pre-reading Flashcards
primary hypertension
• 95% of adult cases due to primary hypertension (5% secondary to other disorders
o Presentation can be associated by symptoms (e.g. headache, weariness) but disease is often ‘silent’ as patients have little to no symptoms due to body acclimation to higher and higher pressures over time
• Diagnosis typically (not always) requires readings on 2 separate occasions
o Consider white-coat hypertension (high readings when in healthcare setting)—can utilize at-home measurements or 24-hour measurement to differentiate
o Assume primary blood pressure unless history/physical exam/other screenings suggest alternative cause)
• ASH/ISH and JNC 8
Normal <120 And <80 Prehypertension 120-139 Or 80-89 Stage 1 hypertension 140-159 Or 90-99 Stage 2 hypertension ≥160 Or ≥ 100 Hypertensive Urgency ≥ 180 ≥ 110 Hypertensive Emergency ≥ 180 ≥ 120 (with target organ damage)
• ACC/AHA
categoreis of BP in adults
Normal <120 and <80 elevated 120-129 and <80 hypertension stage 1: 130-139 or 80-89 stage 2: >= 140 or >= 90
• Lifestyle modifications
o Weight reduction if BMI ≥ 25 kg/m2: SBP lowering by 5-20 mm Hg for every 10 kg of weight loss
o Healthy diet (F/V, whole grain emphasis, limit fats, sweets and red meat): SBP lowering by 8-14 mm Hg
o Na restriction ≤ 2.4 gm sodium daily : SBP lowering by 5-6 mm Hg
o K 3.5-5 gms per day
o Exercise: 90-150 minutes aerobic per week SBP lowering by 4-9 mm Hg, resistance 3 times per week
o Alcohol: men ≤ 2 drinks, women ≤ 1 drink per day SBP lowering by 2-4 mm Hg
o Tobacco Cessation
o Limit/Eliminate caffeine
Energy drinks: as little as one per day can raise SBP by 3.5 mm Hg
o Following drug classes can exacerbate HTN: alcohol, stimulants, antidepressants (except SSRI’s), atypical antipsychotics, oral contraceptives
80 or 60 older
Patients 80 years or older (ASH/ISH) or 60 years or older (JNC8) target of <150/90 may provide CV and stroke protection
under 50
Data lacking for blood pressure targets for patients under 50, lower targets could be appropriate
CKD- goal of ash/ish and jnc
Goal of < 140/90 although some experts still recommend < 130/80 in patients with CKD and albuminuria
monitoring
• Every visit
- Drug ADE (see table/Pharmacology notes)
- Yearly
- Causes of resistant HTN (failure to achieve goal BP on 3-drug, diuretic-including regimen)
urgency
often treated in clinic
Hypertensive Urgency
≥ 180 ≥ 110
Goal: Reduce BP to 160/110 mm Hg over several hours to days
after controlled
Resume usual blood pressure regimen with enhanced monitoring or add additional medication if appropriate
drugs for urgency
Captopril
• Captopril: onset of action 15-30 minutes
o Maximum drop in BP: 30-90 minutes
o 25 mg initial dose, followed by 50-100 mg 90-120 minutes later
drugs for urgency
nicardipine
• Nicardipine: onset of action 30-120 minutes
o Usual dose: 30 mg every 8 hours until target BP achieved
o Use of short-acting nifedipine should be avoided due to stroke risk
drugs for urgency
labetalol
• Labetalol: onset of action within 60-120 minutes
o Starting dose 200 mg, repeated every 3-4 hours
drugs for urgency
clonidine
• Clonidine: onset of action within 15-30 minutes
o Peak effect: 2-4 hours
o Typical regimen: 0.1-0.2 mg loading dose, followed by 0.05-0.1 mg every hour until target BP achieved (max dose 0.7 mg)