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MEDS 532 > Lecture 3 - Hypertension & Dyslipidemia Guidelines > Flashcards

Lecture 3 - Hypertension & Dyslipidemia Guidelines Flashcards

1
Q

Cardiovascular Mortality Risk Doubles with each ______ increase in BP

A

20/10 mm Hg

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2
Q

Hypertension can be diagnosed using one of the

following three acceptable measurement strategies:

A
  1. Ambulatory blood pressure monitoring (ABPM)
  2. Home blood pressure monitoring (HBPM)
  3. Office-based blood pressure measurements
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3
Q

Diagnosis of Hypertension: Home Measurement
Why do we like it?
What are some drawbacks?

A 
Why do we like it?
• Available
• Inexpensive
• No white coat syndrome
• Can improve BP control and compliance

What are some drawbacks?
• Training/BP technique
• Access to appropriate/accurate device

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4
Q

Diagnosis of Hypertension: ABPM
Why do we like it?
What are some drawbacks?

A

Why do we like it?
• Detects morning bp surge • Quick results
• Dippers v. non-dippers
• If treatment is working at the best time

What are some drawbacks? • Availability
• Expense

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5
Q

Dippers v. non-dippers

A

Dipper blood pressure dips at night where as non-dippers

Non-dippers are more at risk as BP should dip when you sleep…natural surges in the am

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6
Q

Non-dippers or dippers need ambulatory BP monitoring

A

Non-dippers

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7
Q

The proper measurement of office-based BP requires attention to all of
the following:
(6)

A
  • Time of measurement
  • Type of measurement
  • Cuff placement
  • Patient condition
  • Technique of measurement
  • Number of measurment
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8
Q

Oscillometric method

A

Analyzes pulse waves collected
from the cuff during constricted
blood flow

(Automated one at most doctors offices)

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9
Q

Auscultatory method

A

Listening to the internal sounds of the body, usually using a stethoscope

(Most efficient way uses ear)

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10
Q

Correct Office Based Measurement:

Cuff Placement

A

• Bladder midline over brachial artery • Two finger lengths above “elbow bend”

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11
Q

Correct Office Based Measurement:

Type of Measurement Device

A

Oscillometric method

Auscultatory method

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12
Q

Correct Office Based Measurement:

Patient Condition

A
  • Patient position (sitting, feet on floor etc)

* Extraneous variables (caffeine, smoking etc)

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13
Q

Correct Office Based Measurement:

Technique of Measurement

A

Depends on skill of operator

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14
Q

Correct Office Based Measurement:

Alternative Sites for Measurement

A 
Radial artery
Brachial artery
Dorsalis pedis artery 
Popliteal artery 
Posterior tibial artery
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15
Q

Postural Hypotension

AKA?
What is it?
Add what to diet?

A
  • Aka orthostatic hypotension
  • Low BP when you stand up from sitting/laying down
  • Add sea salt to diet to increase BP
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16
Q

Pathophysiology of Postural Hypotension

Normal

A
  • Stand up
  • Gravity moves blood to legs
  • ** Baroreceptors in neck and heart arteries sence low BP
  • Send signals to brain
  • ** Signals heart to breat faster and vessels to constrict to increase BP
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17
Q

**_____ in neck and heart arteries sense low BP

Signals heart to beat ____ & vessels to ____

A

Baroreceptor

faster & constrict

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18
Q

**Pathophysiology of Postural Hypotension

Abnormal

A
  • Stand up
  • Gravity moves blood to legs
  • **Interruption of natural process
  • Less blood circulating to heart
  • Decreased BP
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19
Q

Risk Factors for Postural Hypotension

Risk Factors for Postural Hypotension

A
  • Age
  • Postprandial hypotension
  • Dehydration
  • Medications
  • Pregnancy
  • Certain disease
  • Bed rest
  • Alcohol
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20
Q

Postprandial hypotension

A

A condition in which a person’s blood pressure drops after they eat

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21
Q

Classification of Hypertension
Sys/Dia

  • Normal
  • Stage 1
  • Stage 2
A
  • Normal = 120/80
  • Stage 1 = >130-139 / 90
  • Stage 2 = >140/90
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22
Q

Non-Pharmacologic Treatment for hypertension

6

A
  1. Weight reduction
  2. Adopt DASH eating plan
  3. Dietary sodium reduction
  4. Physical activity
  5. Moderation of aalcohol consumption
  6. Stop smoking
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23
Q

Recommended sodium intake

A

less than 1500 mg/day

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24
Q

Hypertension BP goals for general population with no diabetes or CKD:

  • Older than 60
  • Younger than 60
A

<150/90

<140/90

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25
Q

Hypertension BP goals for population with diabetes or CKD:

  • All Ages Diabetes present and no CKD
  • All Ages and races with CKD present with or without diabetes
A

140/90

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26
Q

Treatment for nonblack

A
  • Thiazide
  • ACEI
  • ARB
  • CCB

(alone or in combo)

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27
Q

Treatment for black

A
  • Thiazide

- CCB

28
Q

Blood pressure reduction is less with ______ or _____ compared with other drug classes in African Americans

What’s the exception

A

ACE inhibitors or ARBs

Exception: If they have chronic kidney disease (start on ACE and ARB)

29
Q

If ACEI, ARB, CCB and Thiazide are not working what is the next step?

