Lecture 2: HTN Part 2 Flashcards
How often should follow-up occur after starting antiHTN management?
- 4-6 weeks while titrating.
- 6-12 months once stable.
How much BP reduction do we expect per agent at an optimal dose?
10mm Hg per agent added.
How is stage 2 HTN generally treated?
2 agents with complimentary actions.
AKA not ACEI and ARBs together.
What qualifies as HTN urgency?
Severe HTN without symptoms.
Generally around 180/120.
No acute organ damage should be present.
Usually caused by poorly controlled chronic HTN.
What is the primary goal of treating HTN urgency?
Reducing BP within a few hours.
- Clonidine
- Captopril
- Metoprolol tartrate
- Hydralazine
What are the main concerns with clonidine administration?
- Sedative SE
- Rebound HTN
- Potential hypotension depending on efficacy
Why is nifedipine not as preferred for HTN urgency treatment?
Unpredictable response.
What qualifies as HTN emergency?
Severe HTN + end organ damage.
What are the primary organs typically affected in HTN emergency?
- Brain
- Eyes
- Heart
- Lungs
- Kidney
What is the main deciding factor in treating HTN emergency?
The organs currently being affected, i.e. ischemic stroke vs acute aortic dissection.
Why is a CT head performed without contrast in initial workup for HTN emergency?
If there is a hemorrhagic stroke present, contrast will leak out into the vessels.
How much can BP be lowered within the first 2 hours of HTN emergency?
25%, to prevent hypoperfusion.
Afterwards, 160/100.
What are the 4 conditions with specific BP goals in HTN emergency?
- Ischemic CVA: 180-200 with slow reduction.
- Hemorrhagic CVA: < 140
- Aortic dissection: < 120
- MI: AC and O2 + NTG, BP can be variable.
What are the two primary agents in treating HTN emergency?
Combination of BBs and CCBs.
First-line CCB: nicardipine (generally)
First-line BB: Labetalol (generally)
What coronary condition should nicardipine be used in caution with?
MI
What condition might esmolol be preferred over labetalol in HTN emergency?
COPD.
However, both are cautionary in asthma.
Labetalol has beta and alpha properties, and can induce bronchospasm.
Esmolol is a weaker antiHTN.
What are the primary CV changes during pregnancy?
- CO increase by 40% (Primarily SV increase)
- HR increase by 10bpm during 3rd trimester.
- BP tends to trend down in 2nd trimester as SVR lowers.
What BP in pregnancy is considered abnormal?
> = 140/90
Increased risk of morbidity and mortality.
How is HTN during pregnancy diagnosed?
Two elevated readings 4 hrs apart.
What is preeclampsia criteria?
NEW onset HTN (140/90) + proteinuria after 20 wks of gestation.
What is gestational HTN criteria?
HTN (140/90) after 20 weeks gestation w/o pre-existing HTN OR proteinuria.
What is chronic HTN during pregnancy?
HTN (140/90) before 20 wks or 12 weeks postpartum.
Can precede preeclampsia.
What antiHTNs are contraindicated specifically in pregnancy?
ACEis and ARBs
What are the preferred acute antiHTNs in pregnancy?
- IV labetalol
- IV hydralazine
- Oral IR nifedipine
What are the preferred chronic antiHTNs for HTN in pregnancy?
- Labetalol
- ER nifedipine
- Methyldopa
What is the target BP for HTN managment in pregnancy?
130-150/80-100.
Not recommended to drop more than 25% in 2 hrs.
What qualifies as resistant HTN?
Fails to reach goal with a 3-drug regimen that includes a diuretic.
Generally due to non-compliance
For a patient with resistant HTN, what specialists are recommended?
- Cardio
- Nephro
What medication change should be considered for a patient with resistant HTN?
Diuretic change to aldosterone receptor blockers.
Spironolactone, epleronone
What are some common causes of resistant HTN?
- Improper pressure measurements
- Volume overload and pseudotolerance
- Associated conditions
- Secondary causes
- Drugs
