals of Therapy (reduce morbidity and Mortality
Medications Management (ACE/ARB; BBB, Diuretics, SGL2I:
SGL2I : Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
Ertugliflozin (Steglatro)
Left Heart cath
HF DX
> PA
CXR
Echo ( determin EF)
Stress test
Grade I
Faint Murmur
Grade II
Soft murmur , Readily detectable
Grade III
Louder than II w/o precodial thrill
IV
Loud
Precodial thrill
V
very loud
Audible with stetoscope ligly on chest
precordial thrill
Grade VI
Loudest w stethoscope off the chest
Precordial thrill
> Aortic
> Pulmnic
> Tricuspic
> Mitral
DHF
weak fill
preserved pump
SHF
Weak pump
LVEF less than 50%
SOB, orthopnea, edema
**Eight Joint National Committee : HTN Management Recommendations
**AGe >/= 60
- Tx Initiation : > /= 150/90
- BP Goal <150/90
Eight Joint National Committee : HTN Management Recommendations ***
Ages 18 to 60 or any other adults with DM or CKD
- Tx initiation >/= 140/90
- BP goal <140/90
Older Agults
> /= 65 yrs (AHA
Elderly Adutgls
65 to 79 yrs
Initiation: 140/90
Very Old
> /= 80 yrs old
Intiation RX >/= 160/90
BP Target
SBP 130-139
DBP 70 to 79
