Hypertension Flashcards
What are the two major exceptions when a single elevated blood pressure reading is sufficient to diagnose hypertension?
- Obvious evidence of end-organ damage (HTN Emergency)
- BP > 220/125
A 3 month delay in treatment of hypertension in high-risk patients is associated with how much of an increase in cardiovascular morbidity and mortality?
Twofold (2x)
What is considered a Normal blood pressure?
< 120/80
What is considered an Elevated blood pressure?
120 - 129/ < 80
What is considered Stage 1 HTN?
130-139/80-89
What is considered Stage 2 HTN?
≥ 140/90
Type of hypertension that results from multiple genetic and environmental factors with NO IDENTIFIABLE CAUSE.
Primary Essential Hypertension
(95% of patients)
When does Primary Essential Hypertension usually present in life?
25 - 50 years old
Type of hypertension that results from an identifiable specific cause.
Secondary Hypertension
(5% of patients)
What two types of patients should you suspect Secondary Hypertension in?
- HTN develops at Young Age or > 50
- Previously controlled HTN becomes refractory to treatment
Syndrome that is defined by:
- Upper Body Obesity
- Insulin Resistance
- Hypertriglyceridemia
Metabolic Syndrome
How many medications is Secondary Hypertension usually resistant to?
3 Meds
(at max doses)
What is the most common cause of Secondary Hypertension?
Renal Parenchymal Disease
What is the Screening Test for Renal Vascular Hypertension?
None
What is the definitive diagnostic test for Renal Vascular Hypertension?
Renal Arteriography
Is Renal Arteriography recommended as routine to adjunct to coronary studies?
No
Secondary Hypertension occurs in about 80% of patients with what syndrome?
Cushing Syndrome
(excess Glucocorticoid)
Evidence of Radial-Femoral delay should be sough in all younger patients with hypertension out of concern for what pathology?
Coarctation of the Aorta
What can be a cause of Secondary Hypertension in women?
Estrogen Use
When should you refer someone with Hypertension?
Severe
Resistant
Early Onset (Before 20)
Late Onset (After 50)
What are some complications of Untreated Hypertension?
Structural and Functional Changes
Thrombosis
When does morbidity and mortality related to HTN double in rate?
Every 6 mmHg increase in Diastolic BP
What is the most frequent symptoms of Mild to Moderate Primary Hypertension?
Headache
How long can Mild to Moderate Primary Hypertension be asymptomatic for?
Years
What are two urgent presentations of HTN?
Uncontrolled HTN
Hypertensive Emergencies
Symptoms of HTN Encephalopathy.
Headache
Somnolence
Vomiting
Symptoms of Posterior Reversible Encephalopathy Syndrome.
Headache
Seizures
Altered Consciousness
Disturbance of Vision
Focal neurologic deficits would indicate what?
Stroke
Symptoms of Left Ventricular After-load.
Angina
Dyspnea
Symptoms of Aortic Dissection or Rupture.
Severe Chest or Abdominal Pain
Hypertensive Retinopathy findings
Copper Wiring
AV Nicking
Cotton Wool Spots
Papilledma
Falsely elevated BP seen in older patients.
Osler Sign
Weight Loss with a target BMI of 18.5 - 24.9 can reduce blood pressure by how much?
5 - 20 mmHg per 10kg loss
DASH Diet can reduce blood pressure by how much?
8 - 14 mmHg
Sodium intake < 100 mmol/day can decrease blood pressure by how much?
2 - 8 mmHg
Limiting alcohol intake to:
≤ 2 for Men
≤ 1 for Women
can reduce blood pressure by how much?
4 mmHg
Exercise can reduce blood pressure by how much?
5 - 10 mmHg
Mindfulness can reduce blood pressure by how much?
5 mmHg
Who should be treated with Anti-Hypertension medications?
- All patients that will have a reduced Cardiovascular Risk from treatment
- or -
SBP > 140
DBP > 90
What are the Major Risk Factors of Cardiovascular Disease based on the AHA guidelines?
Hypertension
Smoking
Obesity
Inactivity
Dyslipidemia
Diabetes
Microalbuminuria or eGFR < 60
Age (Male 55+ or Female 65+)
Family History of premature CV Disease
What two medications are used to reduce Cardiovascular Events from occurring?
Rosuvastatin
Aspirin
What are the classes of Anti-Hypertensive medications?
ACE Inhibitors
Angiotensin (II) Receptor Blockers
Calcium Channel Blockers
Diuretics
Beta Blockers
Class of medications that are commonly used as the initial medication for mild to moderate HTN. Both cardio- and renoprotective.
ACE Inhibitors
Name two ACE Inhibitors
Lisinopril
Enalapril
What are the indications for ACE Inhibitors?
HTN in Diabetes
Nephropathy
CHF
Post-MI
Before starting a patient on ACE Inhibitors, what must you establish?
K⁺ and Creatinine Serum Levels
(repeat in 1-2 weeks after initiation)
What is a contraindication for giving ACE Inhibitors?
Pregnancy
What are some side effects of ACE Inhibitors?
