Hypertension Flashcards
Risk factors for primary hypertension
Age, Obesity, Family History, Race
Excess Na, OH
Inactivity, Diabetes, Personality Traits
Reduced Nephron Number, Low Vit D
Important roles of the kidney in primary HTN
Secretion of Vasoactive Factors
Sodium retention increasing circulating volume
Explain the vasoactive factors from the kidney’s role in HTn
Renin –> ATII
Most patiets don’t have elevated, but have inappropriately normal levels
How does the Na retention play out in HTN
Patient develop increased peripheral resistane that helps excrete retained Na without volume overload
Aside from the abnormal renin and Na effects, other important components of primary HTN physiology
Elevated adrenergic activity
Hyperinsulinemia
Blockage of Na/K ATP-ase
Renal causes of 2dary HTN
Renal Parenchymal Disease
Renovascular HTN
Elaborate the role of renal parenchymal disease in 2ndary HTN
CKD, Acute GN, AKI
Sodium retention, increased Renin Release, and increased sympathetic activity
Elaborate the role of renovascular disease in 2ndary HTN
Atherosclerosis, fibromuscular dysplasia
Treat w/ ACE Inhibitor and follow renal Fxn
Renal artery stent/angio in select patients (fibromuscular)
Endocrine causes of secondary HTN
Hyperaldosteronism Pheochromocytoma Hyper/hypothyroidism Hyperparathyroidism Cushing's
Suspect hyperaldosteronism in patients with triad of…
HTN, Unexplained hypokalemia, and metabolic alkalosis
Non renal and Non endocrine causes of 2ndary HTN
Coarction of the Aorta
Drug Induced
Obstructive Sleep Apnea
Drugs that can cause 2ndary HTN
Oral Contraceptives
NSAIDs
Antidepressants/Alcohol
Decongestants/Stimulants
Levels of Normal BP
Under 120, 80
Levels of Prehypertension
120-139, 80-89
Levels of Stage 1 HTN
140-159, 90-99
Levels of Stage 2 HTN
Over 160, 100
Explain Moderate to Severe Hypertensive Retinopathy
DBP over 120
Retinal hemorrhages, papilledema, exhudates
assoc. w/ encephalopathy, acute HTN nephrosclerosis
Explain “Hypertensive Emergency”
DBP over 120 with evidence of acute end organ damage.
Parenteral Treatment
Explain “Hypertensive Urgency”
DBP over 120 in asymptomatic patients
No evidence of benefit of parenteral treatment
Important rules to diagnosing HTN
Can’t diagnose if already medicated, acutely ill
Required 2+ visits showing HTN on certified equipment
Preferred method of diagnosing HTN?
ambulatory
Physical exam findings that indicate risk for HTN probs
Obesity, Fundoscopic Exam, Thyroid Exam, Heart/CV and Lung Exam, Aneyursm, Bruits
EKG
Lab tests that may indicate probs with HTN
Urinalysis, Fasting blood glucose, fasting lipid profile, serum electrolytes and creatinine
What do you see on the EKG of a HTN patient
Dropped ST
Inverted Q
Why do an echo on a HTN patient
Assess L ventricular mass, which corellates w/ negative outcomes
Target of therapy for low risk patients over 60? Who are low risk patients?
under 150/90
No diabetes, CKD, or target organ damage
How does the treatment goal change for low risk HTN patients under 60
140/90 goal
Target of HTN therapy for high risk patients
Below 130/80
Important lifestyle modifications to suggest for HTN patients
Lose weight if overweight + Exercise
DASH diet
Dietary Na Reduction
Moderate OH Activity
Important rules of DASH diet
Fruits and Vegetables (4-5 servings/day)
Low fat Dairy Products (2-3)
Low total+saturated fats
First line drugs for Stage 1 HTN
Thiazides
ACE-i of CCB also fair game
WHy use a diuretic for HTN?
Correct Na excretion defect
Lower peripheral resistance
If treating diabetic or black patients, first line antihypertensives include…
Thiazide
CCB
First line treatment of HTN in patient with CKD + HTN
ACEi or ARB
