Treatment of Hypertension Flashcards
How do you define normal, prehypertension, and hypertension stage 1 and 2?
Normal <120/80
Prehypertension: 120-139/80-89
Stage 1 htn: 140-159/90-99
Stage 2 htn: >160/100
Which CV events does antihypertensive therapy help prevent?
CHF
Fatal/nonfatal strokes
LVH
CVD deaths
Fatal/nonfatal CHD events
How much of an increase in BP does CVD risk double?
Starting at 115/75 mmHg, CVD risk doubles with each increment of 20/10 mmHg throughout the BP range
How do you identify/treat secondary htn?
Suspect if it’s: difficult to control, sudden onset, severe htn, changes from well controlled to difficult to control
Check history/physical/labs
Which 5 conditions account for 95% of the causes of secondary htn?
Renal parenchymal dz: UA, spot urine protein/creatinine, serum creatinine, USG
Renovascular: check with captopril scan
Coarctation: check lower extremity BP
Primary alodsteronism: check serum and urinary K, also aldo: renin ratio; if it’s high, suggests tumor
Pheochromocytoma: spot urine for metanephrine/creat
Which lab tests do you do for uncomplicated htn?
ECG to check heart
Urine analysis
Blood glucose
Hematocrit (clue to apnea: symp gets revved up when you choke at night –> hypoxia –> hct goes up)
Basic metabolic panel (Na, K, bicarb, glucose, etc- see if they’re hypoglycemic, test if kidney iesn’t working)
Lipid profile after 9-12 hour fast
Urine microalbumin
How can you estimate risk status for cardiovascular events?
Htn
Smoking
Obseity
Dyslipidemia
Diabetes
Microalbuminuria or GFR < 60 ml/min
Age>55 men, 65 women
Family history of CVD: less than the above ages
What are the goals of antihypertensive therapy?
BP < 140/90 mmHg
If pt has diabetes or chronic kidney dz: BP < 130/80 mmHg
Focus on systolic, not diastolic, if you have to choose
Which lifestyle modifications help? from most to least helpful
Weight reduction
DASH eating plan: “mediterranean diet” low salt, low sat’d fat, lots of K+ from fruits and veggies
Dietary sodium reduction
Physical activity
Moderate alcohol consumption: 2 drinks/day
What are the 5 main classes of drugs for hypertension?
Diuretics: thiazides, loop diuretics, aldo antagonists, K-sparing
- *Adrenergic inhibitors**: central= alpha agonists
- peripheral = alpha blockers, beta blockers, alpha+beta blockers
Direct vasodilators: never 1st choice, BP bounces right back
Ca channel blockers: dihydropyridine, nondihydropiridine
RAAS blockers: ACEI, Angio II blockers, renin inhibitors
Which combos of drugs are good?
For stage 1 htn: thiazide diuretic + ACEI, ARB, B, CCB or combo
Stage 2: same as above but def give 2 drugs
What are the 3 major components of essential hypertension and how can you take this into consideration when you treat it?
Sodium: give diuretic
Sympathetic NS: give beta blocker or combo alpha/beta blocker
Renin-angiotension: renin that’s not suppressed i.e. levels are normal but pt is very hypertensive, so it should be suppressed –> give ACEI, ARB
If patient has another condition, how can it help you decide how to manage their medications?
Choose from diuretic, BB, ACEI, ARB, CCB, Alto ant
HF: give any but CCB
Post-MI: give BB, ACEI, or aldo antagonist
High CHD risk: diuretic, BB, ACEI, CCB
Diabetes: all but aldo antagonist
Chronic kidney dz: ACEI, ARB
Recurrent stroke prevention: diuretic, ACEI
If the patient has MI and is wheezing, which drugs are good to give? bad to give?
Give ACEI and diuretic
Do not give beta blocker, bc SE will be more bronchoconstriction
ACEI improves mortality in HF with systolic dysfunction
Beta blockers are cardioprotective against reinfarction, arrhythmias, sudden death
What meds are good to give if pt has renal insufficiency?
Remeber that your goal is to bring BP to <130/80
ACEI and ARB’s should be used if no contraindications: they decrease mortality
Most pt’s have volume overload so give a loop diuretic!! (thiazides are ineffective if S creat>2.5)
