hypertension Flashcards
definition of HTN
equal to or greater than 140/90 mmHg
need at least 3 occasions to diagnose
risk factors for HTN
age smoking excessive alcohol excessive Na physical inactivity obesity diabetes family history race: more common in blacks (also worse morbidity and mortality associated with HTN)
most common cause of hypertension
idiopathic
primary hypertension: essential hypertension
causes of secondary hypertension
renal artery stenosis (most common)
chronic kidney disease (CKD) or end stage renal disease (ESRD)
meds: OCPs, NSAIDs, antidepressant, glucocorticoid
illicit drugs: cocaine, amphetamines
adrenal disease: hypercortisolism (Cushing syndrome), hyperaldosteronism (Conn syndrome), pheochromocytoma
hypothyroidism OR hyperthyroidism
↑Ca (smooth muscle contraction, vasoconstriction) due to hyperparathyroidism
coarctation of aorta
obstructive sleep apnea
complications of hypertension
left ventricular hypertrophy (form of early end-organ damage due to HTN)
aortic dissection
severe hypertension
↑ arterial blood pressure →↑ afterload (back pressure) on left ventricle → work hard to pump against ↑ afterload
left ventricular hypertrophy
complications of LVH
↑ myocardial O2 demand (more tissue to oxygenate)
LV becomes stiffer (less compliant)
LV holds less blood during diastole (thickened muscle grows inward into lumen of LV + stiff and can’t relax to fill with blood)
result: left sided heart failure + MI risk
heart sound heard with stiffened left ventricle
S4
tear in INTIMA (inner layer) of aorta → blood between layers of media → false lumen → blood pumped into 2 lumens
aortic dissection
blood vessel layers
intima (inner)
media
adventitia (outer)
2 main causes of aortic dissection
HTN (ASCENDING - most common cause)
aortic disease: cystic medial necrosis from Marfan syndrome
“tearing” chest pain radiates through to the BACK
may have HIGH bp
aortic dissection
WIDENING of mediastinum on CXR (need to follow up with CT with contrast)
aortic dissection
type of aortic dissection that involves ASCENDING AORTA or AORTIC ARCH (regardless of how far it travels down)
stanford type A
require SURGERY (life-threatening)
type of aortic dissection that is confined to DESCENDING AORTA (distal to L subclavian artery)
stanford type B
require drugs
B = below branches
antihypertensive DOC for aortic dissection
B blocker: reduce arterial pressure + reduce slop of rise of blood pressure (due to contracting beat of heart - does the most damage with aortic dissection)
definition of HTN urgency
equal to or greater than 180/120 mmHg
WITHOUT end-organ damage (EKG changes, headache, vision, chest pain, renal insufficiency, flash pulm edema)
definition of HTN emergency
equal to or greater than 180/120 mmHG
WITH end-organ damage
treatment of HTN urgency or emergency
lower bp quickly: short-acting (IV infusion that can be titrated) IV nitroprusside (cyanide toxicity) IV labetalol
hypertension + high bp in arms, low bp in legs
coarctation of arota
hypertension + young individual with acute onset tachycardia
stimulant:
cocaine
amphetamine
hypertension + proteinuria
kidney disease
hypertension + hypokalemia
hyperaldosteronism
renal artery stenosis: sense low bp →↑ aldosterone →K+ wasting
hypertension + hyperkalemia
renal insufficiency
