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Clin Med - Cardio Exam #1 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Define HTN

A
  • systolic: over 140
  • diastolic: over90
  • must have more than 2 readings
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2
Q

What are the three occasions to measure BP?

A
  • clinic
  • home monitoring
  • ambulatory setting
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3
Q

What are the BP classifications?

A
  • normal
  • preHTN
  • stage I HTN
  • stage II HTN
  • isolated systolic HTN
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4
Q

normal BP values

A
  • systolic: less than 120
    AND
  • diastolic less than 80
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5
Q

preHTN values

A
  • systolic: 120-139
    OR
  • diastolic: 80-89
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6
Q

stage I HTN values

A
  • systolic: 140-159
    OR
  • diastolic: 90-99
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7
Q

stage II HTN values

A
  • systolic: over 160
    OR
  • diastolic: over 100
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8
Q

isolated systolic HTN values

A
  • systolic: over 140
    AND
  • diastolic: under 90
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9
Q

What can happen with preHTN?

A

develops into stage I HTN in 50% pts w/in 4 yrs

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10
Q

T/F: HTN before 50y/o leads to majority having diastolic HTN.

A
  • false, combo systolic and diastolic
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11
Q

T/F: HTN after 50y/o leads to majority having diastolic HTN.

A
  • false, systolic
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12
Q

HTN epidemiology

A
  • prevalence increases w/ age

- MC: blacks more than whites ==> appears earlier in life, more severe, and higher rates of M+M

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13
Q

T/F: HTN doubles risk of all CV dz.

A

true

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14
Q

Systolic BP tends to _____ w/ age. Diastolic BP _____ until age 55, then it ____.

A
  • rise
  • increases
  • decreases
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15
Q

Why is SBP higher in women over 60 in comparison to men over 60?

A

menopause –> estrogen is CV protective

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16
Q

What is the consequence of the difference in changes of systolic v. diastolic BP?

A

widening of pulse pressures

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17
Q

Which BP, systolic or diastolic, is a better predictor of morbid events in older patients?

A

systolic

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18
Q

Which elevated BP, systolic or diastolic, is a more important CV risk factor in younger, healthy patients?

A

diastolic

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19
Q

Why is there such a low rate of control of HTN?

A
  • poor access to health care/Rx
  • lack of adherence w/ long term tx
  • silent dz therefore pt has no drive to tx
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20
Q

HTN complications

A
  • hypertensive cardiovascular dz
  • hypertensive cerebrovascular dz + dementia
  • hypertensive kidney dz
  • atherosclerotic complications
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21
Q

What is the MC cause of death in HTN pts?

A

hypertensive cardiovascular dz

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22
Q

Describe the pathophys of hypertensive cardiovascular dz

A

LVH –> CHF –> ventricular arrhythmias –> MI –> death

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23
Q

What part of the pathophys of hypertensive cardiovascular dz is preventable?

A

LVH

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24
Q

HTN is the MC and most important risk factor for which dzs?

A

ischemic + hemorrhagic strokes

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25
Q

Which BP measurement does hypertensive cerebrovascular dz + dementia correlate to?

A

systolic

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26
Q

T/F: hypertensive cerebrovascular dz + dementia incidence will not decrease with tx.

A

false (preventable)

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27
Q

What is the MC etiology of secondary HTN?

A

primary renal dz

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28
Q

T/F: Liver is both a target and cause of HTN.

A

false, kidney

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29
Q

Which BP measurement does hypertensive kidney dz correlate to?

A

systolic

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30
Q

Who is hypertensive kidney disease more common in?

A

blacks > whites

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31
Q

What is a reliable marker for hypertensive kidney dz?

A

proteinuria

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32
Q

What is the BP goal for hypertensive kidney dz?

A

130/80

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33
Q

Which type of HTN complication do hypertensive therapies have a lesser impact on?

A

atherosclerotic complications i.e. aortic aneurysms/dissections

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34
Q

How are atherosclerotic HTN complications controlled?

A

multiple factors including but no limited to HTN control

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35
Q

Types of HTN

A
  • primary/essential
  • “White Coat Syndrome”
  • secondary
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36
Q

primary/essential HTN etiology

A
  • no single, reversible cause
  • unknown
  • secondary to genetic and environmental factors
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37
Q

% of blacks v. whites with primary/essential HTN

A
  • 10-15% whites

- 20-30% blacks

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38
Q

age of primary/essential HTN onset

A
  • 25-55 y/o (prevalence increases w/age)
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39
Q

HTN risk factors

A
  • race (blacks)
  • age (m >55, w>65)
  • 1st deg relative w/HTN
  • obesity/wt gain
  • high salt diet
  • excess ETOH
  • metabolic syndrome
  • smoking
  • inactivity/sedentary lifestyle
  • dyslipidemia independent of obesity
  • polycythemia
  • Vit D def.
  • low K intake
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40
Q

Patients with ____ have an increased risk of developing sustained primary HTN.

