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Primary care > Hypertension > Flashcards

Hypertension Flashcards

1
Q

1 killer in us

A

hypertension

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2
Q

major determinant in reduction of CV risk

A

BP reduction

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3
Q

prevalence htn

A

1 in 3; only 25% controlled

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4
Q

most common risk factor for MI stroke

A

htn

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5
Q

complications of htn

A 
lvh 
hf
stroke
ischemic heart disease
MI 
CKD
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6
Q

Screening BP

USPSTF

JNC-7

A

USPSTF- annual screening

adults over 40 + high risk (

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7
Q 
Goals JNC7 vs JNC8
No comorbidities: 
DM: 
CHF:
Renal insufficiency:
RF with proteinuria:
A

no com: 140/90; 80 150/90
CHF: 130/80; ——
Renal insuffiency: 125/75;

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8
Q 
Optimal 
Normal 
Pre-htn 
Stage I 
Stage II
A 
Optimal: 115/80 
Normal: 120/80 
Pre HTN: 120-139/80-89 
Stage I: 140-159/90-99 
Stage II: >160/100

two readings from two separate office visits

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9
Q

Definition of BP

A

Cardiac output (volume of blood) X systemic vascular resistance

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10
Q

-
-

A
  • sympathetic nervous system
  • renin-angiotensin-aldosterone system
  • plasma volume
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11
Q 
Sympathetic nervous system 
"---------"
increases \_\_\_\_, \_\_\_\_\_, \_\_\_\_\_ 
stimulates???
Shunts blood.....
A

fight or flight
increases HR, strength of contraction, rr
stimulates kidney renin release
shunts blood flow to critical organs (cardiac skeletal vasodilation, skin and GI vasoconstriction)

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12
Q 
Renin-angiotension system 
why block angiotensin I 
1.
2.
3.
4.
A

na/fluid retention

  1. renin release (kidneys detect decreased bf, renin secreted)
  2. renin mediated conversion (angiotensinogen to 2)
  3. angiotensin converting enzyme (ACE) conversion (angio I to ACE to angiotension II; occurs in pulmonary vasculature)
  4. angiotensin II effects (NA and H20 retention -increased SVR, antagonist to nitric oxide -vasodilator)
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13
Q

risk factors for HTN

A 
age 
obesity 
family history - 2x as common if parent 
race- AA 
high NA diet 
Excessive alcohol 
DM 
dyslipidemia
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14
Q

Secondary HTN causes

A 
OTC meds (OCP, NSAID, TCA, SSRI, glucocorticoids, decongestants, weight loss meds, stimulants) 
Renal disease 
Hyperaldosteronism (hypokalemia, met alk) 
sleep apnea 
pheochromocytoma 
cushings 
thyroid 
pregnancy 
coarctation
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15
Q

Most common form of hypertension

med choice

A

Isolated systolic hypertension

>140

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16
Q

Metabolic syndrome diagnosis

A 
3 or more of following: 
Abdominal obesity >40 men >35 women 
Glucose intolerance >110 fasting 
High trig (>150) 
HTN >130/85 
Low HDL
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17
Q

S3 s4

A

heart failure HTN

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18
Q

aortic insufficiency

A

murmur

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19
Q

heaves, lifts, displaced PMI

A

LVH

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20
Q

labs

A 
Electrolytes 
Creatinine 
Fasting glucose 
Urinalysis 
Lipid 
ECG 
Echo
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21
Q

Elderly considerations

A

combo therapy if SBP >160 or DBP >100

pseudohtn from calcified arteries
hypotensive episodes: ambulatory blood pressure monitoring

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22
Q

Elderly doc

-
-

A

thiazide diuretic

dehydration
orthostatic hypotension
hypokalemia

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23
Q

Diabetes BP

Goals

A

JNC 8

24
Q

First line medication choice diabetes htn

second line

A

ace-i (increase GFR, decreases proteinuria)
OR ARB

then thiazide diuretic

25
Q

AA HTN respond best to

A

thiazide or CCB above ACEI

increased risk angioedema

26
Q

Ambulatory BP monitoring indications

HTN criteria

A

Newly dx, white coat htn, drug resistant, symptomatic hypotesion

24 average of 130/80
awake average 135/85
asleep average 120/70

27
Q

When to treat htn
1st-
2nd-
3rd-

A

1st lifestyle

JNC8 SBP >140 for 150 if >60
DBP >90 despite lifestyle mod

Initiate combo therapy if: Baseline >160/100- beware of orthostatic hypotension

28
Q

Management BP in low risk patient (no CV risk or target organ damage)
Prehtn
Stage 1
Stage 2 or greater

A

Pre – HTN: 120-139/80-89
Lifestyle Modification

Stage I: 140-159/90-99
Lifestyle Modification
After up to 6-12 months
Thiazide diuretic

Stage II or greater >159/99
Lifestyle Modification
HTN combination therapy

29
Q 
Management of BP in moderate risk patient
define moderate risk 
Prehtn 
stage 1 
stage 2
A

Smoker, Dyslipidemia, Renal Insuff, >60 years
Male or postmenopausal with + CV FMH

Pre–HTN: 
120-139/80-89
Lifestyle modification
Stage I: 
140-159/90-99
Lifestyle Modification 
Thiazide diuretic  
Stage II or greater
>159/99
Lifestyle Modification 
HTN combination therapy
30
Q 
Management of high risk 
define high risk 
pre htn 
stage 1 
stage 2
A

