Intro & Hypertension Flashcards
What are the systolic and diastolic numbers for hypertension?
140/90 or higher
What are the criteria for hypotension?
Systolic BP
What % of “middle-aged (40-59) adults are hypertensive in the US?
Age 60 and over?
Middle-aged- 30.4%
60+ = 66.7%
** Also more prevalent in African Americans
Describe essential hypertension
AKA primary hypertension
- no identifiable cause
- 90-95% of cases
- exacerbated by “bad habits”
Describe secondary hypertension
- cause can be identified
- suspected in patients under 20 and rapid increase in BP
What are some causes to consider for secondary hypertension?
- 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
What are the main organs of concern with hypertension?
End (target) organ damage to the:
- heart
- brain
- kidneys
- eyes
If hypertension has led to a stroke what are the 4 things you should check first?
- Face
- Arm
- Speech
- Time
How would end organ damage to the kidneys present?
Renal failure
- blood test would show reduced glomerular filtration rate
- urine test would show proteinuria
How would end organ damage to the eyes present?
Retinal damage
- retinal hemorrhage & retinal exudates
- papilledema
According to UWS who needs their BP checked?
- All new patients
- Patients already known to have elevated BP
- any patients not seen in over a year
What are the criteria to diagnose hypertension?
- 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)
What would an isolated systolic BP elevation indicate?
Increased risk of stroke/ MI
According to JNC 7 Hypertension Guidelines what BP is normal? pre-hypertension? stage 1? stage 2?
- Normal= 120/80
- Pre-hypertension= 120-139/ 80-89
- Stage 1= 140/159/ 90-99
- Stage 2= >160/ >100
According to JNC 7 how when would you recheck a patient with normal BP?
1-2 years later
According to JNC 7 when would you recheck a pre-hypertensive patient’s BP?
within 1 year & encourage patient to make life-style changes
According to JNC 7 when would you confirm a stage 1 patient’s BP
Confirm within 2 months
- consider home/ambulatory monitoring to confirm
- recommend lifestyle changes & non-pharm treatment
What is the most accurate means of assessing BP?
Ambulatory BP monitoring
What are the JNC 8 treatment goals for patients that DO NOT have diabetes mellitus or renal disease?
- less than 60 = 140/90 or lower
- over 60 = 150/90 or lower
What are the JNC 8 treatment goals for patients with renal insufficiency or diabetes?
less than 80= 140/90 or lower
What are the JNC 8 treatment goals for patients over 80?
Regardless of comorbidities= 150/90 or lower
According to JNC 8 when do you check BP for a stage 1 hypertensive patient?
every 2-4 weeks.
What does ASCVD risk stand for?
AtheroSclerotic CardioVascular Disease Risk
According to the ASCVD risk estimator what is considered high for the 10 year risk?
> 7.5%
According to JNC 7, what are the guidelines of action for a stage 2 hypertensive patient’s treatment?
Confirm within 1 month
Refer for pharmacological treatment & lifestyle changes
What is Hypertensive “Crisis”?
SBP= >180 OR DBP >110
Is hypertensive crisis present a risk of acute or chronic damage to end organs?
Acute
White Coat hypertension accounts for ______% of stage 1 hypertensive patients?
15-20%
If you come across a hypertensive “crisis” what are the 3 steps of action?
- 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
What are the symptoms of end organ damage for the 4 main target organs or hypertension?
Heart= chest pain or dyspnea (difficulty breathing) Brain= Confusion, neurologic deficits Kidneys= decreased urine output Eyes= vision changes (blurry)
Define Hypertensive Urgency
No end organ damage found
Hypertensive Emergency
AKA malignant hypertension
- end organ damage was found
What is usually the first line of treatment for the management of hypertension?
Life-style modifications, except for stage 2 or hypertensive crisis
How big of an effect do the different life style modifications have on BP?
Weight loss= 5/5 Diet= 5/5 Physical activity= 4/5 Reduced salt= 3/5 Limit Alcohol= 2/5
When recommending a hypertensive patient to lose weight, what is the initial goal?
10% reduction in body weight
(associated with 5-20mmHg BP drop_
What is the long term goal for a hypertensive patient for whom you recommend weight loss?
Normal BMI (18.5-24.9)
What does DASH stand for?
Dietary Approach to Stop Hypertension (eating plan)
What are the physical activity recommendations you would make for a hypertensive patient?
Moderate intensity for at least 30 minutes on most days of the week
What are the reduced salt recommendations?
What are considered safe alcohol levels for a hypertensive patient?
2 or less drinks/day for men
1 or less/day for women
What are the 4 non-pharmacological treatment options for a hypertensive patient and what are the improvement ratios?
Coenzyme Q10= 5/5
Garlic powder= 4.5/5
Fish or Fish Oils= 3/5
Dark Chocolate = 2/5
