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
TEST: If patient has angioedema, don’t use
ACE inhibitor
pregnancy don’t use ACE inhibitor, ARB, or renin inhibitor
For patient in ER with HTN, don’t give _________, give ________
hydrochlorothyazide
give Lasix (furosemide)- loop diuretic
**can give thiazides for more long term care after
Side effects of Diuretics (Thiazides, loop)
- Initially lower plasma volume but decrease SVR (systemic vascular resistance) long-term
- electrolytes, gout, ED, hyperkalemia
Renin inhibitors
Lack efficacy data over ACE-I/ARB
Renin inhibitors
Lack efficacy data over ACE-I/ARB
ACE-I
Inhibits RAAS, prevents degradation of bradykinin
Aldosterone receptor blockers
may cause
- CHF, cirrhosis
- Can lead to gynecomastia, hyperkalemia, breast pain
Aldosterone receptor blockers
may cause
- CHF, cirrhosis
- Can lead to gynecomastia, hyperkalemia, breast pain
CCBs
Peripheral vasodilation with less reflex tachy/fluid retention
**Caution in CHF
Alpha Blockers
-Lower PVR; useful with BPH
**First-dose hypotension, caution in CHF (have to start slowly and use at nighttime, cant use of EF is low)
Central sympatholytic (clonidine, methyldopa)
- Stimulate alpha in CNS thus reducing efferent peripheral SNS outflow
- ED, rebound HTN, dry mouth, caution in pregnancy with methyldopa
Direct vasodilators (list 2)
Hydralazine/minoxidil
HTN Urgencies
- Treat when acute end-organ damage or BP > 220/125*
- Reduce ~ 25% in first 1-2 hrs and then target
HTN Urgencies
- Treat when acute end-organ damage or BP > 220/125*
- Reduce ~ 25% in first 1-2 hrs and then target
