Hypertension Flashcards
Risk factors for essential hypertension
80-95% of HTN
Salt Obesity Alcohol Angiotensin excess Sympathetic excess Family history Smoking Male sex Age
Why is HTN important?
World’s leading attributable cause of death
Most important cause of:
- Stroke
- CV disease
Major cause of:
- Renal disease
- LVH
Why treat BP?
What are the current targets?
Reduce stroke, MI and HF
Targets <140/90
Lifestyle treatments for BP?
Weight reduction
DASH diet
Salt restriction
Physical activity
Reduce alcohol intake
Medication treatments?
Stage 1 HTN = BP 140-160/90-100
- Thiazide diuretic
- consider combination with ACE-Is, ARBs, BB or CCB
Stage 2 HTN = BP >160/100
- Combination of thiazide and ACE-I, ARB, BB or CCB
- Add on as necessary
Use specific drugs for specific patient histories
Multiple drugs are better at reducing BP then single agents
Night dosing reduces mortality
Common causes of Secondary HTN
Intrinsic renal disease
Renovascular disease
Primary hyperaldosteronism
OSA
Medications:
- OCP
- NSAIDS
- Steroids
- Decongestants
- CNIs
- Ampetamines and cocaine
Uncommon Causes of Secondary HTN
Pheochromocytoma
Cushing’s syndrome
Coarctation of the aorta
Hypo/hyperthyroidism
PAN
Renovascular HTN
When to suspect?
Up to 45% of patients with HTN
Younger patients Severe or refractory HTN Increasing Cr with ACE-I or ARB Flash APO Vascular disease and HTN
Fibromuscular Dysplasia
Non-inflammatory non-athrosclerotic disorder resulting in arterial stenosis, occlusion, aneurysm and dissection
Younger women
Affects renal arteries most common and also extracranial cerebrovascular arteries
Diagnosis - angiography
CT ango, MRA or dopplers
Treatment is Angioplasty
Renal Artery Stenosis
Stenosis of 1 or both renal arteries on imaging
Treatment:
Unilateral = ACE-I or ARB
Bilateral = No ACE-I or ARB due to the theoretical ACE dependence for filtration pressure
