Management of HTN Flashcards
How do you diagnose HTN in children and adolescents?
Defined according to sex, age, and BMI
S/DBP > 94th percentile
Isolated systolic HTN
More common in the elderly and the young
Greater than or equal to 140, over less than 90
Office readings
White Coat HTN
When office readings are consistently elevated, byt 24 hour ambulatory BP readings are not elevated
When to suspect white coat HTN
If patients do not have target organ damage
If they report home or out of office readings that are lower than the office readings
If they are feeling lightheaded or dizzy when started on anti hypertensive therapy
Normal BP using home/24 hr ABPM
- 24 hour average
- Daytime average
- Night-time average
- Less than or equal to 130/80
- Less than 135/85
- Less than 120/80
Masked hypertension
About 10-30% of patients
Really high risk for CV disease because they are less likely to be treated
Office readings are in normal range, but out of office readings are higher
Suspect if target organ damage or LVH but normal office readings
Values for hypertensive urgency/emergency
Greater than or equal to 180/120
Most asymptomatic or mild headache
Emergency vs urgency
Emergency: presence of progressive/acute target organ damage
Urgency: no TOD
Hypertensive urgency
Severely elevated BP without TOD
Usually can be managed in the ER
Investigate for TOD
Target to lower their BP by 25% over hours or over the day
Can use meds for this (resuming their BP drugs, or short acting meds so they dont drop too low too fast)
Hypertensive emergencies can present with what 6 TODs
Acute pulmonary edema Stroke MI Acute aortic dissection Acute renal failure Hypertensive encephalopathy
3 signs in moderate hypertensive retinopathy
Hard exudates
Flame shaped hemorrhages
Dot and blot hemorrhages
Papilledema
Blurry optic disc
How do you want to reduce BP in hypertensive emergency
Target to lower their BP by 10-20% in the first hour, and then a further 15% over the next 24 hours
5 investigations to check for TOD in everyone who is diagnosed with HTN
History Physical ECG eGFR Urinalysis
Standard investigations for HTN if they also have cardiac risk factors
History Physical Fasting lipid profile ECG Weight and waist circumference A1C or fasting blood glucose