A
  • Reinforce lifestyle and adherence

- Add medication class (beta-blocker, aldosterone antagonist)

30
Q

What are the four

main classes of drugs that are recommended for use as initial monotherapy:

A
  • ACE Inhibitor (ACEI)
  • Angiotensin receptor blocker (ARB)
  • Thiazide diuretic
  • Calcium channel blocker (CCB)
31
Q

ACE Inhibitors work to prevent ________ being converted to __________

A

Angiotensin I to Angiotensin II

This prevents the retention of fluid + vasoconstriction that would raise the BP

32
Q

Volume Regulating Hormones drugs

A

ARBs = targets vasoconstriction
Aldosterone antagonist = aldosterone
Thiazide diuretic = targets Na+ and water retention

33
Q

ARBs

A

Vasoconstriction

34
Q

HTN Drug Classes:

-pril

A

ACE Inhibitor

35
Q

HTN Drug Classes:

-pine

A

CCBs

36
Q

HTN Drug Classes:

sartans

A

ARBs

37
Q

HTN Drug Classes:

ACE Inhibitors

A

Inhibits ACE, preventing conversion of ang I to ang II (see RAAS pathway)

38
Q

HTN Drug Classes:

ARBs

A

Blocks ang II from binding to receptor on vascular smooth muscle

39
Q

HTN Drug Classes:

A

Inhibits Ca movement through Ca channels –> vasodilation and decreased BP

40
Q

How do you calculate estimated VLDL?

A

TG/5

41
Q

What cholesterols are measurable?

A
  • T-C (total cholesterol)
  • HDL (HDL cholesterol)
  • LDL (LDL cholesterol)
42
Q

How do you calculate estimated LDL?

A

LDL = TC - HDL - VLDL

Not to be used when TG > 400mg/dl

43
Q

LDL Cholesterol desirable range

A

< 100

44
Q

HDL Cholesterol desirable range

A

< 40 males

< 50 women

45
Q

Non-HDL Cholesterol (TC-HDL) desirable range

A

< 130

46
Q

Four Major Statin Benefit Groups

A
  1. Individuals with clinical ASCVD (Atherosclerotic vascular disease)
  2. Primary elevation of LDL > 190mg/dL
  3. Diabetes & 40-75 years of age with LDL between 70-189mg/dl
  4. Patient 40-75 with LDL between 70-189 with estimated 10 years ASCVD risk of 7.5
47
Q

We want 10 year ASCVD rate to be ______

A

> 7.5%

less

48
Q

10 year ASCV Risk Calculator

A

Provides an estimate of an individual’s risk of having a cardiovascular event during the next 10 yrs

49
Q

What is the BMI range one should aim for?

A

18.5 - 24.9 kg/m2

50
Q

Saturated fats

A

• Molecules
“saturated” with hydrogen molecules

• Typically solids
at room temperature

(High LDL..example coconut oil)

51
Q

Trans fat

A 
• Industrial
process that
adds hydrogen to
liquid vegetable
oils to make
them more solid

• **AKA: ____ partially hydrogenated oils

52
Q

Unsaturated fats

A
  • Monounsaturated
  • Polyunsaturated
  • Usually liquid at room temp

(Healthy body can’t make these)

53
Q

Cholesterol

A
  • Waxy substance

* Most of what we require is produced by our bodies

54
Q

____________ aka “statins”

are the primary pharmacologic agent used

A

HMG- CoA Reductase Inhibitors

55
Q

Statins

A

Inhibit the enzyme HMG-CoA reductase, which prevents the conversion of HMG-CoA to mevalonate..the rate limiting step in cholesterol synthesis

(decrease LDL + TG; increase HDL)

56
Q

Bile Acid Sequestrants/Bile Acid Binding Resins

A

Binds bile acids in intestine forming a complex that is excreted in the feces

↓LDL

↑HDL

No change or ↑TG

57
Q

Fibrates

A

↓LDL, but can ↑LDL if TG are high

↓ TG

↑HDL

58
Q

Fish oils

A

↓TGs

↑HDL, can ↑LDL

59
Q

Statins target what?

A

Inhibit HMG- CoA reductase which limits cholesterol

60
Q

Pharmacologic agents used to
decrease TG include:
(4)

A
  • Fibric Acids
  • Fish Oils
  • Nicotinic acid
  • Statins
61
Q

Only add a pharmacologic agent to treat TG once LDL goal is reached and if TG remain ______-

A

≥ 200mg/dL

62
Q

Epidemiologic data suggest that ___% to ___% of the population believed to have hypertension may have lower blood pressure outside of the office setting

A

15% to 30%

63
Q

The average nocturnal blood pressure is approximately ___% lower than daytime values in both normotensive and hypertensive patients

A

15%

64
Q

Adverse fish oil effect

A

Increase LDL

65
Q

Adverse bile acid effect

A

No change in TG

66
Q

Adverse Fibrate effect

A

Increase LDL (if TG is high)

MEDS 532 (4 decks)

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