Hypertension/Hypotension Flashcards

1
Q

What are some reversible risk factors for hypertension?

A

smoking, obesity, excessive alcohol intake, physical inactivity, renal disease, dyslipidemia, and Diabetes

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2
Q

What are non-reversible risk factors for hypertension?

A

Age, race, family history of a male <65 y.o. that had a heart attack or stroke

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3
Q

Define Systole

A

-phase of cardiac cycle in which ventricles CONTRACT -point of maximal arterial pressure

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4
Q

Define Diastole

A

-phase of cardiac cycle in which the ventricles RELAX -point of lowest arterial pressure

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5
Q

Essential Hypertension

A

-The cause of the hypertension is unknown

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6
Q

Secondary Hypertension

A
  • high blood pressure that’s caused by another medical condition
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7
Q

Causes of Secondary Hypertension (Endocrine Disorders)

A

Endocrine disorders -Pheochromocytoma -Cushing’s Syndrome -Primary Aldosteronism -Congenital Adrenal Hyperplasia -Hyperparathyroidism -Hyperthyroidism, Hypothyroidism

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8
Q

Causes of Secondary Hypertension

A

Endocrine, Renal, Mechanical, Medication-Induced, “White Coat” Hypertension

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9
Q

Causes of Secondary Hypertension (Renal)

A

-Renovascular disease (stenosis) -Preeclampsia -Renal parenchymal disease

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10
Q

Causes of Secondary Hypertension (Mechanical)

A

-Coarctation of Aorta -A/V Fistula, Patent ductus arteriosus

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11
Q

Causes of Secondary Hypertension (Medication-Induced)

A

-Stimulant use -Corticosteroids -SSRIs -Abrupt withdrawal of medication -Oral contraceptives -Black Licorice

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12
Q

White Coat Hypertension

A

-Falsely elevated blood pressure secondary to measurement in a clinical setting -20-25% of patients will have false mild elevation of pressure -Pearl: LOOK AT DIASTOLIC PRESSURE -Key word: MILD -Can be clarified by ambulatory monitoring

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13
Q

Malignant Hypertension

A

-SBP ≥180 or DBP ≥120 -Most often w/ long-standing, uncontrolled HTN -Multiple other causes (see secondary HTN) -Can lead to hypertensive encephalopathy Symptoms: Headache, nausea, vomiting, non-localizing neurologic symptoms (restlessness, confusion) -Urgency/Emergency, treatment based on symptoms and exam findings -Risk for seizures and/or coma if not treated

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14
Q

What damage can occur with the Brain in association with HTN

A

Stroke Transient ischemic attack reversible ischemic neurological deficit

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15
Q

What damage can occur with the eye in association with HTN

A

Retinopathy - Papilledema - A/V Nicking - Hemorrhage - Exudates - Cotton Wool Spots

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16
Q

What damage can occur with the heart in association with HTN

A

Left Ventricular Hypertrophy

17
Q

What damage can occur with the kidney in association with HTN

A

Proteinuria Renal insufficiency

18
Q

What damage can occur with the vascular system in association with HTN

A

Peripheral Arterial Disease

19
Q

What can cause orthostatic hypertension?

A
  • ANS Disorders:
    • Multiple sclerosis
    • Parkinson’s disease
    • Peripheral Neuropathy (diabetic or other)
    • Guillain-Barre syndrome
    • Raynaud’s syndrome
    • Reflex sympathetic dystrophy (RSD)
  • Other:
    • Drugs (antihypertensives, vasodilators, antidepressants)
    • Physical deconditioning
    • Sympathectomy
    • Decreased blood volume (GI bleed, dehydration, adrenal insufficiency)
    • Idiopathic postural hypotension (familial)
    • Advanced Age
20
Q

What are some characteristics of Orthostatic Hypotension?

A
  • Significant drop in arterial blood pressure with position change
  • Represents a defect in vasomotor reflexes
  • Frequent cause of syncope in elderly
  • Prominent feature in many ANS disorders
21
Q

How do you diagnose Orthostatic Hypotension?

A
  • Orthostatic Testing
    • Measure BP and HR from supine-standing
    • Lying —> Sitting —> Standing
    • Wait 2 minutes between position changes
    • Sustained drop of SBP >20mmHg or DBP >10mmHg
    • Absence of compensatory HR increase (15bpm) suggests neurogenic etiology
    • Compensatory HR increase suggests non-neurogenic etiology
  • Upright Tilt Table Testing
22
Q

How do you manage Orthostatic Hypotension?

A
  • Reduce/eliminate offending drugs
  • Caution patient on position changes
  • Elevate head of bed
  • Compressive stockings
  • Some patients require high sodium diets
  • May require drug therapy