MCP: Cardiovascular Part 1-HTN Flashcards
1
Q
HTN Definition
A
- Persistently elevated arterial BP
- Patients actively taking antihypertensive medications are considered to have HTN (regardless of BP)
2
Q
HTN Prevalence
A
- 1 in 3 Americans
- Often has no symptoms
- “Silent Killer”
- Some symptomsm might include: dizzy spells, dull HA, nosebleeds
3
Q
Impact of HTN
A
- BP correlates directly to risk of cardiovascular morbidity and mortality
- Leads to damage of blood vessels and target organs
- Heart
- Heart disease
- Coronary artery disease
- CV events
- MI
- Chest Pain (Angina)
- Heart Failure
- Heart disease
- Brain
- Cerebrovascular Events
- Stroke
- Cerebrovascular Events
- Kidney
- Kidney Disease
- Heart
4
Q
HTN: As a Major Risk Factor
A
- Major risk factor for heart disease
- The 1st leading cause of death for all Americans
- High BP, 3x more likely for heart disease
- Major risk factor for stroke
- The 4th leading cause of death for all Americans
- High BP, 4x more likely for stroke
5
Q
Lifestyle Modifications
A
- Increased physical activity
- Weight loss
- DASH diet
- Reduced alcohol intake
- Smoking cessation
6
Q
DASH Diet
A
- Reduce risk of HTN and reduce blood pressure for those with HTN
- Limit sodium consumption to 2300mg/day
- Ideally 1500mg/day
- Diet rich in fruits and vegetables
- Increase in minerals such as potasium, calcium and magnesium
- Increase in fiber
- Low in saturated fats, choleseterol, and total fat
7
Q
Modification and BP Reducation
A
- Weight Loss
- 5-20 mmHg
- DASH
- 8-14 mmHg
- Limit Sodium
- 2-8 mmHg
- Physical Activity
- 4-9 mmHg
- Moderation of Alcohol Consumption
- 2-4 mmHg
8
Q
JNC-7 BP Diagnostic Ranges
A
- Normal: 120/80
- Pre-HTN: 120-139/80-89
- HTN Stage 1: 140-159/90-99
- HTN Stage 2: >160/>100
- HTN Crisis: >180/>110
- Goal BP with comorbidities: <130/80
- DM, MI, CKD
9
Q
JNC-8 New Blood Pressure Goals
A
- 18-59 yo with no commorbidities
- 140/90
- 60 yo with no commorbodiities
- 150/90
- 18 to <70 yo with CKD or DM
- 140/90
10
Q
JNC7/JNC8 Difference in a Nutshell
A
- Definition of HTN and pre-HTN were not specifically addressed in JNC8
- Thresholds for BP treament were adopted that were consistent with JNC-7 definition
- JNC8 advice higher BP goals in certain populations and decreased use of several antihypertensives
- follow a different classification system based on age and commorbidities
- Promote safer use of ACE inhibitors and ARBs, no longer promotes beta blockers and aldosterone agonists as a first and second line treatment.
11
Q
Screening vs. Diagnosis
A
- Elevated BP results in screening do not constitute diagnosis
- Proper HTN diagnosis:
- Multiple high BP readings on different days at office visits
- Some consideration for diagnosis of HTN based on at home BP monitoring
- 12-14 reading, both morning and evening reading, over 1 week
- Some consideration for diagnosis of HTN based on at home BP monitoring
- Multiple high BP readings on different days at office visits
- Multiple other physical exam procedures to check cardiac function and HTN complications
12
Q
BP Management and Monitoring
A
- HC Provider Monitoring:
- Monthly BP checks until reach goal
- More frequent visits if stage 2 HTN
- Monthly BP checks until reach goal
- Self-Monitoring:
- Various studies have shown that home monitoring can increase medication concordance and BP control
- Management:
- Lifestyle recommendations recommended for those with pre-HTN and HTN (encouraged for everyone)
- JNC-7
- Stage 1 HTN: At least one anti-htn med
- Stage 2 HTN: 2 anti-HTN medications recommended
13
Q
General Counseling Points
A
- Always encourage a healthy diet and lifestyle
- Time to Effect:
- May take 2-3 weeks to see sustained effects in blood pressure, though they may feel side effects in the first couple of days
- Concordance:
14
Q
Medications Used for Hypertension
A
- Thiazide diuretics
- Angiotensin Converting Enzyme Inhibitors (ACE I)
- Angiotensin II Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCB)
- Beta Blockers
15
Q
Thiazide Diuretics: Indications, MOA
A
- Indications:
- HTN
- Mild edema
- MOA:
- Inhibits Na and Cl reabsorption from teh distal tubule nephron –> increased urinary excretion of water
- Water follows salt
- Reduces blood volume in order to reduce blood pressure
16
Q
Thiazide Diuretics: Side Effects
A
- Polyuria
- Orthostatic hypotension
- Hypokalemia
- Photosensitivity
- Hyperglycemia and dyslipidemia (more common at higher doses)
17
Q
Thiazide Diuretics: Counseling Points
A
- Dose in morning to avoid disturbing sleep
- Rare: Sulfa allergies
18
Q
Thiazide Diuretics: Monitoring
A
- Blood pressure
- Potassium
- Blood Glucose (those with DM)
- Dyslipidemia (standard monitoring, but may watch more carefully)
19
Q
Thiazide Diuretics: Agents
A
- Hydrochlorothiazide (Microzide, HCTZ)
- High doses are associated with increased adverse effects without added clinical benefits
- Chlorthalidone (Hygroton)
20
Q
Angiotensin Converting Enzymes (ACE) Inhibitors: Indications and MOA
A
- Indications:
- Hypertension
- Heart Failure
- Prevention/Treatment of Diabetic Nephropathy
- MOA
- Suppresses renin-angiotension-aldosterone system by blocking the conversion of angiotensin I to angiotensin II (potent vasocontrictor)
21
Q
ACE Inhibitors: Side Effects
A
- Dry cough
- Hyperkalemia
- Caution with potassium suplements of potassium sparing diuretics
- Avoid combining with ARB
22
Q
ACE Inhibitors: Notes and Monitoring
A
- Notes:
- Contraindcated in pregnancy (Category X)
- Acute renal failure (rare)
- Monitoring:
- Blood pressure
- Renal function (SCr), potassium
