Hypertension Flashcards
What is the new definition of Stage 1 hypertension?
SBP > 130
or
DBP > 80
On 2+ separate readings of an appropriate sized cup
What is the definition of hypertensive crisis?
SBP > 180
or
DBP > 110
What is HTN urgency vs HTN emergency?
Urgency -> hypertensive crisis WITHOUT evidence of end-organ damage
Emergency -> malignant HTN WITH evidence of end-organ damage
-> i.e. LV dysfunction, pulmonary edema, stroke / vision changes, renal failure, elevated liver enzymes
What type of hypertension is most common in men, especially younger men?
Isolated diastolic hypertension
-> isolated systolic hypertension becomes more common later in life.
What is essential hypertension and its cause? Is it more common than the other type?
Essential = primary hypertension, no cause is identifiable
-> 95% of HTN
only 5% of HTN is secondary (identifiable cause)
What causes the majority of secondary hypertension?
Intrinsic renal disease
- > i.e. Nephrosis / nephritis
- > Polycystic kidney disease
- > Renal artery stenosis (RAS)
- > Fibromuscular dysplasia
Who is most likely to get fibromuscular dysplasia and renal artery stenosis?
Fibromuscular dysplasia -> especially young women, developmental defective in large and medium muscular arteries, especially affecting renal artery
Renal artery stenosis -> especially older men, due to atherosclerosis of renal arteries
Give one sleep disorder which can cause hypertension?
Obstructive Sleep Apnea
Other than adrenal disorders, give four endocrine disorders or conditions which can cause hypertension?
- Acromegaly - GH excess
- Hypothyroidism -> Increases sodium, also increases lipid levels for hardening of arteris
- Hyperparathyroidism -> increases renin / kidney dysfunction
- Exogenous hormones -> steroids / oral contraceptives
What is one random food associated with HTN?
Licorice
What are the adrenal conditions which can cause hypertension?
Cushing syndrome (hyper ACTH, increasing cortisol), primary aldosteronism (increased Na+ uptake), pheochromocytoma
What causes of hypertension are associated with decreased distal pulses?
- Renal artery stenosis -> peripheral vascular disease / atherosclerosis
- Coarctation of aorta -> decreased lower limb blood flow
What would abdominal bruits give you suspicion for?
Renal artery stenosis -> atherosclerosis is causing whooshing of blood flow.
What condition in pregnancy is associated with high blood pressure?
Pre-eclampsia
What does hypernatremia make you think as the cause of hypertension?
Hypothyroidism -> tends to increase diastolic blood pressure via the RAA axis
Will increase sodium reuptake by kidney all around
What test should be ordered for Cushing’s syndrome suspected?
Dexamethasone suppression test
For Stage 1 Hypertension, what is the first thing that should be done to manage it?
Lifestyle modification:
- Weight loss
- Exercise
- Tobacco cessation (increases CO and peripheral vascular resistance via catecholamines)
- Decrease alcohol consumption (2 for men, 1 for women)
- DASH diet / low sodium diet.
Watch the following sketchy videos (2x speed):
- Loop diuretics
- Thiazide diuretics
- ACE inhibitors
- Alpha-drugs
- K+-sparing diuretics
When are ACE inhibitors contraindicated?
- C1 esterase inhibitor deficiency
- Bilateral renal artery stenosis -> angiotensin II is the only thing maintaining GFR by constricting efferent arteriole
- Pregnancy
Why would you use an ARB over an ACE inhibitor?
ARBs do not cause a dry cough
-> note: still contraindicated in bilateral RAS
What blood pressure meds are contraindicated in heart failure / should be used cautiously?
Calcium channel blocker -> due to negative inotropic effect
Beta blocker -> use cautiously / ramp up slowly due to negative inotropic effect
What are the best blood pressure meds to use post-MI?
Beta blocker + ACE inhibitor
What are the best blood pressure meds to use in coronary disease?
Beta blocker + Ace inhibitor, diuretic . CCB also okay
What are the bestdrugs to use in diabetes and what should be avoided?
Ace inhibitor / ARB
Avoid: Beta blocker -> harder to tell if hypoglycemic except for sweating
Best drugs for chronic kidney disease?
Ace inhibitor / ARB
What is the definition of resistant HTN?
Persistently elevated BP despite 3+ medications
What are the most common causes of resistant HTN?
Noncompliance or medications at not max dose, use of other drugs which elevate BP, volume overload, or undiagnosed OSA
How should you treat resistant HTN?
Maximize dose, add more agents, check for secondary causes (i.e. OSA, or new-onset RAS)
-> experimental obliteration of sympathetic nerve bundle to renal artery (kills B1 stimulation of renin release + drop in renal blood flow due to catecholamines).
