Hypertension Evaluation and Guidelines Flashcards
CVD Risk Factors? (10)
HTN Smoking BMI > 30 Dyslipidemia DM Microalbumiuria/GFR <60 Men> 45 Women >55 Family HX Metabolic Syndrome
What CNS target organ damage is associated with HTN? (3)
Stroke
HTN Encephalopathy
Aneurysm
What target organ damage of the eyes is associated with HTN? (2)
Papilledma,
HTN retinopathy
What cardiovascular target organ damage is associated with HTN?(4)
CV-LV Hypertrophy
HF
MI
PVD
What renal target organ damage is associated with HTN? (4)
Increase BUN
CrCl
ARF
CKD (GFR <60)
Name important considerations when measuring BP and evaluating for high BP (ie specifics of measuring) (10)
Consider >2 or more SEATED readings
At least 5 minutes in between readings
High BP must exist in >2 office visits
No Coffee or smoking within 30 min of reading
Arm with cuff at level of heart
Appropriate cuff size (at least 80% circumference of arm
Feet on floor
No crossed legs
SBP vs DBP determined with stethoscope
Check standing BP in pt at risk of orthostasis or autonomic dysfunction
What is important to remember when evaluating for orthostatic hypotension?
Stand and check BP 1-3 min after each position change
What pressure differences (systolic and diastolic) must exist to diagnose orthostatic hypotension?
Decrease in Systolic by 20mmHG
Decrease in Dyastolic by 10mmHG
What are important physical examination components when evaluating for hypertension?
BP readings height and weight (to determine BMI) Presence of carotid/abdominal/renal bruits JVD Edema Peripheral pulses Neurologic Examination
What are the two key determining factors when evaluating for HTN in children?
AGE
Normal limits based on age/sex
Goal of Hypertension treatment in Adults?
take once/day with 24 hour coverage
What is the preferred diuretic of choice in HTN?
Chlorthalidone (over HCTZ)
Range for normal blood pressure
<120/80
If range above this, encourage lifestyle habits and reasses in 1 year
What is recommended treatment for BP >120/80?
Encourage lifestyle changes, reassess in 1 year
What is the blood pressure range for ‘elevated’ blood pressure?
120-129/<80
What is the treatment recommendation for ‘elevated’ blood pressure?
Nonpharmacological therapy, reassess in 3-6 months
What is the BP range for Stage 1 HTN?
130-139/80-89
What is the recommended treatment for Stage 1 HTN?
10 year risk of CVD >10%
10 year risk of CVD<10%
If 10 year risk of CVD >10%, Nonpharmacologic therapy AND HTN meds
Thiazides(preferred if balck), ACEi, ARB, CCB(preferred if black)
Reassess in 1 year
If 10 yark risk of CVD <10%,Nonpharmacologic therapy, reassess in 3-6 months
What is the BP range for Stage 2 HTN?
> 140/90
What is the treatment for Stage 2 HTN
Nonpharmacologic therapy AND HTN meds
**Use combination w/2 first line agents in different classes
List non-pharmacological therapies for HTN? (7)
Weight loss DASH Diet Limit ETOH Aerobic activity 5 days per week, 30 min Na+ restricted <2.3mg/day Smoking Cessation Consume at least 3500mg K+ per day
What is definition of White Coat HTN (BP range in office)?
> 130/80, < 160/100
In White Coat HTN what BP range in ABPM or HBPM indicates need to start HTN meds?
> 130/80
What HTN drugs need to be avoided in PREGNANCY? (2)
ACEi
ARBS
Both are Teratogenic
What HTN Meds are safe to use in Pregnancy? (4)
Methyldopa (dug of choice)
Guanfacine (Cat B)
Hydralazine (Cat C)
Labetalol (Cat C)
What is the drug of choice for treating HTN in pregnant wormen?
Methyldopa
What are the causes of Secondary HTN (CV)? (3)
Atherosclerosis
Renovascular HTN (Actavation of RAAS)
Recurrent UTI in women (r/t scarring of kidneys)
What are the causes of Secondary HTN (Adrenal)?(3)
Cushing’s
Hyperaldosteronism
Pheochromocytoma
What are the causes of Secondary HTN (Medication Induced)? (6)
Corticosteroids Oral Contraceptives ADHD meds (stimulants) Cocaine TCAs Effexor
What are the causes of Secondary HTN (Herbals)? (1)
Locorice
What are the causes of Secondary HTN (CNS)? (1)
Intracranial HTN with increase release of catecholamines
What are the causes of Secondary HTN (Pregnancy)? (1)
Pre-eclampsia
What sleep disorder can cause secondary HTN? (1)
Obstructive sleep apnea
What are the causes of Secondary HTN (Thyroid Related)? (2)
Graves disease (systolic HTN) Hypothyroidism (diastolic HTN), due to Na+ retention
Definition of Hypertensive Crisis requiring URGENT intervention?
How to treat it (3)?
SBP>180 and/or DBP >110
No target organ damage
BP can be lowered over several hours/days
Consider hospital admission
Definition of Hypertensive Crisis requiring EMERGENCY intervention
SBP >180 and/or DBP 110
Target organ damage
Avoid sudden or drastic decrease in BP (25% reduction in MAP over several hours
Admit to hospital
