T4 - HTN Assessment Flashcards
What are the 2017 ACC/AHA thresholds for hypertension?
SBP > 130 mmHg or DBP > 80 mmHg.
How many people in the US are affected by hypertension?
Over 100 million.
Which race has the highest prevalence of hypertension in the US?
African Americans at 40%.
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Which countries have higher hypertension rates?
Low- to middle-income countries.
What is the lifetime risk of developing hypertension in the US?
90%.
What are the blood pressure parameters in the classification of systemic blood pressure in adults? (i.e. normal, elevated, stage 1, stage 2)
What conditions are associated with chronic hypertension?
Ischemic heart disease
stroke
renal failure
retinopathy
PVD
increased overall mortality.
Name the three subtypes of hypertension based on blood pressure readings.
Isolated systolic HTN (SBP >130 mm Hg and DBP <80 mm Hg)
isolated diastolic HTN(SBP <130 mm Hg with DBP >80 mm Hg)
combined systolic and diastolic HTN. (SBP >130 mm Hg and DBP >80 mm Hg)
What does a widened pulse pressure indicate?
It correlates with vascular remodeling and stiffness
increased risk for cardiovascular morbidity.
What distinguishes primary from secondary hypertension?
Primary HTN = unclear causes but includes factors like SNS activity and RAAS dysregulation
secondary HTN has specific, often correctable, causes.
What are contributing factors to primary hypertension?
Increased SNS activity
dysregulation of RAAS
deficiency in endogenous vasodilators.
What are some genetic and lifestyle risk factors associated with hypertension?
Obesity
alcoholism
tobacco use.
What are common causes of secondary hypertension in middle-aged adults?
Hyperaldosteronism
thyroid dysfunction
OSA
Cushing’s syndrome
pheochromocytoma.
What are common causes of secondary hypertension in children?
Renal parenchymal disease
coarctation of the aorta.
What structural changes does chronic hypertension induce in arteries?
remodeling of small and large arteries
endothelial dysfunction
both of which can cause irreversible end-organ damage.
What role does disseminated vasculopathy play in chronic hypertensive patients?
It contributes to:
ischemic heart disease
LVH
CHF
CVAs
PAD
aortic aneurysm
nephropathy.
Which ultrasound measurement can provide an early diagnosis of vasculopathy?
Measurement of the common carotid intimal-to-medial thickness and arterial pulse-wave velocity.
What diagnostic trends may track the progression of left ventricular hypertrophy (LVH)?
Trends on an EKG and echocardiogram.
Which imaging modality can be used to follow microangiopathic changes indicative of cerebrovascular damage?
MRI (Magnetic Resonance Imaging).
What is the general therapeutic blood pressure goal for treating hypertension?
below 130/80 mmHg.
What is considered resistant hypertension?
Blood pressure that remains above goal despite using three or more antihypertensive medications at maximum doses.
What does treatment for resistant hypertension typically include?
A long-acting calcium channel blocker (LA CCB), an ACE inhibitor (ACI-I) or angiotensin receptor blocker (ARB), and a diuretic.
What is controlled resistant hypertension?
Blood pressure that is controlled but requires four or more medications.
What is refractory hypertension?
uncontrolled blood pressure on five or more drugs.