Hypertension Flashcards
Prehypertension
120-139/80-89
Stage 1 Hypertension
140-159/90-100
Stage 2 Hypertension
greater than 160/100
Symptoms
primarily asymptomatic
most common symptom is a headache
Who do you screen for hypertension?
screen annually for adults over 40, or adults 18-39 who have risk factors for hypertension and have had a previous reading of or greater than 130-139/85-89; every three years otherwise
Ambulatory Blood Pressure Monitoring (ABPM)
a device that takes blood pressure measurements over a 24-48 hour period, usually every 15-20 minutes in the daytime and every 30-60 minutes at night
identifies white coat syndrome, masked hypertension, “non-dipping”
gold-standard, but not available in most clinics
Home Blood Pressure Monitoring
best method if ABPM is not available
at least 12-14 measurements should be obtained, with both morning and evening measurements, over a period of one week
Automated Oscillometric Blood Pressure Measurements (AOBP)
a device that can average multiple consecutive readings with the patient resting alone in a room (removes white coat readings)
Office Based Readings
BP should be taken at least 2 times per visit, separated by at least 1-2 minutes, and averaged
Diagnosing Hypertension
based on the average of 2+ readings at each of 2+ office visits after initial screening
do not need multiple checks if there is evidence of end-organ damage, retinal damage, or severe hypertensive symptoms
Treatment
thiazide diuretics (best for African Americans and obese) reduce plasma volume initially, then reduce peripheral vascular resistance long-term
long-acting Calcium Channel Blockers cause peripheral vasodilation
ACE Inhibitors or ARB (NOT BOTH); ACE Inhibitors are first-line for patients with HF, symptomatic LV dysfunction, STEMI/NSTEMI, diabetes, systolic dysfunction, proteinuric chronic kidney disease
Nonpharmacologic Therapy
DASH diet, activity, weight reduction, smoking cessation
Essential Hypertension
95% of hypertensive patients
idiopathic – cannot single out a single causative agent
more common in African Americans
onset 25-50 years old
assess for end-organ damage and secondary causes
Labs: BMP, Urinalysis – ensures no renal damage, Lipid Profile, and EKG
Secondary Hypertension
5% of hypertensive patients
has treatable, underlying cause
When to consider secondary hypertension:
unusual presentation of hypertension (onset under 20 or over 50)
abrupt onset of hypertension in a patient with previously normal BP
initial presentation of stage 2 hypertension, hypertensive urgency, or hypertensive emergency
resistant hypertension (clue if a patient does not respond to three medications)
