Hypertension Flashcards
Screening (USPSTF)
Start at 18 years of age
Hypertension in a 60 year old
> 150 or > 90
Organ systems impacted by hight blood pressure
Heart Brain Kidney Blood vessels Eyes
How quickly can end organ damage begin
Within 10 years
Family Hx: Death from CAD
Men
Moderate EtOH
- 0 oz men (2 drinks)
0. 5 oz women ( 1 drink)
Kidney markers that indicate higher risk of hypertnesion
Micoalbuminuria
GFR 60 or lower
Secondary HTN
Sleep apnea CKD Endocrine: Aldosterone, Thyroid, Cortisol, Epi/Norepi, Parathyroid Coarctation of the aorta Medications/Supplements/Drugs
Percent of HTN that is essential
95 to 98
How many times should BP be taken at a single visit if elevated
Twice
- 5 minutes apart
- Once in each arm
How many visits does it take to dx HTN
At least two
Length requirements for BP cuff
80% of arm circumference
Width requirement for BP cuff
40% of arm circumference
What should you conduct a neurological exam with new onset HTN
Get a baseline
Explanatory model of illness
How a patient explains the cause of their illness, how they think they can manage it, and how they can stay healthy
Labs for new dx of HTN
ECG: Baseline UA: End organ damage Blood glucose: Risk factor Hematocrit: Anemia K+: Medication Cr or GFR: End organ damage Ca+: May indicate HTN 2/2 renal dysfunction Lipids: Risk factor Albumin or Albumin/Cr ratio: End organ damage
When should an ACEI be used for HTN in the general black population?
Age 60+ Chronic Kidney Disease - Required Diabetes - This is no longer a required medication
Which treatment population can have a goal of
Age 60+
- Unless they are diabetic or have CKD
Most cost effective medication for HTN
HCTZ
Side effects of HCTZ
Low Na+
Precipitate gout flare
Incontinent
Recommended dosages of HCTZ
25 mg is the optimal dose and be started in health adults
Pts 60+ should be started at lower doses and titrated up
Effect of weight reduction
5 to 20 per 10 kgs lost
Effect of DASH on HTN
8 to 14
Effect of Na restriction on HTN
- 100 mmol/day (2.4 g Na or 6 g NaCl
2 to 8
Effect of physical activity on HTN
4 to 9
Effect of moderate EtOH on HTN
2 to 4
ASA use in HTN
Men: 45 to 79 for MI reduction
Women: 55 to 79 for stroke reduction
Options for adjusting medication if not meeting goal
- All of the following are options
- Maximize doses
- Add second agent without changing the first
- Do a fixed combo drug
If BP is resistant to two medications
Add a third
Should alpha-blockers ever be used as first line management?
No
- No reduction in morbidity and mortality
- Not even if patient has BPH
Ethnic groups with worst BP control
Mexican and Native Americans
Which medications are renal protective, regardless of BP control?
BB
ACEI
ARB
One not so well known benefit of thiazides
Slows demineralization in osteoporosis
Good for tachyarrhythmias/fibrillation, migraines, essential tremors, and perioperative HTN
Beta blockers
Can BB mask hypoglycemia?
In theory
What patients should avoid BB
Asthma patients
Acceptable rise Cr after starting ACEI
35%
Preg C category drugs
ACEI
ARBS
Benefit of ARBS of ACEI
Less bradykinin production
Useful in raynaud’s and some arrhythmias
CCB
Contraindicated for use in essential HTN and HTN urgencies or emergencies
Short acting CCB
Cut off for starting a K sparing diuretic
K of 5+
Risk of using high dose aldosterone in CHF
increase risk of sudden death
When to refer to specialsit
Full adherence to appropriate 3 drug regimen
- One drug must be a diuretic
Maximize TLC
Often overlooked medication that worsens HTN
NSAIDs
