Hypertension Flashcards

Cardiloogy I

1
Q

HTN Facts

A

> 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.
__________________________________________________
Summary: > Common Visis
> Treabable Risk Factor for other commorbidies
Unreated and poorly controlled
Leasing cause of death

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2
Q

HTN Epidemiology

A

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

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3
Q

HTN: Primary vs

A

90% Do Not have a single reversible cause

Primary or Essential
Plethora of risk factors
people having HTN just because

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4
Q

HTN : Secondary

A

10% have identifiable mechanism

Remove the problem, fix the high BP
Secondary HTN

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5
Q

HTN: Risk Factors

A

> 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

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6
Q

Metabolic Syndrome

A

Also Call Syndrome X : have to meet 3 outo 5 criteria to dx Metabolic Syndrome:

  1. Abdominal Obesity
  2. Elevated Triglyceride ( >/= 175)
  3. Low HDL (below 40)
  4. Increase BP (130/80)
  5. FG >100
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7
Q

HTN: Clinical Manifestations

A

> 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

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8
Q

HTN Complications

A

> Vascular damage
Heart Failure
CVA (hemorrhagic/ischemic stroke )
Renal disease
Aortic Dissection
Development of atherosclerosis

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9
Q

Normal BP

A

Less than 120 AND
Less than 80

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10
Q

Elevated BP

A

120-129 AND
Less than 80

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11
Q

HTN Stage I

A

130-139 OR
80-89

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12
Q

Stage 2

A

140 or Higher OR
90 or Higher

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13
Q

Hypertension Crisis

A

Highter 180 and /or
Highter 120 DBP
Consult cardiologist
start interventions eventhougth it’s first BP as such

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14
Q

HTN

A

> /= 130 or
/= 80

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15
Q

Isolated SBP

A

> 130 SBP or Highter
DBP <80

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16
Q

Isolated DBP

A

DBP <130
DBP >80

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17
Q

Mix HTN

A

130/80 or More

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18
Q

Atherosclerotic Cardiovascular Disease (ASCVD)
Risk Enhancers

A

> Family Hx of CAD
Persistent Elevated LDL >/=160 OR TG >/= 175
CKD
Metablic Syndrome
Inlfammatory Disease ( RA, Cirrhois, HTN)
Ethnicity ( South Asian’s )
DM

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19
Q

HTN Initial Work Up

A

Labs Diagnostics
_______________________________________
CBC EKG
CMP Echo
Lipid Panel Stress Test
FGM or A1C
TSH
UA ( protein?)
Uric Acid

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20
Q

HTN: Lifestyle Modifications : Approx SBP

A

> 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

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21
Q

HTN RX of Choice Primary Agents Non Aftrican American

A

Thiazides 1st then with or without
ACE Inhibitors
ARBs
CCB (dihydrophyridines )
CCB (nondihydropyridines )

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22
Q

Pimary for African American

A

Thiazides or CCB 1st

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23
Q

Thiazides

A

> 1st line
Monitor Electrolytes
Hydrochlorothiazide (HCTZ); Chlorthalidone; Metolazone ( Strong meds can cause HypoNatremia)

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24
Q

ACE Inhibitors

A

” Pril” “ you give ACE in APRIL”
> Benazepril, Captopril, Lisininopril
> Monitor Renal Function
> Cough and Angioedema

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25
Q

ARB : Angiotensin II Receptor Blocker

A

” TAN” “ARB cost $10
> Losartan, Valsartan, Azilsartan
> monitor Renal Function

26
Q

CCB (dihydropyridines)

A

“PINE” (/ca in pine of blood”
> Amlodipine, Felodipine, Nicardipine
> Avoid patient with HF
>Cause pedal edema

27
Q

CCB (nondihydropyridines)

A

> Diltiazem, Verapamil
Avoid in with HF

28
Q

Aldosterone Antagonists Diuretics /K sparing

A

> Eplerenone, Aldactone
s/E: Importance of caution with men

29
Q

Aldactone

A

> Aldosterone Antagonists Diuretics

> Potassium Sparing Diaurectis
Caution w men cause Impotance

30
Q

Beta-Blocker “lol”
Noncardioselective

A

> Nadolol, Proranolol
Cause impotance. Bronchospastm
Do not given to patient unclesss they have CHF.

31
Q

Alpha 1 Blockers

A

Doxazosin, prazosin, Terazosin

Orthostatic Hypotension
BPH 2nd line

32
Q

Direct Renin Inhibitor

A

> Aliskiren

> Hyperkalemia , Renal Failure

33
Q

Central Alpha 2 Agonist

A

Clonidine

Abrupt Withdrawal Effect
HTN Crisiis

34
Q
A
35
Q

Direct Vasodilators

A

Hydralizine ( cause Reflectory Tachycardia . USe BBB and Diaurects

Minoxidil ( bear grow women )

36
Q

Young patient

A

> Increased Renin Levels
Best treated with ACE/ARB, Thiazides, BBB

37
Q

> 50yrs old

A

> Decrease Renin levels
Best treated with diuretics and CCB

38
Q

African American

A

> Decrease Renin Level
TX with Thiazide Diurectics; and CCB
Do not often response to ACE/ARB

39
Q

CKD/DM

A

> ACE/ARB should be included i regimen for renal progection

40
Q

Cautions with dosing in Alterly

A
41
Q

BP =

A

CO x SVR

42
Q

CO

A

HR x SV

43
Q

BP =

A

HR x SVx SVR

44
Q

HF Treaments

A

> 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

45
Q

HF DX

A

> PA
CXR
Echo ( determin EF)
Stress test

46
Q

Grade I

A

Faint Murmur

47
Q

Grade II

A

Soft murmur , Readily detectable

48
Q

Grade III

A

Louder than II w/o precodial thrill

49
Q

IV

A

Loud
Precodial thrill

50
Q

V

A

very loud
Audible with stetoscope ligly on chest
precordial thrill

51
Q

Grade VI

A

Loudest w stethoscope off the chest
Precordial thrill

52
Q

> Aortic

> Pulmnic

> Tricuspic

> Mitral

A
53
Q

DHF

A

weak fill
preserved pump

54
Q

SHF

A

Weak pump
LVEF less than 50%
SOB, orthopnea, edema

55
Q

**Eight Joint National Committee : HTN Management Recommendations

**AGe >/= 60

A
  • Tx Initiation : > /= 150/90
  • BP Goal <150/90
56
Q

Eight Joint National Committee : HTN Management Recommendations ***
Ages 18 to 60 or any other adults with DM or CKD

A
  • Tx initiation >/= 140/90
  • BP goal <140/90
57
Q

Older Agults

A

> /= 65 yrs (AHA

58
Q

Elderly Adutgls

A

65 to 79 yrs
Initiation: 140/90

59
Q

Very Old

A

> /= 80 yrs old
Intiation RX >/= 160/90

60
Q

BP Target

A

SBP 130-139
DBP 70 to 79