More Notes on HTN Flashcards
For pts under 50 years old diastolic pressure is one that higher and as you get over 50 years old systolic blood pressure is the issue
Systolic tends to be associated with atherosclerosis which is an issue of age
If pt comes in and they can’t see out of one eye if pt has evidence of AKI if they are having a TIA then it’s a hypertensive emergency so usually pt might be having a bleed so if you take pt’s blood pressure and they don’t even know its high which is more likely in hypertensive urgency
Causes of high blood pressure is when pt stops medication abruptly especially a beta blocker they can have kidney changes like renal artery stenosis
If pt has RAAS activated they have increased renin which causes sudden increase in their blood pressure.Pregnant women can have sudden changes in their blood pressure as well pheochromocytoma where they have catecholamine release this can lead to sudden changes in blood pressure
You receive a call from PCP. She has Maryn, a 25-year old white woman in the office today and her BP is 138/98, last week it was 138/96. How would you classify Maryn’s BP?
stage 2 hypertension
We decide if its hypertension or elevated blood pressure…we have 2 blood pressures and we can classify it as hypertension
Caffeine,licorice, st john’s worts, corticosteroids, ibuprofen, naproxen are NSAIDS, decongestants can increase blood pressure
If your getting dehydrated your activating those baroreceptors and causing activation of renin and its similar to if you have renal artery stenosis you get this activated renin because your trying to increase volume because your dehydrated so if you get dehydrated you have this decreased blood pressure leading to an activated RAAS leading to an activated RAAS and leading to increased blood pressure so activated sympathetic nervous system and activating your RAAS which leads to water and salt retention so it can lead to water and salt retention so you can have very inconsistent blood pressure for people who are chronically dehydrated
People sometimes feel like they have low blood sugar right before they eat lunch and then they feel better…unless your on medication for diabetes your body is very good at keeping your sugar steady but its not good at keeping your blood pressure steady
DASH diet helps with incorporating more potassium rich foods and decreasing sodium…its not a weight loss diet necessarily so it doesn’t usually incorporate weight loss but it does alcohol moderation and sodium potassium so it combines all of those things
Primary hypertension=build up over time…if you were to remove it won’t go away right away…obesity and smoking as primary but really the damage is done and once you quit smoking your blood pressure doesn’t improve right away and when you lose weight your blood pressure doesn’t completely reverse the damage is done slowly over time
Damage from smoking is a long-term issue and they are considered primary causes of hypertension cause they cause permanent damage
Secondary= things that can be fixed and its completely cured…so if its pregnancy and you have the baby the problem is fixed…if having the baby doesn’t fix it then it changes to primary diagnosis it wasn’t caused by the baby.
If it’s a brain tumor and the tumor is removed then its fixed
Maryn is a 25 year old white woman she has come to your HTN clinic with newly diagnosed HTN. Her BP today is 146/96. The last 2 readings were 140/100 and 142/98. Medical history significant for ADD, works f/t 3rd shift and is a part time student. BMI 32, A1C was 5.2 on yesterday
Medications: Ortho-Evra patch, methylphenidate 10mg twice daily
What might be affecting Maryn’s BP? Include all that you can find from the case.
secondary causes: methylphendiate, estrogen from birth control lifestyle: stress, sleep issues-third shift, school,BMI
Hypertension has a very significant role in overall major adverse cardiovascular events
We got rid of methylphenidate for this patient and we changed her birth control to one that doesn’t contain estrogen so it won’t effect her blood pressure..her blood pressure is now 136/94 but its still stage 2
Talk to pt about sodium content and get her on the DASH diet this is now primary versus secondary and we removed the secondary causes of hypertension and now we have Maryn with primary hypertension so she now has primary hypertension based on smoking and her BMI is high now we have reason to treat her because we removed all the secondary causes and her blood pressure remains high
If pt is stage 2 hypertension your going to start medication and your going to talk to them about nonpharm options and eating healthy and quitting smoking
For a pt who is stage 1 hypertension we don’t necessarily always start medication first we have to determine ASCVD risk so if pt has ASCVD so if they already had an MI or something like that then pt will definitely get medication
If their 10 year ASCVD is over 10% then pt gets medication. If not then we just talk to them about lifestyle goals and we have them back in 3 to 6 months to see if that brought it down and if not then we would start medication so we give them a little bit of time to see if they can get it down before starting the medication
If you have stage 2 or your risk score is greater than 10% in stage 1 you get medication right away
Blood pressure goal for everyone is less than 130/80
For a brain bleed blood pressure goal is little bit higher
What is Maryn’s blood pressure goal? Less than 130/80
Lower blood pressure is better with evidence based medications so not all medications for blood pressure are created equally…certain medications are evidenced based
