HYPERTENSION Flashcards
What defines elevated BP and Stage 1 hypertension according to ACC/AHA?
Elevated BP: SBP 120-129 mmHg and DBP >80 mmHg; Stage 1 Hypertension: SBP 130-139 mmHg or DBP 80-89 mmHg.
What is blood pressure?
The force exerted by circulating blood against the artery walls.
What are primary risk factors for hypertension?
Smoking, obesity, inactivity, dyslipidemia, diabetes, microalbuminuria, age, family history of cardiovascular disease.
Which conditions increase CVD risk in hypertensive patients?
Hyperinsulinemia, impaired glucose tolerance, type 2 diabetes, insulin resistance, microalbuminuria, hypercoagulability, visceral obesity, dyslipidemia.
What were the findings of the Framingham Study on hypertension?
Higher DBP is linked to increased risks of stroke and MI, especially in combination with other risk factors.
Why is hypertension often called a “silent killer”?
It is usually asymptomatic until complications develop, necessitating lifelong management.
What is the JNC 7 classification of hypertension levels?
Normal: <120/<80 mmHg; Prehypertension: 120-139/80-89 mmHg; Stage 1: 140-159/90-99 mmHg; Stage 2: >160/>100 mmHg.
How should prehypertension be managed?
With lifestyle modifications, and possibly drug therapy if diabetes or kidney disease is present.
What is isolated systolic hypertension?
A condition where only SBP is elevated, often due to reduced aortic compliance with age, increasing CVD risk.
What are the two main types of hypertension?
Primary (essential) hypertension, with no identifiable cause, and secondary hypertension, due to underlying conditions.
What are common causes of secondary hypertension?
Renal disease, renovascular disease, mineralocorticoid excess, pheochromocytoma, sleep apnea, glucocorticoid excess, coarctation of the aorta, thyroid dysfunction.
What historical clues suggest secondary hypertension?
Early onset, severe or treatment-resistant HTN, episodic headache or palpitations, morbid obesity with daytime sleepiness.
What are signs of secondary hypertension on physical examination?
Pallor, edema, truncal obesity, abdominal bruit, and signs of conditions like Cushing’s syndrome or pheochromocytoma.
What symptoms are common in obstructive sleep apnea?
Daytime sleepiness, loud snoring, episodes of stopped breathing, gasping or choking, and difficulty concentrating.
What organs are commonly affected by hypertension?
The heart, brain, kidneys, and eyes, leading to left ventricular hypertrophy, stroke, chronic kidney disease, and retinopathy.
How does hypertension impact the nervous system?
It increases the risk of stroke, intracerebral hemorrhage, lacunar infarcts, cerebral atrophy, and dementia.
What is the purpose of patient evaluation in hypertension?
To assess lifestyle, cardiovascular risks, possible causes, and target organ damage.
What are the guidelines for accurate blood pressure measurement?
Regularly calibrate equipment, ensure patient is seated 15-20 minutes, use correct cuff size, avoid caffeine, smoking, and exercise before measurement.
What are the primary goals of treating hypertension?
Reduce BP to <140/90 mmHg in general, or <130/80 mmHg in patients with diabetes or kidney disease, to reduce cardiovascular and renal morbidity.
What are the main benefits of controlling hypertension?
Reduction in stroke risk by 35-40%, MI by 20-25%, and heart failure by over 50%.
What lifestyle modifications help manage hypertension?
DASH diet, physical activity, smoking cessation, portion control, reduced calorie beverage and food intake.
What are first-line medications for hypertension?
Thiazide diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers.
How do beta-blockers work in hypertension management?
They reduce heart rate and contractility, lowering BP by blocking adrenaline effects on the heart.
What is the function of ACE inhibitors in hypertension treatment?
They prevent angiotensin I from converting to angiotensin II, promoting vasodilation and reducing fluid retention.
When are ARBs used in hypertension management?
ARBs are used when ACE inhibitors are not tolerated, as they block angiotensin II receptors and reduce BP without causing cough.
How do calcium channel blockers aid in treating hypertension?
They block calcium entry into vascular smooth muscle, causing vasodilation and reducing BP.
What are examples of second-line antihypertensive agents?
α1-sympatholytics, α2-sympathomimetics, direct vasodilators, and potassium-sparing diuretics.
How do α1-sympatholytics help reduce BP?
