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Clinical 2.0 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

why dose hypertension seem to be more prevalent in the older categories

A

females live longer so more of them around

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2
Q

hypertension is a sig risk factor for?

A 
cerebrovascular disease
coronary artery disease
congestive heart failure
renal failure
peripheral vascular disease
dementia
atrial fibrillation 
erectile dysfunction
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3
Q

what does it mean when a patients home readings correlate with the doctors readings

A

white coat hypertension not an issue

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4
Q

what is the blood pressure target according to chep

A

140/90

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5
Q

what is the ultimate goal of therapy

A

reducecardiovascular and renal morbidity and mortality

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6
Q

what is the difference between the effects of systolic and diastolic levels and morbidity

A

increasing the diastolic doesnt really change the death rate, increasign systolic see a significant increase in death rate

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7
Q

what is the sprint trial

A

randomized control trial of intensive vs standard blood pressure control

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8
Q

who was involved in the sprint trial

A

9361 patients at high risk of CVD

people with DM2 or LVEF <35% were excluded

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9
Q

what were the interventions for sprint trial

A

intensive <120 vs standard <140 blood pressure control with any antihypertensive for 3.3 years

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10
Q

what were the outcomes of sprint

A

intensive slightly lowered the risk of CV complications and mortality but
increased the number of serious adverse events and renal failure

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11
Q

what did chep think of sprint

A

high risk patients should target<120 but caution should be taken in certain high risk groups

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12
Q

drug causes of hypertension

A

nsaid increase salt and fluid retention so increase CO therefore BP
decongestants
alcohol
estrogen

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13
Q

how long should you allow non drug therapy before considering medications

A

3-6 months

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14
Q

non drug measures

A 
salt intake - 2000mg 
dash diet - ruit, veges, low fat dairy, fiber, whole grain, low sat fat and cholesterol 
exercise 30-60 min 4-7 days 
bmi of 19-25
moderate alcohol intake 
reduce caffiene
stress management 
self monitoring BP
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15
Q

salt reduction recommended?

A

no RCT measuring health outcomes for when salt intake is less than 2.3g
likely to cause harm in both hypertensive andnormotensive people although there is no proof of this either

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16
Q

what was the allhat trial trying to determine

A

major outcomes in high risk hypertensive patients randomized to ACEi or CCB or diuretic

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17
Q

who was involved in the allhat trial

A

33357 patients with hypertension and 1 or more other risk factor for CHD events

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18
Q

what was the intervention in the allhat trial

A

chlorthalidone, lisinopril, or amlodipine for 5 years

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19
Q

what are the results of the allhat trial

A

all reduced BP the same
no diff between fatal CHD or non fatal MI
no difference in mortality

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20
Q

common side effects of thiazides

A

increase urination - short lived
muscle cramps
biochemical abnormalities

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21
Q

what are the biochemical abnormalities with thiazides

A

decreased sodium and potassium
increase uric acid
increased glucose and lipids - dont bother discussing

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22
Q

cautions for thiazides

A

history of gout
hypokalemia
hyponatremia

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23
Q

side effects of acei

A

cough

increase serum creatinine and potassium

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24
Q

cautions for aceis

A

history of bilateral renal artery stenosis
nsaid use becuase they inhibit prostaglandins which cause vasodilation so then there is vasoconstriction in the arteris coming into kidneys so little blood enters the glomerulus meanwhile the acei dilates the efferent and everything goes out with little coming in so no pressure

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25
Q

side effects of beta blockers

A 
cold extremeties
fatigue 
nausea 
decreased HR 
decreased exercise toelrance 
vivid dreams 
impotence
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26
Q

cautions of beta blockers

A

asthma
severe reynauds
heart block
over 60 years old

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27
Q

side effects of calcium channel blockers

A 
flushing 
ankle edema
headache (vasodilation in cerebral)
increased HR 
non DHP: decreased HR, heart block, worsened HF, constipation
28
Q

caution in CCB

A

history of heart failure

29
Q

what was the relationship between dose and metabolic effects

A

increasing the dose leads to progressive hypokalemia and hyperuricemia without further rediction in systemic BP

