Therapeutics of Hypertension 1 Flashcards
essential HTN - elevated alterial BP with an ___ etiology
Can result from
- ___ abnormalities
- ___ mechanisms
- vascular ___ mechanisms
- peripheral ___ defects
- ___ disturbances
unknown
- humoral
- neuronal
- endothelial
- autoregulation
- electrolyte
secondary HTN - elevated arterial blood pressure due to concurrent medical conditions or medications ( ___ cause)
identifiable
Isolated systolic HTN - ___ BP values are elevated and ___ BP are not
systolic, diastolic
Resistant HTN - fail to attain goal BP while adherent to regimen that includes at least ___ agents at max dose (including ___ ) or when ___ or more agents are needed
3, diuretic, 4
Orthostatic hypotension - a systolic BP decrease of > ___ mmHg, a diastolic BP decrease of > ___ mmHg within 3 minutes of positional change, and/or increase in HR > ___ bpm
- 20
- 10
- 20
Hypertension risk factors
modifiable
- high ___ intake
- obesity
- low ___ intake
- excess ___ intake
non-modifiable
- age
- ethnicity
- ___ predisposition
- gender
- Na
- K
- alcohol
- genetic
Hypertension risk factors - non-modifiable
- age < 55: male ___ female
- age 55-64: male ___ female
- age > 64: male ___ female
- >
- <
- «
BP = ____ x ____
CO x TPR
CO = ____ x ____
SV x HR
Secondary HTN
- CKD
- ___ disease
- primary ___
- obstructive sleep apnea
- drug induced
- ___ and ___consumption
- pheochromocytoma
- ___ syndrome/chronic steroid use
- thryoid or parathyroid disease
- ___ coarctation
- renovascular
- aldosteronism
- Na, EtOH
- Cushing’s
- aortic
Substances that can increase BP
- cocaine, ecstasy
- caffeine
- nicotine
- pseudoephedrine, phenylephrine
- amphetamines
- antidepressants (___, ___, ___)
- atypial antipsychotics (___, ___)
- OC (estrogens, androgens, progesterone)
- NSAIDs
- oncology agents ( ___ inhibitors, ___ inhibitors)
- MAOIs, SNRIs, TCAs
- olanzapine, clozapine
- angiogenesis, tyrosin kinase
BP measurement Techniques
In-office - ___ readings, ___ min apart, and sitting in a chair. Confirm elevated reading in opposite ___
Ambulatory - indicated for evaluation of ___ HTN, ___ HTN, and nighttime BP ___
Home BP monitoring - indicated for evaluation of ___ HTN, ___ HTN, response to therapy, and may improve ___
- 2, 5, arm
- white coat, masked, dipping
- white coat, masked, adherence
BP Classifications
Normal
< 120
AND
< 80
BP Classifications
Elevated
120-129
AND
< 80
BP Classifications
HTN Stage 1
130-139
OR
80-89
BP Classifications
HTN Stage 2
greater than or equal to 140
OR
greater than or equal to 90
ACC/AHA BP Strategies based on BP Class
Normal BP ( < ___ / ___ )
1) promote ___
2) reassess in ___ year
120/80
- healthy lifestyle
- 1
ACC/AHA BP Strategies based on BP Class
Elevated BP ( ___ - ___ / < ___ )
1) ___ treatment
2) reassess in ___ - ___ months
120-129 / < 80
non-PCOL
3-6
ACC/AHA BP Strategies based on BP Class
Stage 1 HTN ( ___ - ___ / ___ - ___)
WITH ASCVD risk greater than or equal to ___ % or a specific ___ : ___ treatment and ___
- reassess in ___ month
WITHOUT: ___ treatment
- reasses in ___ - ___ months
130-139/80-90
10%, comorbidity
Non-PCOL, medication
- 1
Non-PCOL
- 3-6
ACC/AHA BP Strategies based on BP Class
Stage 2 HTN ( greater than or equal to ___ / ___ )
1) ___ treatment and ___ medications
2) reassess in ___ month
140/90
Non-PCOL, 2
1
HTN patients at goal should have follow up every ___ - ___ months
3-6 month
ACC/AHA: BP Thresholds for Treatment Initiation
General
- clinical CVD or 10 year ASCVD risk greater than or equal to 10%: ___
- no clinical CVD and 10 year ASCVD risk < 10%: ___
- patients 65 and older (non-institutionalized): ___
- 130/80
- 140/90
- 130
ACC/AHA: BP Thresholds for Treatment Initiation
Specific Comorbidities
- DM: ___
- CKD: ___
- HF: ___
- stable ischemic heart disease: ___
- secondary stroke prevention: ___
- peripheral arterial disease: ___
- 130/80
- 130/80
- 130/80
- 130/80
- 140/90
- 130/80
BP Goals
ACC/AHA: ___
- may consider < ___ / ___ in elderly frail pts with high comorbidity burden and limited life expectancy
ADA: ___
KDIGO: SBP < ___ for adults with elevated BP and CKD, if tolerated
130/80
140/90
130/80
120
Systolic BP Interventional Trial - SPRINT
intensive group < 120; standard group < 140
- patinets without ___ or prior ___
- majority met goal in ___ group
- intensive group saw ___ % lower risk in MI, SCS, stroke, HF, and CV death, and ___ % reduced risk of death
- however, intense group saw increase risk of ___ abnormalities, ___ , and AKI
TAKEAWAY - good to be ___ intense in patients without diabetes
- diabetes, stroke
- standard
- 25%, 27%
- electrolyte, hypotension
- more
Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP Arm
- pts with ___ ages 40-79 with CVD/multiple risk factors
- primary composite outome (MI, stroke, and CV death) saw no benefit.
- increased risk of ___
TAKEAWAY - better to be ___ intense in patients with diabetes
- T2DM
- AEs
- less
Non-PCOL
- weight loss: 5 mmHG
- ___ diet: ___ mmHg
- decreased ___ intake (< 1500 mg/day or 1000 mg reduction per day): 5-6 mmHg
- enhance dietary ___ intake (3500-5000 mg/day): 4-5 mmHg
- physical activity: 4-8 mmHg
- modration in alcohol intake: 4 mmhg
- DASH, 11
- Na
- K
DASH Diet
recommend
- vegetables and fruits
- whole grains
- fat free or low-fat dairy products
- fish , poultry, beans
- nuts and vegetable oils
- foods rich in ___ , ___ , ___ , fiber, protein, and lower in Na ( ___ mg/day)
Limit foods that are:
- high in ___ fat (fatty meats, full-fat dairy, tropical oils)
- sugar sweetened beverages and sweets
- K, Ca, Mg, 1500
- saturated
Pharmalogic Treatment Options (9)
1) ACE-i
2) ARBs
3) CCB
4) direct renin inhibitors
5) Beta Blockers
6) diuretics (thiazide, loop, K+ sparing, aldosterone antagonists)
7) alpha 1 blockers
8) central alpha 2 agonists
9) vasodilators
