Hypertension Flashcards
Definition of hypertension
as an office blood pressure (BP) of140/90 mm Hg or above, typically at least twice taken on 2 separate days.
Among adult Filipinos, what device is recommended for
accurate blood pressure determination and
monitoring?
Validated automated oscillometric sphygmomanometer
(digital device) is recommended for in office or out of office
use
when aneroid shygmomanometer is recommended
recommended for
special cases like the presence of arrhythmias or extremes
in BP levels.
what are the blood pressure
thresholds for treatment and BP targets for the
prevention of cardiovascular disease
A therapeutic threshold of 140/90 mmHg to achieve a goal of
less than 130/80
cornerstone for the
management of hypertension
lifestyle modification
are the first line of antihypertensive
treatment and of course are synergistic to the effects of
antihypertensive medications
healthy lifestyle choices
sodium limit of hypertensive patients
1500 mg/day
The American Heart Association recommends that sodium
intake be limited ____ in people with prehypertension or hypertension
to 2300 mg/d (about roughly half a
teaspoon of table salt) in most healthy individuals
§ 1500 mg/d
Significant weight loss of ___ of the baseline weight for
those who are overweight or obese
> 5%
What are the preferred drugs for the treatment of
hypertension among adult Filipinos for prevention of
cardiovascular diseases?
angiotensin-converting enzyme (ACE) inhibitors or
o angiotensin-receptor blockers (ARBs)
o calcium channel blockers
o thiazide/thiazide-like diuretics
what antihypertensive drugs are not recommended to be used
in combination.
ACE inhibitors & ARBs
are suitable as initial therapy in hypertensive
patients with coronary artery disease, acute coronary
syndrome, high sympathetic drive and pregnant women
Beta blockers
Beta blockers for those with congestive heart failure was
specified to be
bisoprolol, carvedilol, metoprolol succinate or
nebivolol.
Among patients with BP >150/100 mm Hg (or >160/100 mm
Hg in the elderly), a combination of 2 agents
preferably
combination of a RAAS inhibitor (ARB/ACE-is) and CCB or
diuretic, should be given initially since it is unlikely that any
single agent would be sufficient to achieve the BP target
Hpertension-mediated Organ Damage (HMOD):
o LVH (LVH with ECG)
o moderate-severe CKD (CKD; eGFR <60 ml/min/1.73m2)
Significant Comorbid Diseases which increase
cardiovascular risk with the background of hypertension
- previous coronary heart disease (CHD)
- Heart Failure
- Stroke
- peripheral vascular disease
- atrial fibrillation
- CKD stage 3+
Patients with hypertension who continue to be uncontrolled
on 3 drug combinations one of which is a diuretic are
considered to have
RESISTANT HYPERTENSION
Among persons with diabetes, what is the threshold for
treatment of elevated blood pressure?
it is
recommended that drug therapy (along with lifestyle change)
be initiated at a blood pressure of > 140/90 mm Hg.
o the threshold for treatment continues to be 140/90 mm Hg.
Among persons with diabetes and hypertension, what
are the blood pressure targets for prevention of
cardiovascular diseases (mortality and morbidity)?
A blood pressure target of <130/80 mm Hg is recommended
for most persons with diabetes mellitus and hypertension;
however, do not lower down the blood pressure below 120/70
due to an increased risk for adverse events.
Among patients with CKD who are pre-dialysis, what is
the level of blood pressure to start pharmacotherapy to
prevent cardiovascular complications and renal
progression?
Patients with BP more than or equal to 140/90 mmHg should
have prompt initiation and timely titration of pharmacotherapy
to achieve blood pressure goals.
Among patients with CKD who are pre-dialysis, what is
the target blood pressure to prevent cardiovascular
complications and renal progression?
For routine office blood pressure measurement, maintain a BP
target consistently less than 140 mmHg systolic and less than
90 mmHg diastolic in patients with low risk of cardiovascular
disease and CKD grade 4 and 5, or if with adverse effect on
intensive target of less than 130/80 mmHg
Among patients with CKD, what is the level of blood
pressure to start initiation with two antihypertensive
drugs to prevent cardiovascular complications and
renal progression?
Patients with confirmed office-based blood pressure or more
than or equal to 160/100 mmHg should, in addition to lifestyle
modification, have prompt initiation and timely titration of two
drugs or a single-pill combination of drugs demonstrated to
reduce cardiovascular events.
Among patients with CKD with albuminuria/proteinuria,
what is the anti-hypertensive of choice to prevent
cardiovascular complications and renal progression?
An ACE inhibitor or Angiotensin receptor blocker, at maximally
tolerated dose is the recommended first-line treatment for
hypertension in CKD patients with urinary albumin-tocreatinine
ratio more than or equal to 30 mg/g (or equivalent).
If the patient is intolerant to both ACE inhibitor and
angiotensin receptor blocker, ____may be used as first
line treatment in this setting.
a non-dihydropyridine calciumchannel blocker (verapamil or diltiazem)
Among patients with CKD with resistant hypertension,
is the addition of mineralocorticoid receptor antagonist
beneficial in reducing albuminuria and cardiovascular
events?
CKD patients with resistant hypertension not meeting blood
pressure targets on three classes of anti-hypertensive
medications (including diuretic) should be considered for
mineralocorticoid receptor antagonist therapy
For adults with acute ischemic stroke (AIS) who are
eligible for intravenous (IV) thrombolysis but not for
mechanical thrombectomy, what is the threshold for
pharmacological treatment and the target blood
pressure (BP)?