TOD or CV (LVH, Angina or Prior MI, CVA/TIA, Neuropathy, CKD, PVD, Retinopathy)

Pre-HTN or greater
Lifestyle modification
Antihypertensive
Combination therapy if >20/10 over goal

31
Q

Management general guidelines

Titration

Combination therapy if

A

one step titration- most efficacy

combination if >20/10 mmHg above goal

32
Q

Dx orthostatic hypotension

A

within 2-5 minutes of standing
20 drop SBP
10 drop DBP
symptoms cerebral hypoperfusion dizziness

33
Q

HTN diet

Salt intake

A

No added salt

34
Q 
DASH diet 
whole grains 
vegetables 
fruits 
nuts, seeds, legumes
dairy 
fats/oils

other: sweets, sodium, red meat, cholesterol

A 
whole grains 6-8 
vegetables 4-5 
fruits 4-5 
nuts, seeds, legumes 4-5
2-3 dairy 
2-3 fats oils
35
Q

Exercise recommendations

A

150 a week
3x a week at least 30 minutes
4-6 drop SBP
3 drop DBP

36
Q

Weight loss reduction

A

1 mmhg for every lb

37
Q

-

SE:

mechanism of action:

A
  • hctz - chlorthalidone

Potassium loss occurs only during the first two weeks of therapy
Unless there is an external loss or dosage change

Acts by decreasing blood volume

38
Q

chlorthalidone
benefits

cautions:

A

Longer half life, Reduced risk of heart failure

Caution hypokalemia, hyponatremia, hyperglycemia, and hyperurecemia

need to cut in half

39
Q

ACE inhibitor
Action:

First line therapy for:

Contraindicated in:

A

Block conversion from Angiotensin I to angiotensin II

First line therapy:
HF or LV dysfunction (Reverse remodeling)
DM
Proteinuric kidney disease (renal protective)

Absolutely Contraindicated in Pregnancy/Breast feeding

40
Q

AceI adverse effects

A

-AA more prone to angioedema
Can occur months to years after starting
ACE angioedema not a normal allergic reaction Treatment removal of drug and supportive care (airway management)
-Cough (dry and irritating) - 5 to 20%
More common in women and black patients
stop within 4 days when medication stopped
-Hyperkalemia (5% of patients)
-Renal Insufficiency (Baseline Serum Creatinine

41
Q

ARB
Contraindication

peak effects

proteinuria compared to ace

A

contraindication: already on ACE, previous angioedema

4-6 weeks

proteinuria control equal to that of ace

42
Q

CCB
drugs
mechanism of action

reynauds??

A
  • Dihydropyridines – Amlodipine (Norvasc)
  • Non-Dihydropyridines – Diltiazem, Verapamil

Myocardial (non-dihydropiridine) and vascular smooth muscle relaxation

Favorable in reynauds

43
Q

Amlodipine
Action
SE

A 
Peripheral vasculature
Adverse Effects: Peripheral Edema 
Women
Doses >5 mg
Adding Ace decreases edema
44
Q

Diltiazem, Verapamil (nondihydro)

Action

A

Negative inotrope
Peripheral vasculature and cardiac tissue
Slow AV node conduction

45
Q

CCB adverse effects

A 
Hypotension
Flushing
Nasal congestion
Tachycardia
Dizziness
Nausea
Nervousness
Bowel Changes
\+ PERIPHERAL EDEMA
46
Q

Beta blockers
Action: inhibit _____ reduce _______ and ______ and _____ demand

Beta 1
Beta 2

A

Inhibit effects of circulating catecholamines and reduces myocardial contractility – reduces HR and myocardial O2 demand

Block beta adrenergic receptors
Beta 1:
Cardiac Muscle (Contraction)
Allows calcium entry into cells
Inotropic and chronotropic effects
Beta 2:
Smooth muscle
Bronchioles
47
Q

Beta blockers general info

Cost

Weaning

Initial therapy??

A

well tolerated low cost

must wean

Not used for initial therapy unless specific indication: Known CAD, MI, Systolic dysfunction

48
Q

Beta blockers SE

A 
SA and AV nodal blockade
Hypotension or Orthostasis
Bradycardia
Bronchospasm(Unlikely to occur in cardioselective) 
Major Depression exacerbation
Fatigue 
Exercise intolerance
Weight gain
Sexual SE
49
Q

Beta blockers med list
Beta 1
Nonselective beta 1 and 2
Alpha 1 Beta 1 Beta 2

A

Beta 1: atenolol, bisoprolol** most, metoprolol
Nonselective: timolol, nadolol, propanolol
Combined: labetalol, carvedilol (has most BP reduction)

50
Q

Systolic hf med choices

A

ACE, ARB, BB, Diuretic

51
Q

Post MI med choices

A

ACEI, ARB, BB

52
Q

Proteinuria CKD med choices

A

ACE ARB

53
Q

Angina med choices

A

BB CCB

54
Q

Afib rate control med choices

A

BB

(nondihydro) verapamil diltiazem

55
Q

Contraindications

Angioedema

A

angio-ace
bronchospasm- BB
pregnancy- ACE ARB
heart block-BB nondihydro (verapamil and diltiazem)

56
Q

Nocturnal BP should be ___% lower than day

Night time dip

A

15%

if does not dip at least 10% strong predictor of CV outcome compared to daytime

Shift a drug from am to pm
reduce mean BP

Primary care (16 decks)

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