Hypertension CIS Flashcards
to diagnose hypertension
need TWO readings
essential HTN
no known cause - idiopathic
most likely cause of HTN
essential - no known cause
risk factors for essential HTN
obesity high salt diet hereditary alcohol age
headaches and HTN
don’t treat to solve headache
HTN risk of what conditions
stroke MI heart failure ESRD aortic dissection PVD
HTN in young**
increased peripheral vascular disease (vasospasm)
- level of small arterioles
- both systolic and diastolic elevated
HTN in old**
aorta stiff - collagen replaces elastin
-isolated systolic HTN**
recommended life-style modifications for patient
minimum 30 minutes most days of week
-HR elevation 70% (220-age)
DASH diet - fruit, veggies, low fat
moderation of alcohol - less than 2/day or 10/week
treat with drugs or wait for lifestyle mods?
drug.
intitial HTN med for non-black
ACE (-)
ARB
CCB
thiazide diuretics
initial HTN med for black
CCB
thiazide diuretics
cushings
- adrenal overactivity
- striae - fast weight gain
- cause of HTN
dexamethasone suppression test
cushing test
secondary HTN
- hard to control HTN
- compelling ginding
- atypical age
- absence of predisposing factors
renal artery stenosis
cause of secondary HTN
Dx for renovascular HTN
captopril DSA MRI - angiography arteriography renal vein renin ration
captopril
rise in renin and large fall in BP after administration
captopril - ACE (-)
- abnormal test - renovascular disease
- diagnosis - renal artery stenosis
two main causes of renal artery stenosis
- atherosclerosis
- fibromuscular dysplasia
careful with these meds with renal a. stenosis
ACE (-)
unilateral - BP falls
bilateral - unpredictable, may worsen HTN
one kidney - unpredicatble, may worsen HTN
fibromuscular dysplasia
young females
bilateral renal a stenosis
responds to angioplasty
atherosclerosis
older males
unilateral renal a stenosis
test for hyperthyroid
TSH
black with hyperthyroid meds for HTN
beta-blocker
- non-selective
- propanolol
HTN with low K
hyperaldosteronism
hypokalemia is the clue**
hypertensive urgency
systolic > 180
diastolic > 130
NO evidence of organ damage
hypertensive emergency
any BP - includes end organ damage
secondary hyperaldosteronism
diuretics CHF cirrhosis ascites nephrosis etc
weak with hyperaldosteronism?
hypokalemia - muscle weakness
Tx for hyperaldosterone HTN
spironolactone
-aldosterone blocker**
adrenal conditions with 2nd HTN
cushings
hyperaldosteronism
pheochromocytoma
test for pheochromocytoma
VMA levels
coarctation of aorta
difference in BP arms to legs
-20mmHg
also - systolic ejection murmur
can cause secondary HTN
narrowing medial layer of aorta
- commonly at ligamentum arteriosum
- interrupted, preductal, postductal
