Hypertension Flashcards
Blood pressures that qualify as “HTN”
BP is 140/90 in office multiple times or 135/85 at home= HTN
Blood pressures that qualify as “HTN”
BP is 140/90 in office multiple times or 135/85 at home= HTN
Prehypertension
120-139 mmHg SBP or
DBP 80-89 mmHg
Prehypertension
120-139 mmHg SBP or
DBP 80-89 mmHg
Stage 2 HTN
> 160 mmHg SBP or
> 100 mmHg DBP
Prehypertension
120-139 mmHg SBP or
DBP 80-89 mmHg
Etiology of HTN
- Overactivitation of SNS and RAAS
- Blunting of pressure-natriuresis relationship
- Variation in CV/renal development
- Elevated intracellular Na+/Ca+
- Exacerbating factors
NSAIDs cause hypertension, too much salt intake, family history, smoking, alcohol can all cause HTN
**Sleep apnea is a MAJOR cause of CV problems, A-Fib, HTN
Stage 2 HTN
> 160 mmHg SBP or
> 100 mmHg DBP
Higher BP and left untreated= higher incidence of
kidney disease
Another major cause of Secondary HTN……
Renal/renovascular causes:
- FMD (fiber musculodysplasia) in young women (young woman with refractory HTN, reversible cause of high BP in young women; “beads on a string”)
- Refractory HTN
- Bruits, PAD, Cr increase with ACE-I
- Pulmonary edema
OR primary renal disease
Clinical Example- If Creat is 1.2, give ACE inhibitor, creat goes up to 2.0; suspect _________
bilateral renal artery stenosis
*Flash pulmonary edema with HTN (recurrent), think renal artery stenosis
Other random causes of Secondary HTN
- Oral contraceptives, NSAIDs, cocaine/stimulants, antidepressants, calcneuriun inhibitors
- Pheochromocytoma, primary aldosteronism, Cushing’s syndrome, Sleep apnea Syndrome, Coarctation of the aorta, Hypothyroidism, Primary hyperparathyroidism
Other cases of Secondary HTN
Renal/renovascular causes:
- FMD (fiber musculodysplasia) in young women (young woman with refractory HTN, reversible cause of high BP in young women; “beads on a string”)
- Refractory HTN
- Bruits, PAD, Cr increase with ACE-I
- Pulmonary edema
Clinical Example- If Creat is 1.2, give ACE inhibitor, creat goes up to 2.0; suspect _________
bilateral renal artery stenosis
HTN may cause episodic presentations of
Pheochromocytoma
-Anxiety, palpitations, profuse perspiration, tremor, HA
Most cases of HTN are
asymptomatic (“silent killer”)
- Headaches
- If severe can cause encephalopathy with N/V, confusion, vision changes (retinopathy)
During HTN, optho exam will show
Cotton wool spots, AV nicking, hemorrhage, papilledema
-flame hemorrhages, hard exudates too
_________ should be in every treatment plan
Diet and exercise should always be in treatment- every 10 kg of weight loss BP can drop 10-20 mmHG
Fruits veg, Mediterranean diet can drop it 10 mmHg; low sodium intake; moderate alcohol; DASH diet; physical activity and weight loss
What meds to start with for treatment?
ALL race/age groups receive lifestyle modification
AA: CCB and thiazide
White (ISOLATED HTN): ACE-I and BB
However, many pts have comorbidities which should prompt targeted therapy
ie: AA pt with DM should receive ACE-I first
What meds to start with for treatment?
ALL race/age groups receive lifestyle modification
AA: CCB and thiazide
White (ISOLATED HTN): ACE-I and BB
However, many pts have comorbidities which should prompt targeted therapy
ie: AA pt with DM should receive ACE-I first
Who gets ACE inhibitor?
Whites with isolated HTN, pts with systolic heart failure, post MI, proteinic chronic kidney disease
Who gets Beta Blocker?
Pts with angina pectoris, a fib and flutter rate control
Don’t use alpha blocker if
EF is low
-use alpha blocker for pt with BPH
Don’t use alpha blocker if
EF is low
-use alpha blocker for pt with BPH