First-Dose Hypotension
Hyperkalemia
Cough
Skin Rashes
Angioedema
Name two Angiotensin (II) Receptor Blockers.
Losartan
Valsartan
Patients that cannot tolerate which two medications should receive ARBs?
Beta-Blockers
ACE-Inhibitors
(don’t use in combo with ACE-I)
What are some side effects of ARBs?
Hyperkalemia
Hypotension
Renal Insufficiency
What is a contraindication for giving ARBs?
Pregnancy
Class of medications that causes vasodilation.
Calcium Channel Blockers
What are the two classes of Calcium Channel Blockers?
Dihydropyridines
Non-Dihydropyridines
Class of Calcium Channel Blockers that have little to no effect on cardiac contractility.
Dihydropyridines
- Amlodipine
- Nifedipine
- Nicardipine
Class of Calcium Channel Blockers that affect cardiac contractility and conduction.
Non-Dihydropyridines
- Diltiazem
- Verapamil
What are the contraindications of Calcium Channel Blockers?
CHF
2ⁿᵈ + 3ʳᵈ AV Blocks
What is the only Calcium Channel Blockers with established safety in patients with severe Heart Failure?
Amlodipine
Diuretics that increase sodium and water excretion by preventing the reabsorption of Na⁺ and water at the distal diluting tubule.
Thiazide Diuretics
What is an example of a Thiazide Diuretics?
Hydrochlorothiazide
Diuretics that inhibit water transport across the Loop of Henle.
Loop Diuretics
What electrolytes do Loop Diuretics affect?
Excretion of:
Water
Na
Cl
K
What are some examples of Loop Diuretics?
Furosemide
Bumetanide
What are some side effects of Loop Diuretics?
Ototoxicity
Do not use with Sulfa Allergy
Diuretics that inhibit aldosterone mediate Na⁺ & Water absorption.
Potassium-Sparing Diuretics
(Mineralocorticoid Receptor Blockers)
What is an example of a Potassium-Sparing Diuretic?
Spirinolactone
Which diuretics are first-line for uncomplicated HTN?
Thiazide Diuretics
Which diuretics are the strongest?
Loop Diuretics
Which diuretics are the weakest?
Potassium-Sparing Diuretics
What are some side effects of Potassium-Sparing Diuretics?
Hyperkalemia
Gynecomastia
(do not use in renal failure or hyponatremia)
Which diuretics should be used with caution in Gout and Diabetes?
Thiazide Diuretics
What are some side effects of Thiazide Diuretics?
Hyponatremia
Hypokalemia
Hypercalcemia
Hyperglycemia
Cardioselective Beta Blockers.
Atenolol
Metoprolol
Esmolol
Nonselective Beta Blockers.
Propranolol
Alpha + Beta Blockers
Labetalol
Carvedilol
What class of Beta Blockers are a good choice for people with lung issues?
Cardioselective
What do Beta Blockers do?
Decrease Renin Release
↓Heart Rate + CO
What can Beta Blockers be used to treat?
HTN
Angina
HF
MI
Migraines
Essentail Tremor
Name some Alpha Blockers.
Prazosin
Terazosin
Doxazosin
What are the First-Line hypertension medications for either:
Black Persons
Persons Age 55+
Calcium Channel Blockers
- or -
Thiazide Diuretics
What are the First-Line hypertension medications for:
Persons Under 55
ACE-Inhibitor
ARB
Calcium Channel Blocker
Thiazide Diuretic
What is the Second-Line hypertension medication for:
Persons Under 55
Vasodilating Beta-Blocker
What are the Second-Line hypertension medications for:
Black Persons
Persons Age 55+
ARB
ACE-I
Vasodilating Beta Blockers
What medications are used for all patients with Resistant HTN?
Aldosterone Receptor Blocker
(Spironolactone)
What are some additional options for patients needing hypertension medication?
Central Alpha Agonist
Peripheral Alpha Antagonist
What type of follow-up is recommended for Hypertensive patients?
Blood Lipids (Yearly)
EKG (Every 2 - 4 years)
Failure to reach blood pressure control in patients who are adherent to full doses of an appropriate three-drug regimen (including a diuretic)
Resistant Hypertension
Hypertension above what values is considered a Hypertensive Emergency?
> 180/120
If you suspect End-Organ Injury due to Hypertension, what tests should you perform?
Blood Screening:
- Thrombotic Microangiopathy
- AKI
- Myocardial Damage
Urine Exam:
- Blood or Protein
- Substances of Abuse (Cocaine)
What is the goal reduction rate when treating a Hypertensive Emergency?
No more than 25% in first hour
5-15% over the next 23 hours
What are the two exceptions to treating Hypertensive Emergencies?
Stroke
- often falls spontaneously
- don’t treat unless BP exceeds 180-200
- Reduce by 10-15%
Aortic Dissection
- Keep under 120SBP and under 60HR all within 30 minutes
In most situations, which medications can be used to best control blood pressure?
Calcium Channel Blockers + Beta Blockers
(Nicardipine + Labetalol or Esmolol)
