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

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

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

Essential/ Primary Hypertension

A

Hypertension with no identifiable cause

90% cases hypertension

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

Secondary Hypertension

A

with a cause

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

Systolic <80

A

Normal

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

S 120-139 D 80-89

A

Prehypertension

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

S 140-159 D 90-99

A

Stage 1 Hypertension

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

S >=160 D >=100

A

Stage 2 Hypertension

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

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

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

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

Identifiable causes of hypertension?

A

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

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

Physical exam?

A

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

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

Retinopathy

A
Grade 1- narrowing of arterioles
Grade 2- AV nicking
Grade 3- Flame hemorrhage
Grade 4- Soft exudates
Grade 5- Papilledema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Goal of therapy?

A

<130/80 if diabetic or renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If not at goal with compelling indications?

A

individualized

diuretics, ACEI, ARB, BB, CCB as needed

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Stable angina?
beta blockers, Calcium channel blockers
26
Acute Coronary syndrome?
BB, ACE- Inhibitors
27
Post MI?
ACEI, BB, Aldosterone antagonists
28
Asymptomatic heart failure?
ACEI, BB
29
Symptomatic heart failure?
ACEI, BB, Angiotensin receptor blocker (ARB), Aldosterone antagonist, loop diuretics
30
Diabetes?
ACEI, ARB, CCB
31
Chronic Kidney Disease?
ACEI, ARB
32
African Americans?
Diruetics, CCBs | hydralazine plus nitroglycerin as a sub for ACEI
33
Mexican Americans?
high rate of DM | Thaizides and beta blockers increase risk of diabetes
34
Elderly?
ACEI, CCB, Thaizide
35
Pregnancy?
Methyldropa, BB, vasodilators
36
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 ```
37
Resistant hypertension?
failure to reach goal on full dose of appropriate three drug regimen that includes a diuretic
38
Common drug induced resistant hypertension?
Nsaids
39
Obstructive sleep apnea leads to hypertension?
apnea reults in negative intrathoracic pressure causing increased preload and afterload leading to hypertension
40
Key signs pf Hyperaldosteronism?
Hypertension, polyuria, polydipsia, hypokalemia
41
Classic sign on CT for fibromuscular dysplasia?
String of beads (renal artery)
42
Indicate Chronic Kidney disease?
GFR less than 60 ml/1.73 m2
43
Pheochromocytoma?
rare catecholamine producing tumor of the adrenal chromaffin cells
44
5 Ps of Pheochromocytoma?
paroxysmal pressure, pain headache, palpitations, pallor, perspiration
45
Cushing's disease?
excessive cortisol secondary to pituitary ACTH hypersecretion
46
Diagnose hypercortisolism?
24 hr urinary free cortisol, dexamethasone suppression test, salivary cortisol
47
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
48
Hyperthyroidism hypertension?
systolic with a wide pulse pressure | palpitations, exopthalamos, weight loss, goiter
49
Hypothyroidism hypertension?
diastolic | hair loss, cold intolerance, weakness, constipation
50
Hyperparathyroidism?
treat with fluids, furosemide, bisphosphates, calcitonin, glucocorticoids