Hypertension Flashcards
What is primary (essential) HTN?
the cause is unknown, but a combination of risk factors is usually present
What are risk factors for HTN?
- obesity
- sedentary lifestyle
- excessive salt intake
- smoking
- family history
- diabetes
- dyslipidemia
What is secondary HTN?
identifiable underlying cause, such as renal disease, adrenal disease (excess aldosterone secretion), obstructive sleep apnea, or drugs
What is the pathophysiology of HTN?
activation of the sympathetic nervous system(SNS) and renin-angiotensin-aldosterone system(RAAS), resulting in an increase in neurohormone levels (NE, angiotensin II, aldosterone)
What drugs increase blood pressure by increasing sympathomimetic activity?
- ADHD drugs (amphetamine)
- decongestants (pseudoephedrine, phenylephrine)
- recreational substances (cocaine, caffeine)
- antidepressants (TCAs, SNRIs, MAO inhibitors)
What drugs increase blood pressure via increased sodium and water retention?
- NSAIDs
- immunosuppressants (cyclosporine)
- systemic steroids
What drugs increase blood pressure via increased blood viscosity?
erythropoietin stimulating agents (epoetin alfa)
What other drugs classes are known to increase blood pressure?
- oral contraceptives (higher estrogen content)
- VEGF inhibitors
How is HTN diagnosed?
based on the average of at least 2 readings on separate occasions
What type of blood pressure monitoring is preferred?
out-of-office BP monitoring with an ambulatory BP monitor or automated home device; BP readings in a clinical setting may be falsely elevated
What blood pressure reading is normal?
<120/<80
What blood pressure reading is elevated?
120-129/<80
What blood pressure reading is stage 1 HTN?
130-139 OR 80-89
What blood pressure reading is stage 2 HTN?
≥140 OR ≥90
What should be done before BP readings to ensure accuracy?
- goto the restroom and empty the bladder
- sit in a chair (both feet on the ground supported) and relax for at least 5 minutes
- use the correct cuff size
- support the arm at the heart level (rest on a desk)
- wait 1-2 minutes between measurements
What can reduce the accuracy of BP readings?
- talking
- lying down/sitting without back support (on the examination table)
- drink caffeine, exercise, or smoke 30 minutes prior
- use a finger or wrist monitor (unless necessary, incorrect cuff size for obese patient)
How should patients monitor BP when using an ambulatory BP monitoring device?
typically worn continuously during activities and sleep (24 hours), obtains readings every 15-60 minutes; bring device and BP log to clinic visits
How should patients monitor BP when using a home BP monitoring device?
the patient should measure and record the average of at least 2 readings in the morning and evening before eating or taking any medications; bring device and BP log to clinic visits
What are lifestyle modifications to treat HTN?
- weight loss (1kg loss–> 1mmHg decrease)
- heart-healthy diet (DASH diet; high in fruits vegetables fiber and low-fat dairy, low in saturated fat and sugar)
- adequate dietary potassium intake or supplementation if not CI (CKD)
- sodium intake <1,500mg/day
- limited alcohol consumption (<1 drink woman and ≤2 men per day)
- tobacco cessation
- diabetes and cholesterol mamangement
What natural products can be used to treat (or supplement) hypertension?
garlic and fish oil; counsel patients that both products can increase the risk of bleeding (stop before procedures, etc)
Which anti-HTN medications have boxed warnings for teratogenicity and should be discontinued if family planning or pregnant?
- ACE/ ARB
- Aliskiren (direct renin inhibitor)
What oral antihypertensives are preferred in pregnancy?
- labetalol
- nifedipine
- extended-release methyldopa (less effective at lowering BP)
What is the BP goal for pregnancy?
120-139/80-89
What is the difference between gestational HTN and preeclampsia?
both defined as new onset HTN after 20 weeks gestation; preeclampsia also has proteinuria and significant end-organ dysfunction