primary and secondary HTN Flashcards
lowering BP can reduce the risk of…
stroke incidence
MI
heart failure
white coat HTN
high BP in office, normal at home
Masked HTN
normal BP in office, high at home
HTN can target kidneys and cause _____
CKD
at what BP do you start treatment for a pt with no CVD and a low risk
140/90
lifestyle modifications for HTN
weight loss
DASH diet
exercise
moderation of alcohol
stage 1 HTN
systolic 130-139 or diastolic 80-89
stage 2 HTN
systolic 140+ or diastolic 90+
which lifestyle mod can have the largest impact on BP reduction
weight loss
how long should rx take to start to help in stage 2 HTN?
should work immediately
goal BP for adults with HTN and CVD or CVD event risk 10%+
BP less than 130/80
how much will 1 rx change BP?
8/5 mmHg
how much will 2 rx change BP?
15/9 mmHg
___ of the world’s population has HTN
25%
when to suspect secondary HTN
<30 years old at onset
resistant HTN
malignant HTN
sudden onset
most common correctable cause of secondary HTN
renovascular HTN
2 causes of renovascular HTN
fibromuscular dysplasia
atherosclerosis
most common cause of renovascular HTN in young females
fibromuscular dysplasia
what is fibromuscular dysplasia?
non-atherosclerotic medial fibroplasia where there are alternating areas of thin and thick areas of the renal arteries
most common cause of renovascular HTN
atherosclerosis
causes of secondary HTN
renal artery stenosis
endocrine causes
coarctation of aorta
sleep apnea
sleep apnea tx
CPAP
how does sleep apnea cause secondary HTN
hypoxia and hypercapnia increase SNS activity and RAAS
how does coarctation of aorta cause secondary HTN
HTN in upper limbs
reduced BP in lower limbs because there is a narrowing of the aortic lumen
aldosterone _____ BP
increases
cause of HTN where there is unregulated aldosterone release from the adrenal gland
primary hyperaldosteronism
clinical presentation of secondary HTN
new refractory HTN
hypokalemia
metabolic acidosis
renovascular HTN pathophys
narrowing of one or both renal arteries leads to obstruction of blood flow-ischemia and renin release which increases sodium retention and PVR leading to HTN
how does renin lead to HTN?
increased angiotensin leads to increased aldosterone which increases Na retention and PVR leading to HTN
imaging for suspected secondary HTN
renal ultrasound
renovascular HTN treatment
RAAS inhibitors
CCBs
diuretics
aldosterone increases BO by…
Na retention in the kidney
direct vasoconstriction
SNS upregulation via CNS
2 causes of primary hyperaldosteronism
adrenal hyperplasia (bilateral) adrenal adenoma (unilateral)
adrenal hyperplasia tx
MRA aldactone or eplerenone
adrenal adenoma tx
adrenalectomy as long as unilateral
Cushing’s syndrome causes secondary HTN by
excess cortisol production
delayed femoral pulses
coarctation of aorta
patients with renal parenchymal disease have reductions in ____ which leads to _____
sodium excretion
HTN
