hypertension - schreiber Flashcards
stage 2 HTN
systolic > 160
D: > 100
in essential HTN you often have
both systolic and diastolic BP elevated
who gets 2x more HTN than whites
Non hispanic blacks, 5-18x ESRD increased risk
MAP =
SVR x CO
most patients with hypertension have
INCREASED SVR
what changes do NO and endothelin undergo in hypertensive patients?
reduced NO activity maybe due to oxidative stress and AT2
Elevated levels of endothelin
why do hypertensive patients fail to excrete more Na to lower BP?
less nephrons
- activated SNS and RAAS
2 reasons why increased BP leads to more vasoconstriction
organ perfusion -
Na/K atpase inhibitor to get rid of salt but vasoconstricts
in sustained hypertension what does increased SVR lead to
structural vessel changes -
hypertrophy and hyaline arteriosclerosis
secondary HTN can be due to
renal parenchymal disease endocrine drug - OSA coarctation of aorta
when do you suspect RAStenosis
- young patient with HTN
- old person with diastolic HTN
- refractory HTN
3 clues for endocrine causes of secondary HTN
- hypokalemia
- headache, sweating, palpitations
- Cushinoid features
coarctation of the aorta results in
hypertension in the arms
hypotension in the legs
drugs that can cause secondary HTN
- licorice!
- cocaine
- EtOH
- NSAIDs, steroids, exogenous Epo
every 20/10 increase in BP after 115/75
double risk for CV disease
ACE inhibitors MOA
- vasodilate, natriuresis
- anti fibrotic
- antiproliferative
(teratogenic)
ACE inhibitors that result in acute renal failure have a drop in GFR of
> 30 %
Side effects of ARBs
hyperkalemia
renal failure and teratogenic like ACEi
which beta blockers have more CNS effects
lipid soluble ones - metoprolol and propranolol
Side effects of dihydropiridines -
peripheral edema
flushing, headache
major function of the DHP calcium channel blockers
arteriolar vasodilators
Major mechanism of Non-DHP calcium channel blocker
- decreased HR and contractility
Side effects of NON-DHP Ca channel blockers
- bradycardia
- heart block
- constipation
to prevent hypokalemia what can you do
combine a thiazide with a K+ sparing diuretic
side X of alpha drenergic blockers
- orthostatic hypotension
For refractory hypertension what can you use?
- direct vasodilators like minoxidil and hydralazine
which drug is good for use during pregnancy
methyldopa
Over 60, african descent, what should you use as an antihypertensive?
CCB or Diuretic
younger patients use Ace and arb
if you have angina, avoid using which anti hypertensive
hydralazine
if you have bradycardia or severe PAD dont use
beta blocker
ditliazem
verapamil
if you have gout avoid using
a diuretic
useful fourth drug antihypertensive is
alpha blocker
what should you avoid adding to a beta blocker?
diltiazem or verapamil
factors that reduce the NNT
- higher baseline cV risk
- higher initial raised BP
- longer duration of treatment
- greater magnitude of BP drop
- statin/aspirin
hypertensive encephalopathy is
diffuse brain dysfunction
goal of therapy with hypertensive crisis
decrease MAP by 25%
MAP-
diastolic + 1/3 pulse pressure
