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Case Files: IM > Hypertension (outpatient) > Flashcards

Hypertension (outpatient) Flashcards

1
Q

When is it okay to begin pharmacologic treatment of hypertension?

A

When the pt is in stage II hypertension or when they have end organ damage as a result of their hypertension.

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2
Q

What are the most common types of end organ damage from hypertension?

A

-Cardiomyopathy/MI - heart and pulm
-Retinopathy
-CKD, Renal
-Neuropathy, Cerebrovascular

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3
Q

What is the cutoff for stage II hypertension?

A

160/100.

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4
Q

What is the drug combination for treating hypertension, initially?

A

-Some antihypertensive agent.
-THIAZIDE diuretic (must be included).

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5
Q

What is a recommendation as to the amount of alcohol per night for people trying to avoid hypertension?

A

Men: No more than 2 glasses.
Women: No more than 1 glass per night.

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6
Q

What is the cutoff for prehypertension?

A

120-129 systolics.
80-89 Diastolics.

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7
Q

What is the cutoff for stage I hypertension?

A

Systolics: 130-159.
Diastolics: 90-99.

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8
Q

Stage II hypertension cutoffs?

A

Systolics: 160+
Diastolics: 100+

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9
Q

What percentage of hypertension cases are essential (idiopathic)?

A

95%.

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10
Q

When hypertension has a known cause, which two organ systems are the main culprits?

A

-Renal system.
-Endocrine system.

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11
Q

What are renal causes of secondary hypertension?

A

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)

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12
Q

What are some endocrine causes of secondary hypertension?

A

-Primary aldosteronism (too much Aldost)
-Cushing syndrome (excess cortisol, might deal with ACTH or not)
-Pheochromocytoma
-Hyperthyroidism

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13
Q

What medications can cause hypertension?

A

-High-dose estrogen
-NSAIDs
-Glucocorticoids (b/c of cortisol)
-Sympathomimetics

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14
Q

What electrolyte abnormality can cause hypertension?

A

Hypercalcemia

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15
Q

How can a pt be hypertensive after a transfusion?

A

Too much fluid causing increased intravascular volume.

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16
Q

When should we look for another cause of a pt’s hypertension?

A

-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?

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17
Q

What are risk factors for hypertension?

A

-Family history of premature cardiovascular issues
-Renal disease

-Smoking
-Hyperlipidemia
-Age
-Diabetes
-Obesity
s

Fr. SHADO

18
Q

What’s a mnemonic to help remember the risk factors for hypertension?

A

FK SHADOs

19
Q

When should we give pts with prehypertension antihypertensive medications?

A

Only if they have diabetes or some other relevant comorbidity.

20
Q

If a regular, healthy, pt comes in with prehypertension, what do we do for them?

A

Solely counsel on lifestyle modifications - weight loss, smoking cessation, limit alcohol to 2 or 1 glass a night, activity 3 times a week.

21
Q

For stage I htn, what do we give them for intervention?

A

1 antihypertensive drug.

22
Q

For type II htn, what intervention is given?

A

2 antihypertensive medications.

23
Q

Which class of anithypertensive drugs is more effective on the general population?

A

Each class of antihypertensive drug is equally effective on the general population. Blacks make it different.

24
Q

What are some lab tests that we order to evaluate the cause of htn?

A

-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??

25
Q

Which antihypertensive medications do the elderly respond really well to? (50 and up)

A

Thiazides and CCBs (amlodipine)

26
Q

Which antihypertensives do blacks typically respond well to?

A

Thiazides.

27
Q

Which antihypertensives do young whites typically respond to?

A

Beta blockers and ACE-I’s.

28
Q

What is the typical bp target for pts while on antihypertensive meds?

What if they have DM or CKD?

A

-130/80.
-125/75.

29
Q

For the man with BPH and hypertension, what antihypertensive meds should we give?

A

Thiazide and Alpha blockers.

30
Q

For pts with DM or HF, what is the preferred antihypertensive?

A

ACE-I’s

31
Q

If suspecting RAS as cause of htn, what imaging do we order?

A

MRA (MR angiography)

32
Q

What is the inheritance pattern of polycystic kidney disease?

A

Autosomal dominant.

33
Q

What are “licit” drugs that can lead to hypertension?

A

Caffeine and alcohol.

34
Q

Why do OSA pts have hypertension?

A

They have their airway collapse during sleep. This leads to pts becoming hypoxic and hyperbaric. As result, there is constriction of blood vessels systemically and in the pulmonary system, causing hypertension and pulmonary hypertension.

35
Q

How does a pt with hypertension 2/2 hyperthyroidism typically present?

A

Goiter with tremor, warm to touch.

36
Q

What test is used for Addison’s disease?

What test is used for Cushing’s disease?

A

-Dexamethasone stimulation test.

-Dexamethasone suppression test.

37
Q

A pt with bp of 160/95 in the right arm and 162/98 in the left arm presents to clinic with claudication of the legs after walking 15 steps and recurrent pounding headaches. On physical exam, he has 1+ pulse on the right and no pulses were palpable in the left femoral and pedal areas. What condition does he likely have?

A

He likely has coarctation of the aorta.

38
Q

What are examples of thiazide diuretics?

A

Chlorthalidone or hydrochlorothiazide.

39
Q

When do we use thiazide diuretics for hypertension?

A

Thiazides are best initial therapy for hypertension only when it is uncomplicated by comorbid diagnoses.

They are also cost effective.

40
Q

What antihypertensives would I give to my mom?

*Definitely stage II hypertension with no comorbidities.

A

-Offer two agents because stage II hypertension.

-Thiazide diuretic b/c she’s older and also no comorbidities.

-Calcium channel blocker b/c older people respond to it well. (amlodipine).

Case Files: IM (1 decks)

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