Primary and Secondary Hypertension Flashcards
What is hypertension? (18 and greater)
average of 2 or more office visits on seperate days, based on either systolic or diastolic
Home bp 135/85 or higher or office bp 140/90 or higher
(High risk) Office bp 130/80
On hypertensive med
What is hypertension? (children/adolescents)
the average of 2 or more office visits on seperate days
based on either systolic or diastolic
blood pressure at or above the 95th percentile for age, height, and gender
on hypertensive meds
Essential/ Primary Hypertension
Hypertension with no identifiable cause
90% cases hypertension
Secondary Hypertension
with a cause
Secondary casues of hypertension (ABCDE)
- Apnea and Hyperaldosteronism
- Bruits and Bad kidneys
- Catecholamines, Coarctation of the aorta, HyperCortisolism
- Drug-induced causes
- Endocrine
Systolic <80
Normal
S 120-139 D 80-89
Prehypertension
S 140-159 D 90-99
Stage 1 Hypertension
S >=160 D >=100
Stage 2 Hypertension
Risk of CVD and high BP?
age 40-70 each 20/10 increase between 115/75-185/115 Doubles the risk of CVD
Proper way to take a BP?
subject with feet on the ground comfortable, back supported, arm at heart level
cuff bladder encircle 80% of the arm cuff width should be 2/3 of the arm width
2 or more readings averaged
Ambulatory blood pressure monitoring?
indicated for white coat hypertension, drug resistance, hypotension, episodic hypertension, and autonomic dysfunction
> 135/85 awake, >130/80 awake with CAD, DM, CKD, >120/75 asleep
Identifiable causes of hypertension?
Drug induced, sleep apnea, renovascular, hyperaldosteronism, pehochromocytoma, hypercortisolism, coarcation of the aorta, thyroid disease, hyperparathyroidism
Target organ damage?
Heart left ventricular hypertrophy, angina or prior myocardial infarction, prior coronary revascularization, heart failure Brain Stroke, TA Chronic Kidney disease Peripheral arterial disease reinopathy
Physical exam?
BMI, waist circumference, BP both arms, optic fundi, auscultation for bruits, palpate thyroid, CV, respiratory, Abdomen, lower extremity, neurological
Retinopathy
Grade 1- narrowing of arterioles Grade 2- AV nicking Grade 3- Flame hemorrhage Grade 4- Soft exudates Grade 5- Papilledema
Lab and diagnostic tests
Urine analysis proteinuria Blood glucose screen for diabetes Hematocrit anemia, renal insufficiency Potassium hypokalemia, primary aldosteronism Creatnine indicator of GFR albumin/creatinine ratio Calcium hypercalcemia Lipid profile high cholesterol risk factor EKG left ventricular hypertrophy
Goal of therapy?
<130/80 if diabetic or renal disease
If not at goal with compelling indications?
individualized
diuretics, ACEI, ARB, BB, CCB as needed
If not at goal without compelling indications Stage 2?
SBP>160 or DBP >100
2 drug combo, usually thiazide diuretic and ACEI or ARB or BB or CCB
If not at goal without compelling indications Stage 1?
SBP 140-159, DBP 90-99
Thiazide diuretics, may consider ACEI, ARB, BB, CCB or combo
Lifestyle mod?
weight reduction, dietary approach to stop hypertension, physical activity, moderate alcohol consumption
Compelling indications?
Ischemic heart disease, heart failure, diabetes, chronic kidney disease, cerebrovascular accident, african-american, pregnancy
Ischemic heart disease?
Stable angina, Acute Coronary Syndrome, Post MI
Stable angina?
beta blockers, Calcium channel blockers
Acute Coronary syndrome?
BB, ACE- Inhibitors
Post MI?
ACEI, BB, Aldosterone antagonists
Asymptomatic heart failure?
ACEI, BB
Symptomatic heart failure?
ACEI, BB, Angiotensin receptor blocker (ARB), Aldosterone antagonist, loop diuretics
Diabetes?
ACEI, ARB, CCB
Chronic Kidney Disease?
ACEI, ARB
African Americans?
Diruetics, CCBs
hydralazine plus nitroglycerin as a sub for ACEI
Mexican Americans?
high rate of DM
Thaizides and beta blockers increase risk of diabetes
Elderly?
ACEI, CCB, Thaizide
Pregnancy?
Methyldropa, BB, vasodilators
Follow up?
2 to 4 wks until goal more frequent if stage 2, complication 3-6 month visit after goal is reached serum creatinine and potassium 1-2/yr low dose aspirin only after goal is reached address lipids as needed
Resistant hypertension?
failure to reach goal on full dose of appropriate three drug regimen that includes a diuretic
Common drug induced resistant hypertension?
Nsaids
Obstructive sleep apnea leads to hypertension?
apnea reults in negative intrathoracic pressure causing increased preload and afterload leading to hypertension
Key signs pf Hyperaldosteronism?
Hypertension, polyuria, polydipsia, hypokalemia
Classic sign on CT for fibromuscular dysplasia?
String of beads (renal artery)
Indicate Chronic Kidney disease?
GFR less than 60 ml/1.73 m2
Pheochromocytoma?
rare catecholamine producing tumor of the adrenal chromaffin cells
5 Ps of Pheochromocytoma?
paroxysmal pressure, pain headache, palpitations, pallor, perspiration
Cushing’s disease?
excessive cortisol secondary to pituitary ACTH hypersecretion
Diagnose hypercortisolism?
24 hr urinary free cortisol, dexamethasone suppression test, salivary cortisol
Coarctation of the aorta?
Narrow of aorta typical distal to origin of left subclavian artery
bp is lower in legs than arms
diagnose: ck pulses, bp and O2 sat, CT angiography
Hyperthyroidism hypertension?
systolic with a wide pulse pressure
palpitations, exopthalamos, weight loss, goiter
Hypothyroidism hypertension?
diastolic
hair loss, cold intolerance, weakness, constipation
Hyperparathyroidism?
treat with fluids, furosemide, bisphosphates, calcitonin, glucocorticoids
