Hypertension Lecture Powerpoint Flashcards
fuck me
Hypertension prevalence in the US
50 million individuals
hypertension is most prevalent in (men v women) and (white v blacks)
males, blacks
A patient with blood pressure over 160/90 more than twice requires…
….medication to bring it down
only ___% of adults with hypertension are receiving treatment
58
BP classifications (current guidelines)
normal <120 and <80 elevated 120-129 and <80 Stage 1 130-139 or 80-89 Stage 2 >140 or >90 Hypertensive crisis >180 or >120
The ACC/AHA hypertension guidelines became the standard following…
…JNC 8 conditions which are too lax on target SBP and DBP goals
systolic BP that is lowest risk for stroke
<120 mmHg
Untreated high blood pressure can cause these condition (5)
- left ventricular hypertrophy
- angina
- CHF
- CVA
- Retinopathy
Symptoms of hypertension (6)
- typically asymptomatic
- headache behind eyes particularly in morning
- dizziness
- visual disturbances
- confusion
- fatigue
Constant tobacco use throughout the day can result in…
….consistent vasospasm that results in peripheral vascular disease or coronary artery disease
Metabolic syndrome puts a patient ___x higher risk for heart disease
2-4
Major drugs that can increase BP (8)
- OCP’s
- alcohol
- recreational drugs
- NSAIDS
- corticosteroids
- TCA’s
- MAO inhibitors
- ephedrine sulfate
White coat hypertension
Patient’s tendency to have higher blood pressure in presence of doctor’s office due to nerves, still needs to be treated as hypertension but can be mitigated by having patient rest 5 min prior to taking BP
BP should ____ by 10-20% during sleep, failure to do so indicates…
decrease, indicates increased CVD risk
Physical exam for hypertension
- 2 or more bp measurements separated by 2 min sitting, with arm supported at heart level
- verification in contralateral arm
- ocular fundus exam
- exam neck for carotid bruits, jvd, enlarged thyroid
- cardiac murmur, s3, s4, PMI, lifts or heaves
- abdominal bruits
- do CNS exam checking orientation, mental status, cranial nerve, motor and sensory
- do skin exam looking for hydration, pallor, hair loss, edema
Imaging studies for hypertension
-Echocardiography can pick up late disease
Types of hypertension and notes about each (3)
- essential or primary (without identifiable cause, 90% of them, treated with 2 medications)
- 2ndary hypertension (often in those older than 60)
- isolated systolic hypertension (elevated systolic pressure with normal or mildly elevated with diastolic, most common in older population)
Kinogen-kallikrein system
Stimulates nitric oxide release, bradykinin is an active vasodilator and a natriuretic substance, bradykinin broken down by angiotensin II causing further increase in vasoconstriction in the RA system
Sleep apnea is an often undiagnosed and untreated condition that is a risk factor for…
…cardiovascular disease
5 drug classes for treatment of hypertension and one to avoid
- diuretics
- B blockers
- ace inhibitors
- ARB’s
- Ca2+ channel blockers
- alpha blockers should be avoided except in therapy with prostatic
Thiazide diuretics mechanism of action, relative contraindications (3)
- Works on distal convoluted tubule to prevent reabsorption of Na+, allowing water to follow and increase urine production
- relatively contraindicated in patients with cardiac arrhythmias, gout, hypokalemia
Loop diuretics mech of action, indication, and ADRs (4)
- Works on ascending loop of henle
- Only indicated to use for Htn associated with renal insufficiency
- can result in weakness, hypokalemia, hyperlipidemia, hyperglycemia
B blockers mech of action, ADR’s (5)
- Reduces cardiac output and treats tachycardia
- bronchospasm, fatigue, exercise intolerance, decreases HDL, increases triglycerides,
atenolol is associated with…
Increased risk of diabetes and stroke (so probably don’t use this medication)
Nebivolol (bystolic) - New B blocker
-highest specificity for B1 receptor resulting in no metabolic or sexual side effects unlike current B blockers
Ca2+ channel blockers side effects of 2 common bois
really awesome, can cause edema as most common side effect of amoldipine, and constipation is most common side effect of felodipine
ACEI, what patient group is it used for and why?
inhibits angiotensin I from converting to angiotensin II, slows progression of renal disease so used if a patient has proteinuria or diabetes
If a patient has proteinuria or diabetes you treat with a ___ or ___ rather than a ___
ACEI ARB, Ca2+ channel blocker
2 drugs that are always used in hypertensive patients
- ACEI
- B blocker
a receptor antagonist for hypertension and most common ADR
only use on patient with underlying BPH prostate problems, problems include syncope most common
ARB ADR’s (2)
-hyperkalemia or angioedema
2ndary hypertension causes (7)
- atherosclerosis
- PKD
- Cushing’s disease
- hyperaldosteronism
- AV fisula
- coarctation of aorta
- sleep apnea
Hyperensive urgency
Desirable to reduce BP within 24-48 hrs
Hypertensive emergencies
Severe Htn that requires immediate reduction over minutes to hrs
Accelerated hypertension
markedly elevated BP associated associated with acute, target organ damage
Malignant hypertension
A hypertensive emergency with papilledema due to increased intracranial pressure requiring imediate but controlled decrease of BP
Hypertension must be controlled in order to prevent…
…end organ damage
Pharmacologic therapy for hypertension begins at a BP of ____ for most patients or ____ for patients with diabetes, CKD, age >65, or 10 year risk of atherosclerotic disease >10%
140/90, 130/80
Nonblack patient first line of hypertension treatment (5)
- thiazide diuretic
- Ca2+ channel blocker
- B blocker
- ACE inhibitor
- ARB
Black patient first line of hypertension treatment
- thiazide diuretic
- Ca2+ channel blocker
In patients with kidney disease, initial hypertension treatment should be these 2 regardless of race
ACEI and ARB’s
