Overview of HTN

Question 1

Definition of HTN

Answer 1

• At least 2 subsequent visits over several weeks w/ repeated BP >140/90
• HTN can be due to increased CO or TPR (BP= CO x TPR)

Question 2

Systems that regulate BP

Answer 2

• Heart CO
• Blood vessel tone (TPR)
• Kidneys regulating intravascular volume

Question 3

End organ damage from HTN

Answer 3

• Cardiac: LVH, HF, MI
• Brain: stroke
• Renal: CKD, end-stage renal disease
• Aorta and vasculature: Ao aneurysm/dissection, claudication
• Retinopathy: arterial narrowing, hemorrhage, papiledema

Question 4

Regulation of BP

Answer 4

• Short term: baroreceptor reflexes, chemoreceptor reflexes, SNS
• Long term: kidneys, renin/angiotensin/aldo, ADH, ANP, endothelin
• Resistant HTN: full doses of 3 drug regimen doesn’t lower BP

Question 5

Pathogenesis (risk factors)

Answer 5

• Obesity
• Tobacco
• Caffeine
• EtOH
• Mineral metabolism: decreased Ca, K, Mg

Question 6

Secondary causes of HTN

Answer 6

• If not due to secondary causes, its essential HTN (idiopathic)
• Think secondary if pt is 65, abrupt onset, no family Hx, 3x drug Rx failed
• Most common secondary causes of HTN: ABCDE
• Apnea, Bruits (renal artery stenosis), CKD, drugs, endocrine d/o

Question 7

Evaluating BP

Answer 7

• Best for pts to take BP at home, at rest sitting w/ arm at level of heart
• Hx for cardiac-related diseases, vasculature-related diseases metabolic diseases, family Hx of these
• Evaluate weight, smoking, exercise, diet (fat, EtOH, salt), previous HTN, medications, other Sx suggesting 2o
• Physical: check BP on both arms, funduscopic exam, check for bruits
• Cardiac exam: laterally displaced PMI indicating cardiomegaly, precordial heave, clicks, murmurs, S3/4 gallops
• Labs: urinalysis, CBC, CMP, lipid profile