Hypertension (outpatient) Flashcards
When is it okay to begin pharmacologic treatment of hypertension?
When the pt is in stage II hypertension or when they have end organ damage as a result of their hypertension.
What are the most common types of end organ damage from hypertension?
-Cardiomyopathy/MI - heart and pulm
-Retinopathy
-CKD, Renal
-Neuropathy, Cerebrovascular
What is the cutoff for stage II hypertension?
160/100.
What is the drug combination for treating hypertension, initially?
-Some antihypertensive agent.
-THIAZIDE diuretic (must be included).
What is a recommendation as to the amount of alcohol per night for people trying to avoid hypertension?
Men: No more than 2 glasses.
Women: No more than 1 glass per night.
What is the cutoff for prehypertension?
120-129 systolics.
80-89 Diastolics.
What is the cutoff for stage I hypertension?
Systolics: 130-159.
Diastolics: 90-99.
Stage II hypertension cutoffs?
Systolics: 160+
Diastolics: 100+
What percentage of hypertension cases are essential (idiopathic)?
95%.
When hypertension has a known cause, which two organ systems are the main culprits?
-Renal system.
-Endocrine system.
What are renal causes of secondary hypertension?
Damage to the kidneys because of vascular flow…
-Renal Artery stenosis
-Fibromuscular dysplasia
From damage to kidney tissue itself…
-Glomerulonephritis
-Polycycstic kidney disease
-Renal tumors (Wilm’s tumor = npehroblastoma in children)
What are some endocrine causes of secondary hypertension?
-Primary aldosteronism (too much Aldost)
-Cushing syndrome (excess cortisol, might deal with ACTH or not)
-Pheochromocytoma
-Hyperthyroidism
What medications can cause hypertension?
-High-dose estrogen
-NSAIDs
-Glucocorticoids (b/c of cortisol)
-Sympathomimetics
What electrolyte abnormality can cause hypertension?
Hypercalcemia
How can a pt be hypertensive after a transfusion?
Too much fluid causing increased intravascular volume.
When should we look for another cause of a pt’s hypertension?
-When their htn comes on before the age of 25 or after the age of 55.
-When they are on 3 antihypertensive medications and still can’t have their bp at goal (<130/80).
-When they have elevation in their creatinine when taking an ACE-inhibitor.
-When there are clinical signs of end organ damage with their hypertension?
What are risk factors for hypertension?
-Family history of premature cardiovascular issues
-Renal disease
-Smoking
-Hyperlipidemia
-Age
-Diabetes
-Obesity
s
Fr. SHADO
What’s a mnemonic to help remember the risk factors for hypertension?
FK SHADOs
When should we give pts with prehypertension antihypertensive medications?
Only if they have diabetes or some other relevant comorbidity.
If a regular, healthy, pt comes in with prehypertension, what do we do for them?
Solely counsel on lifestyle modifications - weight loss, smoking cessation, limit alcohol to 2 or 1 glass a night, activity 3 times a week.
For stage I htn, what do we give them for intervention?
1 antihypertensive drug.
For type II htn, what intervention is given?
2 antihypertensive medications.
Which class of anithypertensive drugs is more effective on the general population?
Each class of antihypertensive drug is equally effective on the general population. Blacks make it different.
What are some lab tests that we order to evaluate the cause of htn?
-Serum sodium and potassium in a BMP or CMP - evaluates for aldosteronism.
-Urinalysis and serum creatinine and BUN for kidney pathologies.
-TSH for hyperthyroidism.
-Serum Ca2+ b/c hypercalcemia can cause htn??
-ECG??
-Lipid panel (LDL, HDL, triglycerides)
-Glucose, fasting??
