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MOD 1 Quiz 1 > Primary and Secondary Hypertension > Flashcards

Primary and Secondary Hypertension Flashcards

1
Q

What is hypertension? (18 and greater)

A

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

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2
Q

What is hypertension? (children/adolescents)

A

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

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3
Q

Essential/ Primary Hypertension

A

Hypertension with no identifiable cause

90% cases hypertension

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4
Q

Secondary Hypertension

A

with a cause

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5
Q

Secondary casues of hypertension (ABCDE)

A
  • Apnea and Hyperaldosteronism
  • Bruits and Bad kidneys
  • Catecholamines, Coarctation of the aorta, HyperCortisolism
  • Drug-induced causes
  • Endocrine
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6
Q

Systolic <80

A

Normal

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7
Q

S 120-139 D 80-89

A

Prehypertension

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8
Q

S 140-159 D 90-99

A

Stage 1 Hypertension

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9
Q

S >=160 D >=100

A

Stage 2 Hypertension

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10
Q

Risk of CVD and high BP?

A

age 40-70 each 20/10 increase between 115/75-185/115 Doubles the risk of CVD

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11
Q

Proper way to take a BP?

A

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

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12
Q

Ambulatory blood pressure monitoring?

A

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

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13
Q

Identifiable causes of hypertension?

A

Drug induced, sleep apnea, renovascular, hyperaldosteronism, pehochromocytoma, hypercortisolism, coarcation of the aorta, thyroid disease, hyperparathyroidism

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14
Q

Target organ damage?

A 
Heart
 left ventricular hypertrophy, angina or prior myocardial infarction, prior coronary revascularization, heart failure
Brain
 Stroke, TA
Chronic Kidney disease
Peripheral arterial disease
reinopathy
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15
Q

Physical exam?

A

BMI, waist circumference, BP both arms, optic fundi, auscultation for bruits, palpate thyroid, CV, respiratory, Abdomen, lower extremity, neurological

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16
Q

Retinopathy

A 
Grade 1- narrowing of arterioles
Grade 2- AV nicking
Grade 3- Flame hemorrhage
Grade 4- Soft exudates
Grade 5- Papilledema
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17
Q

Lab and diagnostic tests

A 
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
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18
Q

Goal of therapy?

A

<130/80 if diabetic or renal disease

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19
Q

If not at goal with compelling indications?

A

individualized

diuretics, ACEI, ARB, BB, CCB as needed

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20
Q

If not at goal without compelling indications Stage 2?

A

SBP>160 or DBP >100

2 drug combo, usually thiazide diuretic and ACEI or ARB or BB or CCB

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21
Q

If not at goal without compelling indications Stage 1?

A

SBP 140-159, DBP 90-99

Thiazide diuretics, may consider ACEI, ARB, BB, CCB or combo

22
Q

Lifestyle mod?

A

weight reduction, dietary approach to stop hypertension, physical activity, moderate alcohol consumption

23
Q

Compelling indications?

A

Ischemic heart disease, heart failure, diabetes, chronic kidney disease, cerebrovascular accident, african-american, pregnancy

24
Q

Ischemic heart disease?

A

Stable angina, Acute Coronary Syndrome, Post MI

25
Q

Stable angina?

A

beta blockers, Calcium channel blockers

26
Q

Acute Coronary syndrome?

A

BB, ACE- Inhibitors

27
Q

Post MI?

A

ACEI, BB, Aldosterone antagonists

28
Q

Asymptomatic heart failure?

A

ACEI, BB

29
Q

Symptomatic heart failure?

A

ACEI, BB, Angiotensin receptor blocker (ARB), Aldosterone antagonist, loop diuretics

30
Q

Diabetes?

A

ACEI, ARB, CCB

31
Q

Chronic Kidney Disease?

A

ACEI, ARB

32
Q

African Americans?

A

Diruetics, CCBs

hydralazine plus nitroglycerin as a sub for ACEI

33
Q

Mexican Americans?

A

high rate of DM

Thaizides and beta blockers increase risk of diabetes

34
Q

Elderly?

A

ACEI, CCB, Thaizide

35
Q

Pregnancy?

A

Methyldropa, BB, vasodilators

36
Q

Follow up?

A 
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
37
Q

Resistant hypertension?

A

failure to reach goal on full dose of appropriate three drug regimen that includes a diuretic

38
Q

Common drug induced resistant hypertension?

A

Nsaids

39
Q

Obstructive sleep apnea leads to hypertension?

A

apnea reults in negative intrathoracic pressure causing increased preload and afterload leading to hypertension

40
Q

Key signs pf Hyperaldosteronism?

A

Hypertension, polyuria, polydipsia, hypokalemia

41
Q

Classic sign on CT for fibromuscular dysplasia?

A

String of beads (renal artery)

42
Q

Indicate Chronic Kidney disease?

A

GFR less than 60 ml/1.73 m2

43
Q

Pheochromocytoma?

A

rare catecholamine producing tumor of the adrenal chromaffin cells

44
Q

5 Ps of Pheochromocytoma?

A

paroxysmal pressure, pain headache, palpitations, pallor, perspiration

45
Q

Cushing’s disease?

A

excessive cortisol secondary to pituitary ACTH hypersecretion

46
Q

Diagnose hypercortisolism?

A

24 hr urinary free cortisol, dexamethasone suppression test, salivary cortisol

47
Q

Coarctation of the aorta?

A

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

48
Q

Hyperthyroidism hypertension?

A

systolic with a wide pulse pressure

palpitations, exopthalamos, weight loss, goiter

49
Q

Hypothyroidism hypertension?

A

diastolic

hair loss, cold intolerance, weakness, constipation

50
Q

Hyperparathyroidism?

A

treat with fluids, furosemide, bisphosphates, calcitonin, glucocorticoids

MOD 1 Quiz 1 (15 decks)

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