Hypertension Flashcards
classification of normal blood pressure
<120 AND <80
classification of elevated blood pressure
120-129 AND <80
classification of stage 1 hypertension
130-139 or 80-89
classification of stage 2 hypertension
> or equal to 140 or > or equal to 90
risk factors for primary htn
smoking unhealthy diet excess alcohol intake obesity/weight gain physical inactivity dyslipidemia and others
secondary htn etiology
renal disease renovascular disease obstructive sleep apnea coarctation of the aorta primary hyperaldosteronism cushing's syndrome pheochromoctoma medication induced
what is the gold standard for diagnosing elevated blood pressure
ambulatory blood pressure monitoring
what is white coat HTN
erroneously high BP in clinic due to anxiety
what is masked HTN
erroneously low BP in clinic due to being sneaky
what is nocturnal monitoring
useful in predicting cardiovascular events
Basic an optional tests for primary HTN *know well
fasting blood glucose complete blood count lipid profile serum creatine with eGFR serum sodium, potassium, calcium thyroid-stimulating hormone urinalysis electrocardiogram urinary albumnin to creatine ratio in all patients with diabetes or chronic kidney disease
Management of htn first line for ALL patients
dietary modifications: low salt, DASH, EtOH reduction
exercise 3-4 days week
achieve and maintain a healthy weight
smoking cessation
management of htn medications
Diuretics
angiotensin converting enzyme inhibitors ACE-1
angiotensinogen receptor blockers ARB
calcium channel blockers CCB
beta blockers
alpha blockers
central alpha agonists
direct renin inhibitor
what do you use for initiation of antihypertensive drug therapy
first line include thiazide diuretics, CCBs, and ACE inhibitors or ARBs
what do you use for stage 1 initial medication
a single hypertensive drug is reasonable, titrating up or adding a second medication as need to achieve BP goal
what do you use for stae 2 initial medication
starting with 2 first line agents of different classes
how often do you follow up
monthly after starting/change dose of medication until control is achieved
if chronic kidney disease what med should be first
if albuminuria greaterthan or equal to 300 or creatinine then should be an ACE inhibitor
if diabetes mellitus what med first
if albuminurea present ACE or ARB should be considered if not use first line choices
if heart failure what med first
avoid nondihydropyridine CCBs not recommended if ejection fraction is reduced
should receive ACE, ARB, or beta blocker if ejection fraction is preserved
Diuretics MOA
decreases body’s sodium stores by inhibiting sodium reabsorption in the nephron
reduces plasma volume and peripheral vascular resistance
Thiazide-type diuretics preferred what to monitor and contras
Chlorthalidone
monitor for hyponatremia, hypokalemia, uric acid and calcium levels (electrolyte imbalance)
contras: sulfa hypersensitivity
Loop diuretics (secondary agents) diuretics preferred what to monitor and contras
furosemide (lasix)
preffered diuretic in symptomatic HF
monitor for hyponatremia, hypokalemia, and calcium levels
contras: sulfa sensitivity
potassium sparing diuretics diuretics preferred what to monitor and contras
triamterene
weak antihypertensives
Ses: hyperkalemia nephrolithiasis, renal dysfunction
caution combining with ACE-1, ARB, DRI, K supplements
