Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ICM-Cardio > hypertension > Flashcards

hypertension Flashcards

1
Q

hypertension is

A

elevation of systemic arterial pressure above deemed to carry excessively high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is BP

A

CO x SVR

  • pressure of blood in artery
  • specific location in body and time
  • function cardiac output and PVR
  • influenced by genetic and environmental factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HTN is a major riskactor for

A

cardiovascular morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

benefit for lowering BP with antihypertensive treatment

A

decrease 35-40% stroke
decrease 20-25% MI
decrease 50% CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

one of the biggest problems for treating HTN

A

non-compliance

  • 40% stay on meds over 10 years
  • 40% new patients stop medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

other non compliance issues

A

expenses

follow up issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

detrimental issues for HTN

A 
obesity
sedentary life style 
salt intake
excessive water intake
alcohol 
caffeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

detrimental drugs for HTN

A 
cigarettes
NSAIDS
recreational drugs
decongestants
herbal supplements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

hormonal regulation of BP

A

diagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

goals of therapy: isolated HTN, DM, CKD

A

<150/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

things to look for when someone is being treated

A

resistant HTN
->140/90 despite 3 drugs
30% need more than 3 drugs anyway
-<30% can get by with 1 drug alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pathology of systemic HTN

A

intimal thickening and atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

findings on exam

A 
LV enlargement
HTN nephrosclerosis
intracranial bleeding
thromboembolic episodes
disease of retina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

stages of HTN: normal

A

<120/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

preHTN

A

120-139/80-89

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

stage 1 HTN

A

140-159/90-99

-treat with diuretics (combo of ACEI, ARB, BB, CCB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

stage 2 HTN

A

> 160/ or >100

-2 drug combo, diuretics and ACEI, ARB, BB or CCB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

malignant HTN

A

over 200/130 in presence of retinal abnormalities and often acute vascular damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

risk of complications are

A

proportional to BP without threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how to measure BP to diagnose

A

3 readings at least 1 week apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

technique

A
  • two readings at least 5 mins apart

- initially take BP in both arms, pick higher value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how is one positioned while having BP taken

A
  • sit quietly for 5 mins
  • back supported
  • arm supported at heart level
  • no caffeine
  • quiet, warm setting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

first diagnosis of HTN

A
  • not on anti-hypertensives medications
  • not acutely ill
  • based on average of >2 readings taken at 2 office visits after initial screening visits
  • BP should be measured using certified equipment
  • proper BP measuring technique should be used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

common presentation of HTN patients

A

often no complaints

  • morning headaches (occipital)
  • less often change in vision
  • palpitations or chest discomfort
  • fatigue or shortness of breath with exertion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

important past medical history

A
  • prior HTN
  • angina
  • kidney disease
  • diabetes
  • drugs
  • family history of renal disease of HTN
  • alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

primary (essential) HTN

A

no known identifiable etiology

-accounts for 90% of HTN individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what to look for in secondary HTN

A

about 5-10% of patients

  • renal parenchymal disease
  • renovascular HTN
  • coarctation of aorta
  • endocrine HTN
  • obstructive sleep apnea
  • drug induced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

secondary HTN

A
  • identifiable etiology
  • often cause of resistance HTN
  • patients often younger (less than 30) and older (more than 50)
  • proscribed treatment options even surgery may be curative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

secondary HTN causes

A
  • CKD
  • hyperaldosteronism
  • renal artery stenosis
  • pheochromocytoma
  • coarctation of aorta
  • hyperthyroidism
  • hyperparathyroidism
  • cushing’s syndrome
30
Q

most common cause of secondary HTN

A

CKD (chronic kidney disease)

  • renal parenchymal disease-> CKD, acute, chronic GN orther AKI
  • sodium and volume retention
31
Q

renal causes of secondary HTN

A
  • renal parenchymal disease
  • renovascular HTN: atherosclerosis, fibro-muscular dysplasia (women)
  • renin production excess
32
Q

endocrine causes of HTN

A

hyperaldosteronism, pheochromocytoma, hyper/hypoT, hyperpara, cushing’s, acromegaly, insulin resistance, pregnancy (3rd trimester), oral contraceptives

33
Q

coractation of aorta

A
  • HTN in children

- exam clues: asymmetric BP, brachial-femoral delay

34
Q

drug induced HTN

A 
oral conctraceptives
NSAIDs
some anti-depressants
alcohol
stimulants
decongestants
35
Q

clues for secondary HTN on physical exam

A
  • prolonges abdominal bruit-> renal artery stenosis
  • decreased or diminished femoral pulses-> coarctation
  • renal calculi-> hyperparathyroidism
  • hypert-> sweating heat intolerance, weight loss, hair loss, tremor
  • abdominal striae-> cushings: central obesity, moon faces
  • paroxismal H/A, pallor, palpitations-> Pheochromocytoma
36
Q

treatments of secondary HTN

A

depends on what it is

pheochromocytoma: surgery
contraceptives: discontinue

37
Q

primary HTN associating factors

A
  • genetic
  • race
  • salt sensitivity
  • gender (male more likely)
38
Q

contributing factors for 1 HTN

A
  • salt diet in face of imparied Na excretion
  • obesity
  • metabolic syndrome
  • occupation and stress level
  • NSAIDS use
  • family size and crowding
  • gender
  • race
39
Q

major risk factors for 1 HTN

A
  • obesity
  • elevated lipids
  • DM
  • cigarette
  • inactivity
  • micro-albuminuria
  • age
  • family history
40
Q

kidney role in 1 HTN

A

most patients with essential HTN do NOT have high renin levels
-renin levels often inappropriately normal (not suppressed)

