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Cardio Exam 1 > Treatment of HTN > Flashcards

Treatment of HTN Flashcards

1
Q

Types of HTN

A 
Primary HTN
Secondary HTN
White-coat HTN
PseudoHTN
Isolated systolic HTN
Resistant HTN
Hypertensive crises
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2
Q

Define Primary HTN

A

Unknown cause; due to body’s compensation

90%

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3
Q

Define Secondary HTN

A

Identifiable cause - disease (CKD), drug (NSAIDs), birth control, etc

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4
Q

Define White-Coat HTN

A

BP increases in a clinical setting

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5
Q

Define PseudoHTN

A

BP falsly elevated due to rigid calcified brachial artery

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6
Q

Define Osler’s maneuver

A

BP cuff inflated above peak SBP, if radial artery remains palpable + Osler’s = PseudoHTN

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7
Q

Define Isolated systolic HTN

A

Only systolic BP increase

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8
Q

Define resistant HTN

A

Not at goal BP on max dose of at least 3 drugs, one of which is a diuretic

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9
Q

Define Hypertensive crisis

A

> 180/120

Emergency or urgency

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10
Q

Define Hypertensive Emergency

A

Extreme elevation in BP accompanied with acute or progressing target-organ damage

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11
Q

Treatment goals for Hypertensive Emergency

A

Immediate but gradual decrease in BP with IV agents over minutes to hours (DBP <110)

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12
Q

Define Hypertensive Urgency

A

High BP without acute or progressing target-organ damage

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13
Q

Hypertensive Urgency treatment

A

Decrease BP with PO agent to stage 1 values over several hours to days

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14
Q

Automated BP measurment arm cuff

A

Preferred over manual bc they decrease user error

Arm cuff because finger and wrist are as accurate

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15
Q

Diagnosis from automated BP cuffs

A

Average of 2 reading taken on separate occasions

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16
Q

Self Monitoring of BP

A

Should be routine
Useful to guide in diagnosis, response to therapy and improve adherence
- Evaluate white-coat HTN

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17
Q

Diagnosis based on self monitoring

A

Average readings over 5-7 days

>130/85 is abnormal

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18
Q

Ambulatory BP Monitoring

A

24 hour monitoring records BP at frequent intervals throughout the day
- Evaluate white-coat HTN
>130/85 is abnormal

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19
Q

BP during sleep

A

should dip 10-20%, if not may indicated increased risk of CVD

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20
Q

Normal Classification

A

less than 120/80

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21
Q

Pre-HTN Classification

A

Systolic: 120-139
AND
Diastolic: 80-89

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22
Q

Stage 1 Classification

A

Systolic: 140-159
AND
Diastolic: 90-99

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23
Q

Stage 2 Classification

A

Systolic: >160
AND
Diastolic: >100

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24
Q

Major CV Risk Factors

A 
HTN
Obesity >30
Dyslipidemia
DM
Smoking
Physically inactive
Albuminuria GFR 55, F: >65)
Family history of premature CVD
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25
Q

Identifiable causes of HTN?

A 
Sleep apnea
Primary aldosteronism
Cushing's syndrome or steroids
Drug induced
Renovascular disease
Pheochromocytoma
CKD!!!
Thyroid
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26
Q

Baseline Lab test to look at?

A

Urinalysis (albumin, RBC, WBC), microalbumin:creatinine, hematocrit, fasting lipid panel, Chem 7, calcium, ECG, LFTs

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27
Q

5 Steps of Diagnostic Workup

A 
Assess RF and co-morbidities
Reveal identifiable causes
Assess presence of target organ damage
History and PE
Baseline labs
28
Q

Goals of therapy

A

Decrease CV and renal morbidity/mortality
Prevent target organ damage
Lifestyle modifications

29
Q

Who needs lifestyle modifications?

A

All patients

For stage 1 pts with CV abnormalities (6-12 months)

30
Q

What kind of lifestyle modifications?

A 
Weight reduction 
Dash diet
Dietary Na restrictions
Physical activity
Moderate alcohol (<2 per day)
31
Q

Define DASH diet

A

Fruits and veggies, low-fat dairy, reduced saturated fat

32
Q

Define Na restrictions

33
Q

How much exercise?

A

30-40 minutes x 3-4 per week

34
Q

BP Goals for CKD or DM or most patients

35
Q

BP Goal for >80 or 60-80 and frail

A

Unless CKD or DM

<150/90

36
Q

Stage 1 HTN Therapy?