It is recommended that the BP be maintained <185/110 mmHg
prior to treatment and during infusion.
* For the next 24 hours after treatment is given, the BP is
recommended to be maintained <180/105 mmHg.
For adults with AIS who are eligible for IV thrombolysis
but not for mechanical thrombectomy, what are the
pharmacologic agents of choice to reach the target BP?
Nicardipine 1- 5mg/hr.
IV, titrated up by 2.5mg/hr. every 5-15 minutes, with maximum
of 15mg/hr.
* If available, labetalol 10 mg IV over 1-2 minutes followed by
continuous IV infusion of 2-8 mg/min may also be used.
For adults with AIS who are not eligible for IV
thrombolysis or mechanical thrombectomy, what is the
target BP and threshold for pharmacological
treatment
it is recommended to maintain a
target mean arterial pressure (MAP) of 110 to 130 mmHg.
the threshold for urgent
antihypertensive treatment is with severe hypertension of
Systolic BP >220 mmHg or Diastolic BP >120 mmHg. If with
severe hypertension, it might be reasonable to reduce the BP
by 15% during the first 24 hours after the onset of stroke.
For adults with AIS who are not eligible for IV
thrombolysis or mechanical thrombectomy, what
pharmacological agent may be used to achieve target
BP, when needed?
use of IV nicardipine
For adult patients with acute hypertensive parenchymal
intracerebral hemorrhage (ICH), what is the threshold
for BP lowering in the first few hours upon presentation
at the emergency room?
For adult patients with acute ICH, the threshold for BP lowering
is SBP ≥ 180 mmHg.
For adults who have a history of stroke, what is the
target blood pressure level for secondary prevention?
less than or equal to 130/80 mmHg
definition of preeclampsia
Systolic blood pressure of 140 mm Hg or more or diastolic
blood pressure of 90 mm Hg or more on two occasions at
least 4 hours apart after 20 weeks of gestation in a woman
with a previously normal blood pressure.
300 mg or more per 24 hour urine collection (or this amount
extrapolated from a timed collection), or
o Protein/creatinine ratio of 0.3 mg/dl or more or
o Dipstick reading of 2+ (used only if other quantitative
methods not available)
in the absence of proteinuria, new onset hypertension with
the new onset of any of the following( pre eclampsia)
Thrombocytopenia: Platelet count less than 100,000 x 109/L
Renal insufficiency: Serum creatinine concentrations greater
than 1.1 mg/dL or a doubling of the serum creatinine
concentration in the absence of other renal disease
o Impaired liver function: Elevated blood concentrations of
liver transaminases to twice normal concentration
o Pulmonary edema
o New-onset headache unresponsive to medication and not
accounted for by alternative diagnoses or visual symptoms
definition of eclampsia
New-onset tonic-clonic, focal, or multifocal seizures in the
absence of other causative conditions such as epilepsy,
cerebral arterial ischemia and infarction, intracranial
hemorrhage, or drug use.
Chronic Hypertension with Superimposed Preeclampsia-
Chronic hypertension in association with
preeclampsia
Others define it as worsening baseline hypertension
accompanied by new-onset proteinuria or other findings
supportive of preeclampsia
Gestational Hypertension
Systolic blood pressure 140 mm Hg or more or a diastolic blood
pressure of 90 mm Hg or more, or both, on two occasions at
least 4 hours apart after 20 weeks of gestation, in a woman
with a previously normal blood pressure
What blood pressure threshold is
used to define hypertension in pregnancy?
Hypertension is diagnosed empirically when appropriately
taken blood pressure is 140 mm Hg systolic or 90 mm Hg
diastolic or above. Korotkoff phase V is used to define diastolic
pressure.
What antihypertensive agents can be used for urgent
blood pressure control in pregnancy?
The first line of treatment is intravenous (IV) hydralazine and
labetalol; intravenous nicardipine is also an option.
* Extended release oral nifedipine also may be considered as a
first line therapy, particularly when IV access is not available
When do we treat hypertension during pregnancy?
Treatment of severe hypertension (blood pressure of>160/100mmHg) is always recommended as it prevents
serious maternal and fetal complications to set in.
What are the pharmacologic treatment options in the
OPD management of hypertension in pregnancy?
The first line drugs are methyldopa, calcium channel blockers
or beta blockers, and ACE-inhibitors and angiotensin-receptor
blockers (ARBs) are generally not recommended.
Among pediatric patients, what is the threshold for
commencing pharmacologic treatment for
Hypertension?
Children who remain hypertensive even after six (6) months
of lifestyle modification strategies
Presence of co-morbidities like chronic kidney disease
(CKD) or diabetes mellitus (DM), or any evidence of target
organ involvement (e.g. left ventricular hypertrophy).
What are the preferred medications for hypertensive children?
Any of the following drugs may be used as initial treatment for
children with hypertension: ACE inhibitors (Enalapril,
Captopril), ARBs (Losartan, Valsartan), or calcium channel
blockers (Amlodipine).
For children with co-existing chronic kidney disease,
proteinuria or diabetes mellitus, _____
recommended as the initial antihypertensive drug unless with
absolute contraindications
an ACE-inhibitor or ARB
An auscultatory device using ______
sphygmomanometer is recommended for children
an aneroid non-mercury
limitation of alcohol in hypertensive patients
Alcohol intake should be limited to no more than 1 oz (30
mL) of ethanol, the equivalent of two drinks per day in
most men and no more than 0.5 oz of ethanol (one drink)
per day in women and lighter weight persons
