pre-reading Flashcards

1
Q

primary hypertension

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

• Diagnosis typically (not always) requires readings on 2 separate occasions

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

• ASH/ISH and JNC 8

A
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

• ACC/AHA

categoreis of BP in adults

A
Normal <120 and <80
elevated 120-129 and <80
hypertension 
stage 1: 130-139 or 80-89
stage 2: >= 140 or >= 90
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

• Lifestyle modifications

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

80 or 60 older

A

 Patients 80 years or older (ASH/ISH) or 60 years or older (JNC8) target of <150/90 may provide CV and stroke protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

under 50

A

 Data lacking for blood pressure targets for patients under 50, lower targets could be appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CKD- goal of ash/ish and jnc

A

 Goal of < 140/90 although some experts still recommend < 130/80 in patients with CKD and albuminuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

monitoring

A

• Every visit

  • Drug ADE (see table/Pharmacology notes)
  • Yearly
  • Causes of resistant HTN (failure to achieve goal BP on 3-drug, diuretic-including regimen)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

urgency

A

often treated in clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hypertensive Urgency

A

≥ 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

drugs for urgency

Captopril

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

drugs for urgency

nicardipine

A

• 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

drugs for urgency

labetalol

A

• Labetalol: onset of action within 60-120 minutes

o Starting dose 200 mg, repeated every 3-4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

drugs for urgency

clonidine

A

• 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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

emergency

A

 Defined by Numbers and/or target organ damage
 Send to ER (not treatable in clinic)

 Ideal rate of blood pressure reduction unclear, proposed decrease to BP by 25% during first hour and to 160/100-100 mmHg over the next 2-6 hours

17
Q

Hypertensive Emergency

A

≥ 180 ≥ 120

(with target organ damage)

18
Q

monitoring every visit

A

o Blood pressure and pulse
o Lifestyle modifications
o Symptoms of elevated BP (HA, blurred vision, chest pain, SOB, epistaxis, tinnitus, tremor, weakness)

19
Q

monitoring yearly

A

o Eye exam
o Physical
o sCr and microalbumin

20
Q

monitoring

Causes of resistant HTN

A
o	Medication nonadherence
o	Volume overload
o	Improper BP measurement
o	Excessive sodium intake
o	Volume retention
o	Ineffective medication regimens (selection and doses)
o	Obesity
o	Alcoholism
o	Medications (NSAIDS, Cocaine, amphetamines, Sympathomimetics, Adrenal steroids, Cyclosporin or tacrolimus, Erythropoietin)
21
Q

resistant HTN

A

failure to achieve goal BP on 3-drug, diuretic-including regimen