They promote vasodilation by blocking α1-adrenergic receptors, which reduces vascular resistance.
What is the mechanism of α2-sympathomimetics in hypertension?
They decrease norepinephrine release, reducing sympathetic nervous activity and lowering BP.
What lifestyle changes does the JNC 8 recommend for hypertension?
Quit smoking, control blood glucose and lipids, DASH diet, reduce sodium, and regular physical activity.
What complications can arise from untreated hypertension?
Congestive heart failure, myocardial infarction, renal failure, retinopathy, and cerebrovascular accidents (CVA).
How does renovascular disease cause hypertension?
Narrowed renal arteries lead to renin release, which raises blood pressure.
What is mineralocorticoid excess and how does it affect BP?
Excess mineralocorticoids cause sodium and water retention, leading to high blood pressure.
What is pheochromocytoma and how does it affect BP?
A tumor in the adrenal gland producing catecholamines that increase heart rate and BP.
What lab tests are used to diagnose secondary hypertension?
Tests include renal function, serum electrolytes, thyroid function, and hormonal assays for conditions like pheochromocytoma.
What imaging studies are used for secondary hypertension?
Renal Doppler studies, CT angiography, echocardiography, MRI for adrenal or pituitary tumors.
What are signs of renal parenchymal disease related to hypertension?
Increased creatinine, abnormal urinalysis, proteinuria, and hyperkalemia.
How does hypertension affect the kidneys?
It can cause glomerular sclerosis, reduced GFR, and eventual end-stage renal disease.
What are eye changes associated with hypertensive retinopathy?
Retinal hemorrhages, narrowed blood vessels, exudates, and in severe cases, papilledema.
How does hypertension cause blood vessel damage?
It leads to endothelial injury and arteriosclerosis, increasing stiffness in the blood vessels.
What symptoms might a hypertensive crisis present with?
Fatigue, decreased activity tolerance, dizziness, palpitations, angina, dyspnea.
What is the significance of left ventricular hypertrophy (LVH) in hypertension?
LVH increases oxygen demand, which can lead to heart failure and increases risk of MI.
What is the DASH diet?
A diet rich in fruits, vegetables, and low-fat dairy, which has been shown to lower blood pressure.
How does physical activity affect blood pressure?
Regular aerobic exercise lowers BP and improves cardiovascular health.
What are different types of diuretics used for hypertension?
Thiazides, loop diuretics, potassium-sparing diuretics, and carbonic anhydrase inhibitors.
How do thiazide diuretics lower BP?
They promote salt and water excretion in the kidneys, reducing blood volume.
What is the difference between cardioselective and non-selective beta-blockers?
Cardioselective beta-blockers primarily block β1 receptors in the heart, while non-selective beta-blockers affect both β1 and β2 receptors, impacting heart and lung function.
What are common side effects of ACE inhibitors?
Cough, angioedema, and hyperkalemia.
Why are ARBs a good alternative to ACE inhibitors?
ARBs block angiotensin II receptors without causing cough, making them suitable for patients intolerant to ACE inhibitors.
What are the primary indications for calcium channel blockers?
Effective in elderly patients and those with isolated systolic hypertension.
What are α1-sympatholytic agents, and when are they used?
They block α1 receptors to lower BP, used in resistant hypertension or cases with benign prostatic hyperplasia (BPH).
What is white coat hypertension?
Elevated BP in clinical settings but normal BP at home, which still poses cardiovascular risk.
What medications are used for resistant hypertension?
α2-agonists, direct vasodilators, and combination therapy with other classes.
What are alcohol recommendations for hypertensive patients?
Limit alcohol to 2 drinks per day for men, 1 drink per day for women.
How does smoking contribute to hypertension?
Smoking increases vascular stiffness, promotes plaque buildup, and raises BP through adrenaline release.
How do NSAIDs affect blood pressure?
NSAIDs can raise BP by reducing sodium excretion and increasing fluid retention.
How does dietary sodium affect blood pressure?
Reducing sodium intake can lower BP, particularly in salt-sensitive individuals.
What are the JNC 8 BP goals for different populations?
General target: <140/90 mmHg; age >60 without comorbidities: <150/90 mmHg; with diabetes or CKD: <130/80 mmHg.
What is the goal for BP management in diabetes or CKD patients?
BP target is <130/80 mmHg to reduce cardiovascular and renal complications.
