Hypertension Flashcards
1
Q
Prevalence of HTN in US
A
- 50-60 million people
- 50% of 60-70 yo
- 65% of 70-80 yo
- 70% of 80+
- normotensive ppl @ age 55 have 90% risk of developing HTN
2
Q
CVD risk associated with HTN
A
- Starting @ 115/75, CVD risk doubles w/each increase of 20/10 mmHG
- positive linear association between systolic BP and ischemic HD mortality
- more important risk factor in persons > 50 yo (vs. diastolic)
3
Q
Essential HTN pathogenesis (2 theories)
A
- MAP = CO x SVR
- Theory 1: defect in renal sodium excretion => increased plasma volume => increased CO => autoregulatory increase in SVR => increase in BP
- Theory 2: Na+ transport inhibitor inhibits Na+/K+/ATPase => increases cell Na+, cell can’t extrude Ca2+ via NCX => increases cell Ca2+ => VSMC contraction => increase in SVR/BP
4
Q
Elements of lifestyle modification tx for HTN
A
- Weight reduction
- 5-20 mmHg/10kg weight loss
- DASH eating plan
- 8-14 mmHg reduction
- Dietary sodium reduction
- 2-8 mmHg reduction
- Increase physical activity
- 4-9 mmHg reduction
- Moderation of alcohol
- 2-4 mmHg reduction
5
Q
Classification of HTN
A
- Normal = <120/<80
- PreHTN = 120-139/80-89
- Stage 1 HTN = 140-159/90-99
- Stage 2 HTN = >160/>100
6
Q
PreHTN tx
A
- lifestyle modification
- no antiHTN drugs
- if pt has chronic kidney disease, give drugs for this/other compelling indication
7
Q
Stage 1 HTN tx
A
- lifestyle modification
- thiazide diuretics for most
- may consider ACE-i, ARB, BB, CCB or combo
- drugs for compelling indications (e.g. chronic kidney disease)
8
Q
Stage 2 HTN tx
A
- lifestyle modification
- Two drug combo: thiazide diuretics + ACE-i/ARB or BB or CCB
9
Q
Secondary HTN definition/pathogenesis
A
- Secondary hypertension (secondary high blood pressure) = high BP caused by another medical condition.
- can be caused by conditions that affect your kidneys, arteries, heart or endocrine system.
- can also occur during pregnancy.
10
Q
Tx of secondary HTN
A
- control both the underlying condition and the high blood pressure ==>
- reduces the risk of serious complications — including heart disease, kidney failure and stroke.
11
Q
CVD risk factors
A
- HTN
- tobacco use
- physical inactivity
- metabolic syndrome: obese, diabetes, dyslipidemia
- microalbuminuria/GFR <60 ml/min
- age
- Fhx
12
Q
Possible causes of HTN
A
- sleep apnea
- drug-induce
- chronic kidney disease
- primary aldosteronism
- renovascular disease
- chronic steroids/Cushing’s
- coarctation of aorta
- thyroid/parathyroid disease
- RAD PACTS: reno, apnea, drug, primary, aorta coarc, chronic, thyroid, steroids
13
Q
A