hypertension Flashcards

1
Q

what are the three main goals for new HTN patients

A

identify any co morbidities
asses target organ damage
exclude any secondary causes

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2
Q

what are some drugs that elevate blood pressure ?

A
estrogen 
NSAIDS 
antidepressants
corticosteroids
diet pills
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3
Q

on examination what would indicate coartication of the aorta ?

A

arm-leg discrepancy or a decrease in femoral pulse

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4
Q

what would renal bruit on examination suggest ?

A

renal artery stenosis

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5
Q

what would a buffalo hump or moon face suggest ?

A

cushing syndrome

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6
Q

what would unprovoked hypokalemia suggest ?

A

hyperaldosternism (Conn’s syndrome)

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7
Q

what would elevated hematocrit suggest ?

A

polycythemia

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8
Q

what would azotemia or proteinurea suggest ?

A

renal disease

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9
Q

what is the ABCDE approach with hypertension

A
A - Accuracy , apnea aldosteronism
B - bad kidneys 
C - cortications catecholamines cortisol 
D - Diet Drugs 
E - Endocrine erythropoeitn
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10
Q

what is the most common etiology causing 2ry hypertension in children

A

renal parenchymal disease
coartication of the aorta
left ventricular hypertrophy

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11
Q

what is the most common etiology causing secondary hypertension in older patients

A

hypothyroidism
atherosclerotic renal artery stenosis
renal failure

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12
Q

most children with hypertension secondary or primary ?

A

secondary hypertension (70-85%)

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13
Q

what routine testings could you add for children with hypertension

A

urine culture and renal ultrasonography

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14
Q

how would we confirm hypertension ?

A

Ambulatory blood pressure monitoring

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15
Q

what is the second most common cause of HTN in children

A

coartication of the aorta

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16
Q

what can confirm aortic coartication ?

A

arm-leg discrepancy and decrease in femoral pulse along with the classic 3 sign oor rib notching on the chest x ray

17
Q

what is resistant hypertension ?

A

when the patient isn’t improving and not responding to medications

18
Q

what is the best initial test when suspecting hyperaldosteronism ?

A

aldosterone :renin ratio

19
Q

when should a sample be takin for the aldosterone/renin ratio?

A

preferabbly in the morning at least 2 hrs after waking up and in the upright position

20
Q

what are the causes of hyperaldosteronism ?

A
adrenal hyperplasia ( rarley a carcinoma)
aldosterone secreting adenoma
21
Q

what drugs should the patient stop before taking a sample for aldosteron renin ratio

A
Any of :
spironolactone (aldosterone receptor agonist)
NSAIDS 
potassium wasting diuretics 
licorice (causes potassium wasting)
ACE/ARBs inhibitors
22
Q

what drugs are okay to use when preparing to test for aldosteron renin ratio

A

calcium channel blockers : verapamil
hydralazine
alpha blockers

23
Q

what to do when aldosterone;renin ratio is high ?

A

diagnostic for hyperaldosternism
if the cause is an adenoma then surgical resection
If hyperplasia, mineralocorticoid antagonist: Spironolactone - non selective

24
Q

what to consider with an old patient that has a new onset of hypertension ?

A

renal artery stenosis

atherosclerotic disease

25
what are the diagnostic investigations for renal artery stenosis ?
* Colour doppler ultrasound of renal arteries * MRA renal arteries * CT renal angiography
26
when to use MRA and when to use CTA ?
if the patient has renal insufficiency then use MRA no contrast
27
what is the problem with using renal doppler ?
operator dependent and can be changed by body habitus
28
when to suspect obstructive sleep apnea ?
patients with resistant hypertension , obese and have a wide neck circumfrence
29
what can be used to treat OSA
CPAP
30
what is the diagnostic criteria for coartication of the heart?
echocardiograph
31
what is the diagnostic criteria for cushing?
24hr urinary cortisol | dexamethasone suppression test
32
what is the diagnostic criteria for phaeochromocytoma?
urinary and plasma metanephrines
33
what is the diagnostic criteria for renal parenchymal disease ?
renal ultrasound serum creatinine , urea eGFR Urinary albumin Kidney biopsy
34
if i am still suspecting 2ry hypertension in a child what test should you do first ?
renal ultrasound
35
if i am still suspecting 2ry hypertension in a young adult ?
renal artery MRI or CTA
36
if i am still suspecting 2ry hypertension in a middle aged patient what test should i do first?
measure renin/aldosterone levels