A

White Coat Syndrome

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41
Q

Causes of secondary HTN

A
  • primary renal disease
  • drug induced
  • renovascular (renal a. stenosis)
  • adrenal
  • other endo d/o
  • obstructive sleep apnea
  • coarctation of aorta
  • (pre)eclampsia
  • rare genetic d/o
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42
Q

What is the MC cause of secondary HTN?

A

renal parenchymal disease (CKD)

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43
Q

What is the cause of renovascular causes of secondary HTN?

A
  • arteriosclerosis

- fibromuscular dysplaisa

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44
Q

What is the definitive diagnostic test for renovascular causes of secondary HTN?

A

renal arteriography

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45
Q

When should renovascular causes of secondary HTN be suspected?

A
  • HTN onset before age 20 or after 50
  • HTN resistant to 3+ drugs
  • epigastric or renal a. bruits
  • atherosclerotic dz in aorta or peripheral a.
  • abrupt increase in serum creatinine after ACE-I admin
46
Q

What are the causes of adrenal causes of secondary HTN?

A
  • pheochromocytoma
  • primary aldsteronism
  • Cushing’s Syndrome
47
Q

Patient presents with triad of HTN, unexplained hypokalemia, and metabolic alkalosis. What do you suspect?

A

primary aldosteronism causing secondary HTN

48
Q

75-80% of patients with what disease/syndrome have HTN?

A

Cushing’s Syndrome

49
Q

What other endocrine disorders are causes of secondary HTN?

A
  • hypOthyroidism
  • hypERthyroidism
  • hypERparathyroidism (hypERcalcemia)
50
Q

> 50% of patients with what disease/syndrome have HTN?

A

obstructive sleep apnea (OSA)

51
Q

What is the most common congenital CV cause of HTN?

A

coarctation (narrowing) of the aorta

52
Q

What are the BP screening recommendations?

A
  • 18+ y/o

- q2yrs w/BP

53
Q

What is the proper technique for measuring BP?

A
  • sitting w/ arm at heart level for min 5 mins

- after 20-30mi smoking/caffeine consumption

54
Q

A discrepancy of ____ mmHg indicates ______ –> _____.

A

A discrepancy of over 15mmHg indicates subclavian stenosis –> peripheral arterial dx.

55
Q

What do we do if we determine the patient has HTN?

A
  • assess the presence/absence of target organ damage and CVD
  • assess lifestyle + risk factors or current d/o
  • r/o identifiable/secondary causes
56
Q

HTN patient history

A
  • if applicable: duration of HTN dx, previous tx with responses + SE
  • FH
  • dietary + psychosocial hx
  • wt change
  • dyslipidemia
  • smoking
  • diabetes
  • physical inactivity
  • evidence of secondary HTN
  • evidence of target organ damage
57
Q

HTN symptoms

A
  • silent dz i.e. usually asx
  • am occipital H/A in severe HTN
  • nonspecific: dizziness, palpitations, fatigues, impotence
58
Q

When a patient presents with HTN symptoms, what are the symptoms typically related to?

A
  • complications of HTN

- manifestations of secondary HTN

59
Q

HTN physical exam

A
  • body habitus/BMI/wt/ht
  • BP, HR, palpate distal pulses
  • fundoscopic exam
  • thyroid/signs of thyroid dz
  • displaced PMI
  • auscultate the heart, a. for bruits
  • palpate kidneys
  • signs or CHF
  • neuro exam
60
Q

Given the following as S+S, what is a possible cause of secondary HTN?

  • arm to leg SBP difference greater than 20mmHg
  • delayed/absent femoral pulses
  • murmur
A

coarctation of the aorta

61
Q

Given the following as S+S, what is a possible cause of secondary HTN?

  • increase serum creatinine s/p ACE or ARB initiated
  • renal a. bruit
A

renal a. stenosis

62
Q

Given the following as S+S, what is a possible cause of secondary HTN?

  • brady/tachycardia
  • heat/cold intolerance
  • constipation/diarrhea
  • heavy, irregular, or absent menstrual cycle
A

thyroid disorders

63
Q

Given the following as S+S, what is a possible cause of secondary HTN?
- hypokalemia

A

aldosteronism

64
Q

Given the following as S+S, what is a possible cause of secondary HTN?

  • apneic during sleep
  • daytime somnolence
  • loud snoring
A

obstructive sleep apnea

65
Q

Given the following as S+S, what is a possible cause of secondary HTN?

  • flushing, H/A
  • Labile BP
  • ortho hypotension
  • palpitations, sweating, syncope
A

pheochromocytoma

66
Q

Given the following as S+S, what is a possible cause of secondary HTN?

  • buffalo hump
  • central obesity
  • moon facies
  • striae
A

Cushing’s syndrome

67
Q

What labs do you order for HTN?

A
  • urinalysis
  • CBC
  • fasting BMP
  • fasting lipids
  • TSH
  • EKG
  • echo if ? LVH
68
Q

nonpharm tx of HTN

A

LIFESTYLE MODIFICATIONS!

