Hypertension CIS Flashcards
urgency vs emergency
urgency occurs at systolic BP over 180 or diastolic BP over 130 with no evidence of end organ damage
emergency may occur at any BP but involves DAMAGE to at least 1 organ system
signs of target organ involvment
CV
CNS
Renal
Ophthalmologic
CV: MI, angina, aortic dissection, aneurysmal dilation of large vessels, LVH, CHF
Renal: hematuria, proteinuria, AKI
CNS: cerebral edema, altered mental status, bleed, stroke
Ophthalmologic: retinal hemorrhages or exudates, papilledema, A-V nicking
what type of drug is methyldopa
alpha agonist
reponse to angioplasty when you have renal artery stenosis from atherosclerosis
not very responsive because of a progressive disease
2 causes of renal artery stenosis
fibromuscular dysplasia and atheroscleoris
medial fibromuscular dysplasia uni or bilateral
70% are bilateral,
and this type of dysplasia is the most common (85%) of the fibromuscular dysplasias
unilateral, bilateral, one kidney RAS and intravascular volume
unilateral - decreased intravas volume
bilateral and one kidney - increased intravascular volume
which of the RAS are unpredictable and may worsen hypertension
bilateral and one kidney
diagnosis of renovascular hypertension
renal ultrasound with arterial dopplers
captopril test (reactive rise in renin and large fall in BP after admin)
DSA - digital subtraction angiography
MRI - angiography
arteriography
renal vein renin ratio (ratio of 1.5 or greater)
contraindications of ACE inhibitors
bilateral renal artery stenosis
unilateral RAS with solitary kidney
pregnancy
known angioneurotic edema with prior ACE admin
ACE induced cough
secondary hypertension causes
sleep apnea drug induced causes CKD primary aldosteronism renovascular disease steroid therapy or cushing's syndrome pheochromocytoma coarctation of aorta thyroid disesae parathyroid disease
AV nicking found in
long standing HTN
papilledema found in
hypertensive emergency
cardiovascular causes of hypertension
MI acute LV failure vasculitis coarctation of aorta aortic dissection volume overload (including pulm edema) essential hypertension
coarctation of aorta
narrowing of medial layer of aorta commonly at ligamentum arteriosum 3 types -interrupted -preductal -postductal
diagnosis of coarctation
differences in UE and LE
systolic hypertension in infant
20 mmhg btwn arms difference
systolic ejection murmur in aortic outlet
cardiomegaly
rib nothcin on PA chest
3-sign on lateral chest
primary hyperaldosteronism cause
aldosterone producing adenoma
bilateral adrenal hyperplasia
secondary hyperaldosteronism causes
elevated aldosterone and renin levels
from:
diuretics, CHF, cirrhosis, ascites, nephrosis
after MI give
caution with
beta blocker, ACEI
caution: direct vasodilater
with CHF give
caution with
diuretic, ACEI, beta blocker
caution: beta blocker, and CCB
with hypertrophic cardiomyopathy give
caution with:
bb, ccb
caution: diuretic, ACEI, vasodilator
with tachyarrhythmias give
BB, verapamil
with angina give
caution with
beta blocker, ccb, nitroglycerine
caution: direct vasodilators
with copd/road give
caution with
ccb, arb, thiazide diuretic
caution: beta blockers
with aortic dissection give
caution with
nitroprusside and beta blocker
caution: drugs that increase cardiac output
with bilateral RAS be cautious with
ACEI, angiotensin blockers
with chronic renal insufficiency agent of choice
caution with:
ACEI with serum creatinine below 2.5
loop diuretics, CCB
caution: ACEI, angiotensin blockers
renal transplants be careful with
ACEI
migraine headacehes give
beta blockers, CCB
stroke or TIA give
caution with
ACEI
caution: vasodilators (may increase intracranial pressure)
diabetes give
ACEI
prenancy (preeclampsia, eclampsia)
methyldopa, hydralazine
caution: ACEI, angiotensin blockers, diuretics
gout be cautious with
diuretics
cocaine use, use __
caution with
labetalol, clonidine
caution: selective b-blockers
GI bleed use
caution
non selective beta blocker
caution beta blockers
pheochromocytoma use
caution
alpha blocker then beta blockade
caution with selective beta blocker
BPH use and caution with
alpha 1 antag (terazocin)
caution selective beta blocker
weight reduction and BP
maintain normal body weight (BMI 18.5-24.9) reduce 5-20 mm hg/10 kg weight loss
DASH eating plan and BP
diet rich in fruits, veggies, low fat dairy products with reduced saturated and total fat
-8-14 mmhg bp reduction
dietary sodium reduction and BP
reduce intake to no more than 100 mEq/day
decrease bp by 2-8 mmhg
physical activity and bp
aerobic activity for at least 30 mintues per day most days of week
-drop bp 4-9 mmhg
moderation of alcohol consumption and bp
no more than 2 drinks per day in men
no more than 1 drink per day in women
-drop bp by 2-4 mmhg
in coronary ischemia what is the preferred drug treatment
nitroglycerin