A

MONOtherapy: ACEI, ARB, CCB, or Thiazide

37
Q

Stage 1 HTN & Black Therapy ?

A

CCB or Thiazide

38
Q

Stage 2 HTN Therapy?

A

Two drugs: Thiazide or CCB + ACEI or ARB

39
Q

Specifically two drug combo is recommended when?

A

> 20 mmHg SBP above goal or >10 mmHg DBP

40
Q

Left Ventricular Dysfunction Treatment

A

Diuretic + ACEI or ARB then add beta blocker

Add on: aldosterone antagonist

41
Q

Post-MI treatment

A

Beta-blocker then add ACEI or ARB

42
Q

Coronary Artery Disease Treatment

A

Beta blocker then add ACEI or ARB

Add on: CCB then thiazide diuretic

43
Q

DM Treatment

A

ACEI or ARB; ARB, CCB or Thiazide

Add on: CCB or thiazide

44
Q

CKD Treatment

A

ACEI or ARB

45
Q

Recurrent Stroke Prevention Treatment

A

Thiazide diuretic or thiazide diuretic + ACEI

46
Q

ALLHAT Conclusions

A

No difference in primary outcomes or all-cause mortality
ACEI less effective in black pts to decrease BP and CV outcomes
Chlorthalidone was the drug of choice, decreases secondary outcome and least expensive
More than one agent was required to control BP

47
Q

First Line agents

A

Thiazide diuretics, ACEI, ARBs, and CCBs

48
Q

4 Classes of Diuretics

A

Thiazides
Loop
Potassium-sparing
Aldosterone antagonists

49
Q

Diuretics MOA

A

Early BP decrease due to diuresis
Chronic BP decrase due to decreased PVR
Syngergistic on BP with ACEI, ARBs or beta-blockers

50
Q

1st Gen Thiazides

A

Chlorathalidone and HCTZ

51
Q

2nd Gen Thiazide Like

A

Indapamide (Lozol)

Metolazone (Zaroxoyln)

52
Q

Thiazide + Renal Dysfunction

A

1st gens don’t work as well

53
Q

Thiazide place in treatment?

A

1st line

Esp in black and elderly

54
Q

Thiazide side effects

A 
HYPOkalemia
HYPOmagnesemia
HYPERuricemia
Increase Ca reabsorption
HYPOtension and dizziness
55
Q

Thiazide clinical pearls?

A

Effect decrease with time
Takes 2-3 wks to see max benefit
Chlorthalidone is 1.5X as potent as HCTZ with longer half life
Increase the dose = increase electrolyte problems

56
Q

Loop diuretics

A

Furosemide (Lasix)
Torsemide (Demadex)
Bumetanide (Bumex)

57
Q

Loop diuretics place in treatment

A

Considered in uncomplicated HTN in patients with significant renal dysfunction not responsive to thiazides

58
Q

Loop diuretics Clinical pearls

A

Limited routine use
Biggest roles is in resistant HTN with renal dysfunction
Significant diuresis and electrolyte issues (K and Mg)

59
Q

Potassium Sparing DIuretics

A

Amiloride (Midamor)
Amiloride/HCTZ (Moduretic)
Triamterene (Dyrenium)
Triamterene/HCTZ (Dyazide/Maxide)

60
Q

Potassium Sparing Diuretics Clinical pearls

A

Weak diuretics
Primarily with thiazides to decrease HYPOkalemia
May cause HYPERkalemia with ACEI/ARBs

61
Q

Aldosterone Antagonists

A

Eplerenone (Inspra)
Spironolactone (Aldactone)
Spironolactone/HCTZ (Aldactazide)

62
Q

Spironolactone is contraindicated in?

A

When CrCl <30

63
Q

Eplerenone is contraindicated in?

A

CrCl less than 50
Elevated SCr greater than 1.8 in F or >2 in M
Type 2DM

64
Q

Aldosterone Antagonists Clinical Pearls

A

Potassium sparing

Significant HYPERkalemia esp with ACEI, ARB, or K supplement

65
Q

What do you monitor with diuretics?

A

Chem 7

Baseline then 1-2 wks then every 6-12 months or after initiating other agents which may affect electrolytes

Cardio Exam 1 (7 decks)

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