L3: Hypertension Flashcards
Hypertension incidence increases with ______.
Age
What are the ranges for elevated hypertension (aka pre-hypertension)?
SBP: 120-129 mmHg AND DBP: <80 mmHg
Normal: 120/80
What are the ranges for Stage I hypertension?
SBP: 130-139 mmHg OR DBP: 80-89 mmHg
What are the ranges for Stage II hypertension?
SBP: >/= 140 OR DBP: >/= 90 mmHg
How do you diagnose a patient with SBP and DBP in 2 categories?
Dx should be designated to the higher BP category
Name 6 modifiable risk factors for primary HTN.
- Smoking
- Unhealthy diet
- Excess alcohol intake
- Obesity/weight gain
- Physical inactivity
- Dyslipidemia
Which race is most likely to develop HTN?
African American
Name the 6 non-modifiable risk factors for primary HTN.
- Age (55 years old+)
- Male gender
- Family hx
- Psychosocial stress
- Obstructive sleep apnea
- Low socioeconomic/educational status
Secondary HTN is caused by:
medications or secondary conditions.
Name the 9 possible etiologies for secondary HTN.
- Renal disease
- Renovascular disease
- Obstructive sleep apnea
- Thyroid/parathyroid disease
- Coarctation of the aorta
- Primary hyperaldosteronism (hypokalemia, metabolic alkalosis)
- Cushing’s syndrome
- Pheochromocytoma
- Medication induced
What is the triad for Cushing’s syndrome?
- Skin atrophy
- Striae
- Proximal muscle weakness
What is the triad for pheochromocytoma?
- Headache
- Sweating
- Tachycardia
When should all individuals start being screened for elevated blood pressure?
18 years old or older
How many times a year should adults with normal BP have their blood pressure measured?
At least annually (or semi annually for adults whose systolic BP was 120-129)
What is the gold standard for diagnosis of hypertension?
If elevated at screening, gold standard is ambulatory blood pressure monitoring (ABPM) to confirm dx
What are the 4 general principles for appropriate measurement of blood pressure?
- Serial measurements required
- Measure on both arms
- Comfortable, quiet setting
- Avoid eating, exercise, smoking, and caffeine
What are the 8 laboratory tests that should be ordered when assessing to see if pt has HTN?
- Fasting blood glucose
- CBC
- Lipid profile
- Serum creatinine with eGFR (kidney function)
- Serum Na, K, and Ca (electrolytes)
- Thyroid-stimulating hormone (TSH)
- Urinalysis (UA)
- Electrocardiogram
What is another lab test that should be ordered (in addition to the 8 basic HTN labs) for patients with DM or chronic kidney disease?
Urinary albumin to creatinine ratio
What is the primary goal of hx taking when assessing for HTN?
Questions should be geared toward identifying risk factors and secondary etiologies
What is our primary concern in regards to the physical exam when assessing a patient with HTN?
Looking for signs of end-organ damage and secondary etiologies
What is the first-line treatment for pts with essential HTN?
Lifestyle changes!
-Diet, exercise, maintaining a healthy weight, smoking cessation
What dietary suggestions can you offer when counseling a pt with HTN?
- Lower sodium intake (less than 1.5 g/day)
- DASH diet
- Alcohol reduction (1-2/day men, 1/day women)
What are the “Big 4” classes of medications we use to manage HTN?
- Diuretics
- Angiotensin Converting Enzyme Inhibitors (ACE-I)
- Angiotensin Receptor Blockers (ARB)
- Calcium Channel Blockers (CCB)
After implementing life style changes, how would you initiate tx (meds) in a pt with Stage I HTN? How would you adjust the dose?
- Single antihypertensive drug (one of the Big 4)
- Titrate up or add a second med as needed to achieve goal BP