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RCE Guidelines Studying > Hypertension 2021 Guidelines > Flashcards

Hypertension 2021 Guidelines Flashcards

1
Q

How frequent does ABPM cycle blood pressure?

A

30 minutes

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2
Q

What is BP cut off for AOBP? 24 hour?

A

> 135 / 85 mmhg (awake)

> 130 / 80mmhg (24 hour)

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3
Q

What is BP cut off for office measurement?

A

140 / 90 mmhg

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4
Q

How to diagnose hypertension?

A
  • HTN urgency/emergency
  • 3 visits > 160/100mmhg
  • OBP > 140/90mmhg
  • AOBP > 135/85mmhg
  • 24hr AOBP > 130/80mmhg
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5
Q

How to diagnose hypertension in diabetes?

A

3 readings > 130/80 mmhg

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6
Q

5 diagnosis that should be ordered in Hypertension?

A

ECG

Urinalysis

Hba1c

Lytes and renal function

Lipid panel

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7
Q

In which patients are BB first line BP agents?

A

< 60 years old

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8
Q

In which patients are ACEi not a first line agent?

A

Black patients

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9
Q

What two combo pills are recommended?

A

ACE/ARB-CCB

ACEi/ARB-Diuretic

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10
Q

What DBP level should you be concerned about in CAD patients?

A

< 60mmhg

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11
Q

What are two agents preferred for post stroke management?

A

ACEi/Thiazide

< 140/80mmhg

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12
Q

When can Renal artery angioplasty recommended for RAS?

A

Uncontrolled hypertension resistant to maximally tolerated pharmacotherapy

Progressive renal function loss

Acute pulmonary edema

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13
Q

When to assess for renovascular hypertension?

A

2 or more of the following:

>55 <30 
Absence of abdominal bruit 
Hypertension resistant to 3 drugs 
Increase in serum Cr 30% with ACE/ARB 
Other ASCVD 
Recurrent pulmonary edema with hypertensive surges
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14
Q

4 reasons to screen for FMD?

A

Significant > 1.5 cm unexplained asymmetry in kidney sizes

Abdominal bruit without apparent atherosclerosis

FMD in another vascular territory

Family history of FMD

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15
Q

When to screen for primary hyperaldosteronism? (3)

A
  • spontaneous hypokalemia with K < 3.5, diuretic-induced K < 3
  • Resistance to treatment with 3 drugs
  • An incidental adrenal adenoma
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16
Q

When should patients be screened for Pheochromocytoma? (5)

A

Any of the following:

  • Paroxysmal BP > 180/110 mmhg, refractory to usual therapy
  • Multiple symptoms suggestive of catecholamine excess
  • Patients with hypertension triggered by beta blockers, MOAs, micturition
  • Incadentally discovered adrenal mass
  • Patients with a predisposition to hereditary causes (MEN 2a, 2b)
17
Q

What are three indications for BP treatment ?

A

> 160/100

> 140/90mmhg with target organ damage or CV risk factors

> 130/80 with DM

> 130 mmhg who is high risk (by SPRINT)

18
Q

What is high risk in guidelines? (Target SBP < 120mmhg, >130mmhg is threshold)

A

Age > 50, SBP > 130mmhg with:

  • CAD/Subclinical CAD
  • CKD (20-59, Non diabetic Proteinuria < 1g/day)
  • FRS > 15%
  • Age > 75
19
Q

What are 6 behaviour modifications to lower BP?

A
  • Exercise: 30-60 minutes mod aerobic activity 4-7 days per week
  • Weight reduction: BMI 18.5-24.9 WC < 102cm / 88cm
  • ETOH: Limit to < 2/day
  • Diet: DASH Diet
  • Relaxation therapies
  • Smoking Cessation
20
Q

What is diagnosis cut off for Diabetes BP?

21
Q

What are examples of Target Organ Damage?

A

Coronary Artery Disease (CAD, ACS, Angina, HF, LVH)

CVD

Hypertensive Retinopathy

Peripheral Artery Disease

Renal Disease: Albuminuria, CKD eGFR < 60

22
Q

What is definition of Microalbuminuria? What is definition of Proteinuria?

A
  • Microalbuminuria: ACR > 2.0

- Proteinuria: Urinary Protein > 150mg/24h

23
Q

5 important things about positioning for BP measurement

A

Seated

Back supported

Legs uncrossed

Feet flat on the floor

Do not talk or move during the measurement

24
Q

What are three important things about the cuff during BP measurement?

A
  • Use an appropriate cuff size (Bladder width 40% or arm circumference, length of bladder should cover 80-100% of arm)
  • Middle of cuff at heart level
  • Lower edge of cuff 3cm above elbow crease
25
Q

How long should patient rest for before measuring BP?

26
Q

What BP numbers to use when using AOBP?

A

Take 3 measurements, discard first one -> average last 2

27
Q

What is the systolic BP using auscultation?

A

The systolic level is the first appearance of a clear tapping sound (phase I Korotkoff).

28
Q

What is the diastolic BP during auscultation?

A

The diastolic level is the point at which the sounds disappear
(phase V Korotkoff).

29
Q

What is the rate of diabetes developing in those with hypertension?

A

1-3% / year

30
Q

What two hypertension medication classes increase risk of diabetes in treated patients?

A
  • Beta blockers

- Diuretics

31
Q

How frequently should patients be seen with Hypertension on therapy if not at target?

A

q1-2 months until two consecutive readings below target (and then q3-6 months)

RCE Guidelines Studying (52 decks)

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