30
Q

what is th eBP reduction when using 1/2 of the standard doses

A

20% reduction

31
Q

beta blocker reduction of cv events vs placebo

A

under 60 = better

over 60 = similar

32
Q

beta blocker reduction of cv events vs other antihtn

A

under 60 = similar

over 60 = worse, tiny increase in strokes

33
Q

what population should you use beta blockers in

A

over 60 yoa

34
Q

when should beta blockers be used first line for bp reduction

A

if CHF or angina or as an option for atrial fibrillation

35
Q

acei
arbs
beta blockers are less effective in which patients

A

black

36
Q

compare thiazides acei ccb and beta blockers for cost and convenience

A

all relatively cheap and most once daily or twice daily dosing

37
Q

monitoring for acei

A

cough… should go away in 2-4 weeks

check kidnye function, potassium and sCr levels in a couple of weeks

38
Q

what should you monitor for thiazides

A

check sodium and potassium in a couple of weeks

39
Q

according to chep what is the bp target for patients with diabetes

A

<130/80

40
Q

why does usa and europe have target bp of 140/90 for peoplw with diabetes

A

there are no RCT that have ever shown a bp of 130/80 to reduce complications of DM2

41
Q

what conclusions did thebmj have about antihypertensive treatment in patients with diabetes

A

antihypertensive treatment reduces risk of mortality in people with bp over 140. if systolic pressure is less than 140 further treatment is associated with an increased risk of cardiovascular death and no observed benefit

42
Q

what does chep recommend for people with diabetes and hypertension along with cardiovascular or kidney disease

A

acei or arb

43
Q

what does chep recommend recommend for people with diabetes and hypertension wihtout other disorders

A

acei
arb
dihydropyridine CCB
thiazides

44
Q

what was the allhat diabetes subgroup study

A

clinical outsomes in antihypertensive treatment of DM2
13101 patients
compared chlorthalidone, lisinopril, and amlodipine

45
Q

what was the results of the allhat diabetes subgroup study

A

no difference in outcomes between all agent
no difference of incidence of ESRD
no diference in coronary heart diseas, stroke, or combined CV disease

46
Q

what was found in the study of ace inhibitor vs the placebo or other antihtn meds in patients without albuminnuria

A

acei are the only agents known to reduce incidence of microalbuminuria in diabetes vs placebo
no sig decrease in incidence of doubling of SCr or ESRD

47
Q

what was the result of acei vs placebo or other antihtn in patients with albuminuria

A

acei reduce the progression of nephropathy to ESRD

48
Q

what is the target bp for diabetes

A

<140/90

49
Q

what is the effect of combining different medications

A

doubles th eblood pressure effects but not the side effects

50
Q

will taking antihtn at night improve outcomes and reduce side effects

A

maybe but lack of evidence so recommendations are difficult

51
Q

elderly women are more sensitive to sym inhibition and volume depletion so they will have a higher chance of what

A

higher chance of orthostatic hypotension

increased morbidity and falls

52
Q

what might low bp be associated in elderly

A

dementia
cancer
HF
MI

53
Q

what is isolated systolic htn

A

high systolic but low diastolic commin in elderly

54
Q

what does isolated systolic htn increase in the elderly

A

increase risk of stroke, MI, renal failure

55
Q

what was included in the hyvet study

hypertension in the very elderly

A

n=3845
all over 80 with a systolic BP >160
all had comorbid conditions: CV disease, DM2, smokers

56
Q

what was the intervention in the hyvet trial

A

<150/80 target

indapamide and perindopril if needed vs placebo

57
Q

what was the result of the hyvet study

A

BP <150/80 decreased CV events 3% over 2 years and 2.2% decrease in mortality

58
Q

explain the u-curve in the elderly

A

as BP gets really high and really lo increase the mortality

59
Q

how low is too low in the elderly

A

feeling hypotensive

<140/60???

60
Q

are all diuretics equal?

A

chlorthalidone found to have a longer duration of action, more potent, better bp reduction
HCTZ less CV event reduction

61
Q

is hydrochlorothiazide the best diuretic

A

chlorthalidone or indapamide are equal to and very likely superior HCTZ

62
Q

what is the treatment of hypertension after a stroke

A

anthtn therapy should be strongly considered

once patient is stable gradual BP reduction post stroke reduces risk of further strokes

63
Q

what bp target is recommended post stroke

A

<140/90

64
Q

what antihtn should be used posthtn

A

acei/diuretic combo but actually acheiving target bp may be more important than the agent

65
Q

is combo of arb and ace recommended in patients with stroke

A

no

66
Q

what antihtn do we have that can control bp and rapid heart rate

A

non DHP

beta blockers

67
Q

how to treat a hypertensive emergency

A

quiet room to rest leading to a fall of BP >10-20mmhg
tilt head of the bed 15 degrees up
consider antihtn if above 180/100 for more than 3 hours

Clinical 2.0 (24 decks)

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