Hypertension - General Information Flashcards
Pharmacologic treatment for blood pressure should initiated when
(1) Age 60+
(2) Less than 60
(3) With diabetics
(4) CKD, with or without diabetes
(1) 150/90
(2) 140/90
(3) 140/90
(4) 140/90
What are the initial drug choices for HTN?
(1) Thiazide-type diuretic
(2) CCB
(3) ACE Inhibitor
(4) ARB
In the black population, those with no comorbidities, what are the initial drugs of choice for HTN? (2)
(1) Thiazide diuretic
2) CCB (long-acting dihydropyridine
Adults with CKD should receive which drug first? (2 options)
(1) ACE
(2) ARB
Drug classes you can use for treating HTN + the following diseases:
a. High Coronary Disease Risk
b. Diabetes
c. Recurrent stroke
d. Heart failure
e. Previous MI
f. Chronic renal disease
Use ACE for Ace inhibitor, ALD for aldosterone receptor antagonist, ARB for Angiotensin receptor blocker, B for beta blocker, CCB for Ca channel blocker, and D for diuretic
- You start with a diuretic in all but which 2
- Which class is indicated as a 2nd or 3rd choice for every one of these categories?
a. D, B, ACE, CCB
b. D, ACE, ARB, CCB
c. D, ACE
d. ALL of them
e. B, ACE, Ald
f. ACE, ARB
- Previous MI and chronic renal disease
- ACE inhibitors
Chronic HTN can lead to (3)
Heart disease. heart failure, and stroke
HTN is a risk factor for developing (2)
Chronic kidney disease and heart failure
What is essential HTN?
HTN with no identifiable cause. This is actually seen in 90% of patients.
What is the cause of HTN?
Results from the interplay of several
genetic polymorphisms (which individually might be
inconsequential) and environmental factors, which conspire to increase blood volume and/or peripheral
resistance.
Secondary HTN is primarily due to
Renal disease. Others: endocrine (including thyroid), cardiovascular, neurlogic (including sleep apnea)
When there is not enough blood flow to the kidney, what is released?
The kidney secretes renin
What does renin do?
Help the kideny’s retain more water, which increases blood in the arteries, which causes HTN.
What is the range for hypertensive crisis?
Systolic >180mmHg
Diastolic > 120mmHg
HTN urgency
No damage to end organs
HTN Emergency
Damage to end organs
- Confusion
- Drowsiness
- Chest Pain
- Breathlessness
- Elevated troponin
- Elevated Creatine
Why is HTN referred to as a silent killer?
With essential/primary HTN, there usually aren’t any symptoms.
- Normal BP
- Elevated
- Stage 1
- Stage 2
- <120/<80, follow up every year
- <130/<80, Lifestyle modifications, give them 6 months
- Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
- Systolic at least 140 mmHg or diastolic at least 90 mmHg
What are lifestyle modifications
- Diet, less than 2.4g per sodium per day. DASH diet. Potassium supplementation (*CKD or hyperkalemia) for citrus fruits not a tablet. Alcohol limitation
- Exercise. BMI >25, lose weight
- Weight loss
Stage 1 HTN treatment (2 things)
- Lifestyle modification, follow up 3 months.
- Medication IF they have other co-morbid conditions
another risk factor.
a. Start 1 medication
Follow up in 1 month if you start a medication.
Clinically diagnosed with HTN
2 readings
2 weeks apart
2 visits
Home monitoring- take multiple times over the course of the day. Use telehealth to see if they need to titrate. Titrate rapidly.
What is the treatment for stage 2 HTN?
Start 2 medications, which ones you choose are based on co-morbid conditions.
The patient in the ICU on an anti-hypertensive gtt should have their BP dropped
SLOWLY, 25% down. Switch to oral
Treatment for HTN & heart failure and CAD use
Beta blocker and ACE or ARB Beta blockers to use for both HF and CAD. -Metoprolol -Labetolol -nebivolol
Treatment for HTN and stroke
ACE + Thiazide
