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CV <3 > Lecture 1: Intro/HTN > Flashcards

Lecture 1: Intro/HTN Flashcards

1
Q

What is the definition of hypertension?

A

Elevated force of blood against ARTERIAL walls.

Requires the average of 2+ accurate, seated readings, in 2 separate visits.

Exception: HTN crisis/emergency

Quantitative measurement.

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2
Q

What measurements are indicative of stage 1 hypertension per ACC/AHA criteria?

A

S: 130+
D: 80+

Either measurement must be present.

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3
Q

What measurements are indicative of stage 2 hypertension per ACC/AHA criteria?

A

S: 140+
D: 90+

Either measurement must be present.

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4
Q

What measurements are indicative of normal BP per ACC/AHA criteria?

A

S: < 120
D: < 80

Both must be present.

Having a diastolic > 80 indicates hypertension.

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5
Q

What measurements are indicative of elevated BP per ACC/AHA criteria?

A

S: 120-129
D: < 80

Both must be present.

Having a diastolic > 80 indicates hypertension.

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6
Q

Why does systolic BP rise in older patients > 60?

A

Arterial stiffness

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7
Q

What typically causes increases in systolic and diastolic in younger patients under 50?

A
  • Hormonal activation
  • OSA
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8
Q

What is the primary cause of isolated systolic HTN in older patients? Younger patients?

A
  • Older: arterial stiffness and atherosclerosis
  • Young: athletic males with high SV
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9
Q

In a younger patient who presents with a BP of > 140/90, what workup is needed?

A
  1. Obtain history first, as lifestyle modifications can make big changes in a younger patient.
  2. Medications may be needed if patient refuses modifications.
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10
Q

Which BP number is preferred as a predictor of long-term complications?

A
  • In younger patients < 45: DBP.
  • In older patients > 60: SBP.

Systolic can be influenced by many factors in younger patients that can be modified prior to arterial stiffness.

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11
Q

What is white coat hypertension and the recommendations?

A
  • 140/90 in the office, but consistently lower at home.
  • More common in older patients.
  • If it is consistently within range at home, no treatment is recommended; but long-term monitoring is recommended.
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12
Q

What is masked HTN and recommendation regarding treatment?

A
  • Reverse of white coat HTN.
  • Elevated at home but normal in office.
  • Recommended to treat once history is obtained.

Generally due to erroneous measuring.

Often influenced mainly by lifestyle changes.

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13
Q

What is pseudohypertension?

A
  • Calcification of peripheral vessels in elderly patients that results in falsely elevated BP.
  • Often results in symptomatic OVERTREATMENT.

Extremely rare

Usually requires arterial line BP monitoring.

Patients will often complain about feeling dizzy and lightheaded even with elevated BP. (Hypotensive symptoms)

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14
Q

What is the primary concern with hypertension?

A
  • One of the most chronic common conditions present in all populations.
  • It is a MAJOR risk factor for the 1st and 5th leading causes of death in the US (Heart Disease, Stroke)
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15
Q

How does DBP tend to change as we age?

A

Increases until age 55, then begins to decrease.

Wide PP after age 60.

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16
Q

What demographic is most susceptible to HTN?

A

Non-hispanic Blacks

Mainly due to anatomical kidney differences.
First-line treatment of this population for HTN generally is CCBs or Thiazides, NOT ACEIs or ARBs.

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17
Q

How prevalent is HTN in adults > 65?

A

77%

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18
Q

How is BP calculated?

A

CO x SVR

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19
Q

How does HTN tend to present in younger patients if due to SNS hyperactivity?

A
  • Tachycardia
  • HTN
  • Elevated CO
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20
Q

What is natriuresis and its relation to HTN?

A
  • Natriuresis is the excretion of sodium via urine.
  • A defect in natriuresis results in an inability to excrete sodium, resulting in fluid retention and HTN.
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21
Q

How do defects in vasculature elasticity affect HTN?