  • dietary salt restriction
  • wt loss
  • DASH diet
  • exercise (30mins x 5d/wk)
  • decr ETOH
69
Q

tx goals of HTN according to the JNC 8

A
  • 60+ y/o = under 150/90
  • under 60 y/o = under 140/90
  • 18+ y/o with CKD or DM = under 140/90
70
Q

primary goal of HTN tx

A

prevent end organ damage via decr BP

71
Q

secondary goal of HTN tx

A
  • minimize SE
  • minimize pt cost
  • tx comorbid conditions
72
Q

What is the single most effective intervention for slowing the rate or progression of HTN-related CKD?

A

HTN control

73
Q

pharm tx of HTN

A
  • diuretics
  • beta-blockers
  • ACE
  • ARB
  • renin inhibitors
  • aldosterone receptor blockers (not the same as ARBs)
  • CCB
  • alpha antagonist
  • central alpha agonist
  • direct vasodilators
74
Q

SE of thiazides

A
  • hypokalemia
  • insulin resistance
  • increased cholesterol
  • increased uric acid
75
Q

Loop diuretics are used in pts with what?

A
  • renal failure

- CHF

76
Q

K+ retaining diuretics are rx’d how?

A

in combo w/ thiazide

77
Q

MOA of diuretics

A
  • decrease plasma volume initially

- in long term, reduce peripheral vascular resistance

78
Q

MOE of beta-blockers

A

decr. HR and CO

79
Q

beta-blocker SE

A
  • broncospasm
  • bradycardia
  • raynaud’s
80
Q

What is a huge risk of pts not taking their beta-blockers daily?

A

abrupt withdrawal can precipitate acute coronary events and severe increases in BP therefore if/when d/c, taper slowly

81
Q

beta-blocker CI

A
  • asthma/COPD
  • 2nd or 3rd degree heart block
  • sick sinus syndrome
82
Q

MOA of ACE

A
  • inhibit renin-angiotensin-aldosterone system

- renoprotective

83
Q

drug of choice in CHF and diabetes

84
Q

When do you rx an ARB in relation to ACE?

a. always with
b. prior to starting
c. when pt fails ACE
d. idk, whats an ARB?

A

ARBs are second line treatment after ACE usually d/t cough

85
Q

MOA of ARB

A

inhibits angoitensin receptor

86
Q

SE of ARB

A

hyperkalemia

87
Q

MOA of renin inhibitors

A

block renin-angiotensin system

88
Q

T/F: Renin inhibitors are not first line tx of HTN.

89
Q

aldosterone antagonist indications

90
Q

aldosterone antagonist CI

A
  • renal failure

- hyperkalemia

91
Q

aldosterone SE

A
  • hyperkalemia

- gynecomastia/impotence/menstrual irregularities

92
Q

CCB MOA

A

peripheral vasodilation

93
Q

CCB SEs

A
  • H/A
  • peripheral edema
  • bradycardia
  • constipation
94
Q

MOA of alpha blockers

A

decr peripheral vascular resistance

95
Q

When are alpha blockers given as monotherapy?

A

in men w/ BPH

96
Q

SE of alpha blocker

A

hypotension s/p 1st dose

97
Q

MOA of centrally acting alpha agonist

A

decr. peripheral vascular resistance

98
Q

MOA of vasodilators

A

decr. peripheral vascular resistance

99
Q

SE of vasodilators

100
Q

What is the first line therapy in:

  • nonblack 18+y/o
  • nonblack all ages with DM but not CKD
A

thiazide or ACE or ARB or CCB (alone or in combo)

101
Q

What is the first line therapy in:

  • blacks regardless of age
  • blacks w/DM, and no CKD
A

thiazide or CCB (alone or in combo)

102
Q

What is the first line therapy in all races with CKD w/ or w/o DM?

A

ACE or ARB alone or in combo w/other drug classes

103
Q

When is mono therapy indicated?

A

BP over 20/10mmHg above goal BP

104
Q

3 main classes used for initial monotherapy

A
  • thiazide
  • CCB
  • ACE (or ARB)
105
Q

When is the first line combo therapy indicated?

A

BP is over 20/10mmHg above goal
OR
SBP is over 160 and/or DBP is over 100

106
Q

How do you add a second drug to monotherapy?

A
  • select an agent from a different class

- add ACE/ARB to thiazide or CCB

107
Q

define resistant HTN

A

DMP over 90mmHg despite 3+ anti-HTN rx including a diuretic

108
Q

What do you do a pt f/u’s for HTN?

A
  • reinforce lifestyle modifications at EVERY visit
  • reassess risk factors at every visit
  • screen for SE at every visit
109
Q

What else do you do for txing HTN?

A

tx co-morbid/underlying conditions

110
Q

When can you reccomend ASA for HTN tx?

A
  • men 45-79 when the benefit is to reduce MIs

- women 55-79 when the benefit is to reduce ischemic stroke

Clin Med - Cardio Exam #1 (7 decks)

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