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PDX 1 > Intro & Hypertension > Flashcards

Intro & Hypertension Flashcards

1
Q

What are the systolic and diastolic numbers for hypertension?

A

140/90 or higher

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2
Q

What are the criteria for hypotension?

A

Systolic BP

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3
Q

What % of “middle-aged (40-59) adults are hypertensive in the US?
Age 60 and over?

A

Middle-aged- 30.4%
60+ = 66.7%

** Also more prevalent in African Americans

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4
Q

Describe essential hypertension

A

AKA primary hypertension

  • no identifiable cause
  • 90-95% of cases
  • exacerbated by “bad habits”
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5
Q

Describe secondary hypertension

A
  • cause can be identified

- suspected in patients under 20 and rapid increase in BP

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6
Q

What are some causes to consider for secondary hypertension?

A
  • obstructive sleep apnea
  • medication induced or drug-related
  • kidney or renal-vascular disease
  • hormonal abnormalities
    • cushings, aldosteronism, pheochromacytoma, thyroid or parathyroid disease
  • coarctation of the aorta
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7
Q

What are the main organs of concern with hypertension?

A

End (target) organ damage to the:

  • heart
  • brain
  • kidneys
  • eyes
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8
Q

If hypertension has led to a stroke what are the 4 things you should check first?

A
  • Face
  • Arm
  • Speech
  • Time
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9
Q

How would end organ damage to the kidneys present?

A

Renal failure

  • blood test would show reduced glomerular filtration rate
  • urine test would show proteinuria
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10
Q

How would end organ damage to the eyes present?

A

Retinal damage

  • retinal hemorrhage & retinal exudates
  • papilledema
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11
Q

According to UWS who needs their BP checked?

A
  • All new patients
  • Patients already known to have elevated BP
  • any patients not seen in over a year
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12
Q

What are the criteria to diagnose hypertension?

A
  • average of 2 or more reading over 2 or more visits
  • check BP in both arms, use higher BP of the two arms
  • use higher category to classify (systolic vs. diastolic)
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13
Q

What would an isolated systolic BP elevation indicate?

A

Increased risk of stroke/ MI

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14
Q

According to JNC 7 Hypertension Guidelines what BP is normal? pre-hypertension? stage 1? stage 2?

A
  • Normal= 120/80
  • Pre-hypertension= 120-139/ 80-89
  • Stage 1= 140/159/ 90-99
  • Stage 2= >160/ >100
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15
Q

According to JNC 7 how when would you recheck a patient with normal BP?

A

1-2 years later

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16
Q

According to JNC 7 when would you recheck a pre-hypertensive patient’s BP?

A

within 1 year & encourage patient to make life-style changes

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17
Q

According to JNC 7 when would you confirm a stage 1 patient’s BP

A

Confirm within 2 months

  • consider home/ambulatory monitoring to confirm
  • recommend lifestyle changes & non-pharm treatment
18
Q

What is the most accurate means of assessing BP?

A

Ambulatory BP monitoring

19
Q

What are the JNC 8 treatment goals for patients that DO NOT have diabetes mellitus or renal disease?

A
  • less than 60 = 140/90 or lower

- over 60 = 150/90 or lower

20
Q

What are the JNC 8 treatment goals for patients with renal insufficiency or diabetes?

A

less than 80= 140/90 or lower

21
Q

What are the JNC 8 treatment goals for patients over 80?

A

Regardless of comorbidities= 150/90 or lower

22
Q

According to JNC 8 when do you check BP for a stage 1 hypertensive patient?

A

every 2-4 weeks.

23
Q

What does ASCVD risk stand for?

A

AtheroSclerotic CardioVascular Disease Risk

24
Q

According to the ASCVD risk estimator what is considered high for the 10 year risk?

A

> 7.5%

25
Q

According to JNC 7, what are the guidelines of action for a stage 2 hypertensive patient’s treatment?

A

Confirm within 1 month

Refer for pharmacological treatment & lifestyle changes

26
Q

What is Hypertensive “Crisis”?

A

SBP= >180 OR DBP >110

27
Q

Is hypertensive crisis present a risk of acute or chronic damage to end organs?

A

Acute

28
Q

White Coat hypertension accounts for ______% of stage 1 hypertensive patients?

A

15-20%

29
Q

If you come across a hypertensive “crisis” what are the 3 steps of action?

A
  • recheck & if still >180/110, assess for symptoms of target organ damage (TOD)
  • if symptoms- refer to emergency department for further evaluation
  • if no symptoms- refer to PCP urgently- patient needs BP lowering medication immediately
30
Q

What are the symptoms of end organ damage for the 4 main target organs or hypertension?

A 
Heart= chest pain or dyspnea (difficulty breathing)
Brain= Confusion, neurologic deficits
Kidneys= decreased urine output
Eyes= vision changes (blurry)
31
Q

Define Hypertensive Urgency

A

No end organ damage found

32
Q

Hypertensive Emergency

A

AKA malignant hypertension

- end organ damage was found

33
Q

What is usually the first line of treatment for the management of hypertension?

A

Life-style modifications, except for stage 2 or hypertensive crisis

34
Q

How big of an effect do the different life style modifications have on BP?

A 
Weight loss= 5/5
Diet= 5/5
Physical activity= 4/5
Reduced salt= 3/5
Limit Alcohol= 2/5
35
Q

When recommending a hypertensive patient to lose weight, what is the initial goal?

A

10% reduction in body weight

(associated with 5-20mmHg BP drop_

36
Q

What is the long term goal for a hypertensive patient for whom you recommend weight loss?

A

Normal BMI (18.5-24.9)

37
Q

What does DASH stand for?

A

Dietary Approach to Stop Hypertension (eating plan)

38
Q

What are the physical activity recommendations you would make for a hypertensive patient?

A

Moderate intensity for at least 30 minutes on most days of the week

39
Q

What are the reduced salt recommendations?

A
40
Q

What are considered safe alcohol levels for a hypertensive patient?

A

2 or less drinks/day for men

1 or less/day for women

41
Q

What are the 4 non-pharmacological treatment options for a hypertensive patient and what are the improvement ratios?

A

Coenzyme Q10= 5/5
Garlic powder= 4.5/5
Fish or Fish Oils= 3/5
Dark Chocolate = 2/5

PDX 1 (4 decks)

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