special considerations of htn Flashcards
what is the BP goal for pt’s with diabetes
140/90
what is the treatment for nonblack population for HTN with DM in JNC8?
- ACEI/ ARB
- Thiazides
- CCB’s
- Beta-Blockers
what is the general treatment for the black population for HTN with DM
thiazides
CCB’s
for every 10 ml you decreases diastolic bp what happens for DM pt’s
decrease mortality by 50%
what is the JNC 8 BP goal with CKD?
140/90
anyone with HTN and CKD should have what medications started?
ACEI/ARB for renal
what is the most common cause of death with pt’s with CKD?
cardiovascular disease
what are for criteria for patients at risk of HTN crisis?
- men
- elederly
- African americans
- low SES
what percent of patients with HTN experience HTN crisis?
1-2%
the majority of HTN crisis’ are caused by what
idiopathic causes
what is a hypertensive crisis?
what level BP is considered this?
acutely elevated BP
either systolic over 180 or diastolic over 120
>180/120
what is the term for elevated BP without acute end organ damage in HTN Crisis?
hypertensive urgency
what is the term for HTN crisis with acute end-organ damage?
hypertensive emergency
what is the difference in HTN urgency vs. emergency?
urgency doesn’t have acute end organ damage
emergency has acute end organ damage
what are the target organs in a hypertensive emergency?
- Brain
- eyes
- peripheral vasculature
- heart
- kidney
what are 3 types of eye damage seen in a HTN emergency
- narrowing of retinal arteries
- flame shaped hemorrhage
- cotton wool spots (not unique to HTN crisis)
how is mena arterial pressure calculated?
MAP= CO x SVR
what is the cerebral venous pressure (CVP) generally seen in HTN crisis
0-1
what levels should MAP be above to keep blood flow to vital organs?
what is the normal range of MAP
above 60 (normal = 60-120)
in clinical practive how is MAP calculated?
((2 x diastolic pressure) + systolic)/3
why is diastolic multiplied by 2 when calculating MAP
diastolic lasts twice as long as systolic
why does MAP stay high overtime in unmanaged patients?
MAP will autoregulate to a higher level, possibly leading to end organ damage
what happens to vascular resistance in HTN crisis?
What causes this
abrupt increase in vascular resistance
do to an increase in vasoconstrictors
what happens in response to vascular resistance?
endothelial cells release vasodilatiors
overtime, what happens with response to increased vascular resistance
endothelial cells become damaged and cant release vasodilators
causes loss of normal autoregulatory function
what can occur with increased vasoconstriction without opposition
ischemia and infarction
endothelial damage causes what 4 specific, negative things leading to vasoconstriction
increased permability
increased nitric oxide
activates coagulation cascade
fibrin deposits
if a patient has BP that is greater than 180/120 what should be done to confirm it clinically?
confirm it in both arms
what are 3 clinical presentations common in emergency HTN?
- chest pain
- dyspnea
- neurological deficits
what are the physical exams needed to identify end organ damage for an emergency HTN pt.
- pulse evaluation
- auscultation of ungs, heart and renal arteries
- neurological exam
- eye exam
- CV exam
what labs should be evaluated during HTN emergency
- SCr
- BUN
- urinary analysis (UA)
- electrolytes
- CBC
encephalopathy, and eclampsia indicate what HTN urgency or emergency?
HTN emergency
as a pharmacist what should be evaluated with a HTN emergency
medication history and compliance
what is the mortality rate for HTN crisis left untreated?
79%
what are 4 common most common causes of death with HTN crisis
- renal failure (40%
- stroke (23%)
- MI (11%)
- heart failure (10%)