A

Inability to match peripheral vessel elasticity or vice versa results in increased risk of developing HTN in life.

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22
Q

What is the secondary effect of elevated intracellular sodium on HTN?

A

Also increases intracellular calcium, which increases vascular smooth muscle tone. (Increases SVR)

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23
Q

Why can NSAID use result in HTN?

A

It acts upon the same receptors as some antiHTNs.

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24
Q

Describe how a patient should be positioned for an accurate blood pressure reading.

A
  • Seated with supported back
  • Arm supported at heart level
  • BP Cuff over bare arm
  • No talking
  • Legs uncrossed
  • Feet supported and resting on a surface
  • Empty bladder prior to BP measurement.
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25
Q

What is the primary purpose of a physical in regards to HTN?

A

Looking for target organ damage.

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26
Q

What are the complications that can result from HTN?

A
  • Structural and functional changes in the heart.
  • Increased risk of thrombosis
  • Increased morbidity and mortality
  • Target-organ damage

6mm Hg increases in DBP doubles morbidity and mortality

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27
Q

What are the 5 primary organs most affected by HTN?

A
  • Heart
  • Brain
  • Kidneys
  • Peripheral vessels
  • Eyes
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28
Q

What are the 3 primary complications of untreated LVH?

A
  • Diastolic HF
  • Myocardial Ischemia
  • Ventricular arrhythmias
29
Q

What are the S/S associated with LVH?

A
  • Dyspnea and edema
  • Palps/CP
  • LV heave or S4 gallop
  • LVH on EKG

S4 is the atrial gallop, suggestive of left ventricular stiffness.
Delayed diastolic filling of the ventricle.

30
Q

What common cerebrovascular disease has increased risk due to HTN? What is the caveat in treating HTN?

A

Dementia. However, if microvasculature is already noted, then BP control will worsen outcomes.

31
Q

What renal condition more common in black patients due to HTN?

A

Nephrosclerosis

32
Q

What findings are common in HTN retinopathy?

A
  • Retinal artery stenosis/occlusion
  • Exudates
  • Cotton-wool spots
  • Retinal hemorrhages
33
Q

What vascular complications are associated with HTN?

A
  • Atherosclerosis: hardening/narrowing of arteries
  • Aortic aneurysm/dissection
34
Q

List some lifestyle modifications that can help manage HTN.

A
  • Weight reduction
  • DASH diet
  • Dietary sodium restriction
  • Physical Activity
  • Moderate alcohol consumption
35
Q

If CKD is present in a patient, what first-line treatment is generally contraindicated?

A

Thiazide diuretics.

36
Q

In what high risk conditions are ACEIs contraindicated for HTN management?

37
Q

When is pharmacological treatment indicated for HTN management?

A
  • Stage 1 HTN w/ 10%+ ASCVD risk
  • Stage 2 (>= 140 or >= 90)
38
Q

What is the goal BP for all patients per ACC/AHA guidelines?

39
Q

What first-line antiHTNs are generally not recommended in African-American patients?

40
Q

What type of CCB is preferred as an antiHTN and what is the most common SE?

A

DHP-CCB with lower extremity edema.

Amlodipine

Dilation of peripheral vasculature.

Non-DHP = central.

41
Q

What are the main advantages of ACEI in HTN management?

A
  • Helps prevent progression to ESRD
  • Minimal SEs
42
Q

What patient counseling should be provided to someone being initiated on ACEI for HTN management?

A
  • Dry cough or skin rashes (requires stoppage of drug)
  • Angioedema (dangerous SE)
  • Hyperkalemia or hypotension in those with severe renal disease
  • Should not be taken when pregnant due to reduced perfusion to fetus.
43
Q

What conditions are ARBs generally good in for HTN management?

A
  • HF
  • T2DM w/ nephropathy
44
Q

What conditions are ACEIs generally good in for HTN management?

A
  • HF
  • Post-MI
  • High ASCVD risk
  • DM
  • CKD
  • Stroke prevention

All of them.