41
Q

CO and PVR in primary HTN

A
  • CO: NORMAL in most patients
  • PVR is elevated
  • plasma renin are normal (inappropriately, should be suppressed)
42
Q

physical examination of primary HTN

A
  • arterial BP
  • target organ disease evaluate
  • loud second heart sound (A/P) and S4 gallop
  • bruits in carotids, abdomen, thorax
  • neurological exam
  • coarctation: pressure in legs
  • fundascopic exam: look for chronic/acute changes in fundus
  • look for evidence for secondary causes
43
Q

what can be done to check for faulty readings

A
  • measure BP after 5 mins of sitting quietly
  • take 3 measurements
  • arm supported at heart level
  • no smoking within 30 mins of measurement (can raise BP 5-20 mmHg)
44
Q

lab test for HTN

A
  • U/A
  • electrolytes: mainly potassium, calcium
  • BUN and creantinine
  • FBS
  • lipids
  • ECG
45
Q

special tests for HTN

A
  • aldosterone levels
  • TSH
  • renin
  • renal artery dopple/CT, or MRI if suspect renovascular
  • dexamethasone suppression test or 24 hr urinary free cortisol measurement
  • 240hr catecholamines (VMA, metanephrines) in urine if Pheo suspected
46
Q

what should be take into consideration with treatment

A
  • benefits, costs, risks
  • want to treat disease
  • lose weight if obese (can lower systolic BP up to 5-20 for losing 10kg)
47
Q

how to determine risk

A
  • history (diabetes, family history of cardiovascular disease, smoking, physical activity)
  • physical exam
  • ECG
  • lab tests
48
Q

direct treatment toward specific risks

A 
weight loss
regular physical activity
decrease alcohol
stop smoking
decrease sodium intake
increase Ca and K
avoid certain drugs (NSAIDs, steroids, stimulants, decongestants, appetite suppressants)
49
Q

DASH Diet

A

Dietary Approaches to Stop HTN

  • fruits, vegies, low in fats (see 8-14 drop in 8 weeks)
  • low sodium
  • exercise 30 mins (drops 4-8)
  • reduce alcohol (2 for men and 1 for women)
50
Q

goals

A
  • 140/90, but try to get 130/80 (risk factors DM, carotid disease, AAA, CHF, CR, CAD, PVD)
  • systolic <60
51
Q

when to use drugs

A

-when lifestyle change not enough

52
Q

classes of drugs

A 
diuretics 
CCB
ACE-I
ARB
anti-adrenergics
vasodilators
53
Q

drugs if have CAD and HTN

A

non-dihydropyridine CCB, ACE-I,

54
Q

drugs for RF, DM, vascular disease and HTN

A

ACE-I, ARB

55
Q

drugs for CHF and HTN

A

BB, ACE-I, aldosterone

56
Q

drugs for dementia and HTN

A

some CCB’s, ACE-I, Altace

57
Q

drugs for prostatism and HTN

A

hytrin

58
Q

ACE-I are preferred

A

DM, and those with mild to moderate kidney disease (but monitor)

59
Q

ACE-I and diuretics best for

A

CHF

60
Q

avoid B-blockers with

A

patients with bronchospastic disease and in black and younger people, diabetics on insulin (hypoglycemia)

61
Q

what do CCB have risk of

A

short acting CCB increased risk of hypotension and MI

62
Q

what do african americans do better with

A

CCB and diuretics

63
Q

what drug should be used first

A
  • diuretics
  • reduction of morbidity from cardiovascular complications
  • cheap
  • effectiveness
  • well-tolerated
64
Q

if someone isn’t responding to diuretics, why could that be?

A

have hyperaldosternism

65
Q

causes of resistance HTN

A
  • improper BP measurement
  • excess sodium intake
  • inadequate diuretic therapy
  • medication
  • excessive alcohol intake
66
Q

drugs for heart failure and HTN

A

diuretics, BB, ACEI, ARB, aldo ant

67
Q

drugs for post MI and HTN

A

BB, ACEI, aldo ant

68
Q

drugs for high CVD risk and HTN

A

diuretics, BB, ACEI, CCB

69
Q

drugs for those with diabetes and HTN

A

diuretics, BB, ACEI, ARB, CCB

70
Q

drugs for those with CKD and HTN

A

ACEI and ARB

71
Q

drugs for those with recurrent stroke prevention and HTN

A

diuretics, ACEI

ICM-Cardio (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions