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ICM -- Nephrology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Risk factors for primary hypertension

A

Age, Obesity, Family History, Race
Excess Na, OH
Inactivity, Diabetes, Personality Traits
Reduced Nephron Number, Low Vit D

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2
Q

Important roles of the kidney in primary HTN

A

Secretion of Vasoactive Factors

Sodium retention increasing circulating volume

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3
Q

Explain the vasoactive factors from the kidney’s role in HTn

A

Renin –> ATII

Most patiets don’t have elevated, but have inappropriately normal levels

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4
Q

How does the Na retention play out in HTN

A

Patient develop increased peripheral resistane that helps excrete retained Na without volume overload

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5
Q

Aside from the abnormal renin and Na effects, other important components of primary HTN physiology

A

Elevated adrenergic activity
Hyperinsulinemia
Blockage of Na/K ATP-ase

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6
Q

Renal causes of 2dary HTN

A

Renal Parenchymal Disease

Renovascular HTN

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7
Q

Elaborate the role of renal parenchymal disease in 2ndary HTN

A

CKD, Acute GN, AKI

Sodium retention, increased Renin Release, and increased sympathetic activity

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8
Q

Elaborate the role of renovascular disease in 2ndary HTN

A

Atherosclerosis, fibromuscular dysplasia
Treat w/ ACE Inhibitor and follow renal Fxn
Renal artery stent/angio in select patients (fibromuscular)

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9
Q

Endocrine causes of secondary HTN

A 
Hyperaldosteronism
Pheochromocytoma
Hyper/hypothyroidism
Hyperparathyroidism
Cushing's
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10
Q

Suspect hyperaldosteronism in patients with triad of…

A

HTN, Unexplained hypokalemia, and metabolic alkalosis

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11
Q

Non renal and Non endocrine causes of 2ndary HTN

A

Coarction of the Aorta
Drug Induced
Obstructive Sleep Apnea

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12
Q

Drugs that can cause 2ndary HTN

A

Oral Contraceptives
NSAIDs
Antidepressants/Alcohol
Decongestants/Stimulants

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13
Q

Levels of Normal BP

A

Under 120, 80

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14
Q

Levels of Prehypertension

A

120-139, 80-89

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15
Q

Levels of Stage 1 HTN

A

140-159, 90-99

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16
Q

Levels of Stage 2 HTN

A

Over 160, 100

17
Q

Explain Moderate to Severe Hypertensive Retinopathy

A

DBP over 120
Retinal hemorrhages, papilledema, exhudates
assoc. w/ encephalopathy, acute HTN nephrosclerosis

18
Q

Explain “Hypertensive Emergency”

A

DBP over 120 with evidence of acute end organ damage.

Parenteral Treatment

19
Q

Explain “Hypertensive Urgency”

A

DBP over 120 in asymptomatic patients

No evidence of benefit of parenteral treatment

20
Q

Important rules to diagnosing HTN

A

Can’t diagnose if already medicated, acutely ill

Required 2+ visits showing HTN on certified equipment

21
Q

Preferred method of diagnosing HTN?

A

ambulatory

22
Q

Physical exam findings that indicate risk for HTN probs

A

Obesity, Fundoscopic Exam, Thyroid Exam, Heart/CV and Lung Exam, Aneyursm, Bruits

EKG

23
Q

Lab tests that may indicate probs with HTN

A

Urinalysis, Fasting blood glucose, fasting lipid profile, serum electrolytes and creatinine

24
Q

What do you see on the EKG of a HTN patient

A

Dropped ST

Inverted Q

25
Q

Why do an echo on a HTN patient

A

Assess L ventricular mass, which corellates w/ negative outcomes

26
Q

Target of therapy for low risk patients over 60? Who are low risk patients?

A

under 150/90

No diabetes, CKD, or target organ damage

27
Q

How does the treatment goal change for low risk HTN patients under 60

A

140/90 goal

28
Q

Target of HTN therapy for high risk patients

A

Below 130/80

29
Q

Important lifestyle modifications to suggest for HTN patients

A

Lose weight if overweight + Exercise
DASH diet
Dietary Na Reduction
Moderate OH Activity

30
Q

Important rules of DASH diet

A

Fruits and Vegetables (4-5 servings/day)
Low fat Dairy Products (2-3)
Low total+saturated fats

31
Q

First line drugs for Stage 1 HTN

A

Thiazides

ACE-i of CCB also fair game

32
Q

WHy use a diuretic for HTN?

A

Correct Na excretion defect

Lower peripheral resistance

33
Q

If treating diabetic or black patients, first line antihypertensives include…

A

Thiazide

CCB

34
Q

First line treatment of HTN in patient with CKD + HTN

A

ACEi or ARB

ICM -- Nephrology (9 decks)

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