45
Q

In what high-risk conditions are CCBs indicated for in HTN management?

A
  • High ASCVD risk
  • DM

Stroke trials: ALLHAT and systolic hypertension in Europe demonstrated protective effects compared to diuretics.

46
Q

What are the most common SEs associated with CCBs?

A
  • HA
  • Peripheral edema
  • Bradycardia
  • Constipation
47
Q

In what condition are CCBs generally CId in? What CCB is the only exception?

A

HF.

Amlodipine is the only CCB that has established safety in patients with severe HF.

48
Q

Why are thiazide diuretics preferred over loops in regards to HTN management?

A
  • Longer duration
  • Minimal effects on electrolyte and fluid levels
  • Primarily lowers peripheral vascular resistance long-term.
  • Best on people with high plasma volumes or low PRA
49
Q

Administration of what drug classes with CCBs can help reduce edema?

A

ACEIs or ARBs

50
Q

When is spironolactone generally indicated in regards to HTN management?

A

Adjunct therapy for refractory HTN

51
Q

What conditions alongside HTN would make BBs preferred therapy?

A
  • Angina pectoris
  • Previous MI
  • Sinus Tachycardia
  • Stable HF
  • Migraines
52
Q

What happens to selectivity of BBs in high dosages?

A

All of them become non-selective.

53
Q

What BBs can be used in HF and HTN?

A
  • Metoprolol
  • Bisoprolol
  • Carvedilol
54
Q

In what population are BBs commonly most effective?

A

Those with high PRA.

Young white patients mainly.

55
Q

What is the main concern with alpha antagonist use in HTN management?

A

Tachyphylaxis

56
Q

What is the MOA of clonidine and guanfacine?

A

Central alpha-adrenergic agonists.

Reduces efferent peripheral sympathetic outflow via the CNS.

57
Q

What are the main SEs associated with central sympathomimetic agents like clonidine?

A
  • Sedation
  • Xerostomia
  • Postural hypotension
  • ED
  • Rebound HTN
58
Q

When are peripheral sympathetic inhibitors like reserpine typically indicated?

A

Refractory HTN

Many psychiatric SEs.

59
Q

What is the main concern with using arteriolar dilators like hydralazine or minoxidil?

A
  • Reflex tachycardia
  • Positive inotropic effect
  • HA
  • Palps
  • Fluid retention
60
Q

What is the secondary FDA-approved use for minodixil besides HTN?

A

Topical minoxidil is approved for hair loss treatment.

Only topical is FDA approved, not oral.

61
Q

In general, what are the first-line treatments for HTN management?

A
  • ACEI/ARB
  • CCB
  • Thiazides

BBs can be used as well, but only reserved for HF and angina.

62
Q

For a younger patient with HTN, what drug is typically preferred first-line and what drug is NOT recommended?

A
  • Preferred: CCBs
  • Not Recommended: Diuretics
63
Q

What is the mnemonic for HTN management?

A

ABCD

AB refers to ACEI/ARB and BBs, which work on RAAS.

CD refers to CCBs and Diuretics, which work on other systems.

64
Q

In general, what two demographics typically have the same preferred HTN management algorithm?

A

Black people and those over 55.

CCB and diuretics are preferred first-line.

65
Q

If a black person presents with severe kidney dysfunction, what drugs can be used first-line for HTN?

A

Loop diuretics are preferred in severe kidney dysfunction over thiazides.
CCBs can be used as well.

66
Q

What generally falls under second-line HTN management?

A

Vasodilating BBs.

ACEIs and ARBs can also be indicated for black patients or those over 55 since it is not preferred as first-line.

67
Q

In general, what is the preferred first-line antiHTN for people with DM or CKD?

68
Q

If a black patient needs to be prescribed an ACEI or ARB, what is preferred and why?

A

ARB is preferred due to the increased risk of developing angioedema and cough in black patients.

CV <3 (25 decks)

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