Monday HTN highlights Flashcards
For every 20 mm Hg systolic or 10 mm Hg diastolic increase, the risk of major cardiovascular events & stroke __________
doubles
True or false: you should know the physiology of HTN well
True
Give an example of a short term mechanism for maintaining BP
Baroreceptor initiated reflex:
1) Located at carotid sinuses and aortic arch
a) Monitors BP
b) Regulates the activity of the sympathetic nervous system (vascular tone)
What are the exceptions to the typical regulation of vascular tone (i.e. typically sympathetic = constriction)?
Cardiac, skeletal muscles, external genitalia - sympathetic stimulation = relative vasodilation (flight or fight & sex)
What is normal blood pressure?
<120/80 mmHg
According to USPSTF:
1) Who needs to be screened annually for HTN?
2) Who needs to be screened less frequently?
1) For 40+ and any adults 18 + with elevated risks
2) 18-39 y/o without elevated risk (~ 3-5 years)
(A)
Thresholds for HTN in kids are what?
> 95% BP for age, sex, and height
Screening for elevated BP is done where?
In the office
Suspected HTN should be confirmed with what?
Out of office BP measurement
Ambulatory BP Monitoring (ABPM) is recommended for ______________ of HTN
diagnosis
What is the gold standard for BP measurement after an office BP suggests elevated BP?
Ambulatory BP measurement (ABPM)
Describe secondary HTN
(important to know how to differentiate from primary)
Less common
Onset acute
Younger/elderly onset
Symptomatic at onset
Family Hx +/-
May resolve with treating underlying etiology
The first-line imaging test for renal parenchymal disease is ________________________ to assess for the presence of underlying disease
renal ultrasonography
Renal Artery Stenosis (RAS) can be caused by what?
Atherosclerotic disease
Renovascular disease
1) What is most common in young female patients with HTN?
2) What can Kidney transplant cause?
1) Renal artery fibromuscular dysplasia
2) Multifactorial (surgical, native, immune mediate) damage to renal vessels
Renal artery stenosis:
1) Younger than < 30 y/o, most common due to ______________ disease
2) Older than 30 y/o, most commonly _______________ disease
1) fibromuscular disease
2) atherosclerotic disease
Improved glycemic control for patients with diabetes can help Tx what?
Renal artery stenosis
Unprovoked hypokalemia further supports this diagnosis although is not present on the majority of cases of what?
Primary hyperaldosteronism
What is primary hyperaldosteronism diagnosis based on?
aldosterone:renin ratio
Focused history for initial & f/u evaluation of HTN should be about what?
Hx of target organ damage
Give examples of Hx of target organ damage from severe HTN
1) CNS: dizziness, confusion, TIA/Stoke (embolic or hemorrhagic)
2) Eye: vision changes
3) Heart: Chest pain – angina, ACS, aortic dissection
4) Kidneys: hematuria
What is the key to the HPI/ ROS for HTN? Give examples
Target organ symptoms:
1) CNS: dizziness, confusion, TIA/Stoke (embolic or hemorrhagic)
2) Eye: vision changes
3) Heart: Chest pain – angina, ACS, aortic dissection
4) Kidneys: hematuria
What the the Sx for the following target organs?:
1) CNS
2) Eye
3) Heart
4) Kidneys
1) Dizziness, confusion, TIA/Stoke (embolic or hemorrhagic)
2) Vision changes
3) Chest pain: angina, ACS, aortic dissection
4) Hematuria
PMHx of a pt with HTN may include what?
Smoking, co-morbid conditions (DM), family hx HTN or heart disease
Focus of an HTN exam is to evaluate for signs of what? (3 things)
1) Target-organ damage
2) Assessment of CV disease and risk (CAD, Cerebral vascular disease, PAD)
3) Clues about possible secondary HTN
What would you expect the PE of a pt with HTN to look like?
“Unremarkable except for maybe a few vital signs”
