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52 Cards in this Set

  • Front
  • Back
what is the most common contributory factor for morbidity and mortality from CVD, CVA, and renovascular disease
essential hypertension
if untreated, a 35 yo man with BP of 150/100 has his life expectancy reduced by...
28 years
individuals who are normotensive at age 55 have a __% lifetime risk for developing hypertension
What percentage of individuals have inadequate control of their hypertension
Name three populations where hypertension (HTN) is most prevalent
Has HTN related mortality increased or decreased significantly in the last two decades
decreased significantly
How often do HTN clusters with metabolic abnormalities of obesity, glucose intolerance, and dyslipidemia occur?
less than 20% of the time
what appears to be the common hormonal inciting event for HTN
insulin resistance
again BP =
= HRxpreload/afterload x contractility x PVR
What is salt sensitive BP related to (increased sodium intake increases BP)
low renin BP (as opposed to high renin BP)
what's the work up for HTN
PE- fundi, carotids, thyroid, lungs, heart, abdomen, pulses, lower extremities
Lab- CBC, CHEM-7, calcium, lipid profile, U/A, 12 lead EKG
what is prehypertension (in terms of systolic pressure, diastolic)
when would you use drugs
120-139 over
use drugs to treat BP to 130/80 for kidney disease and diabetes
what is hypertension stage 1?
what drugs to use?
140-159 over
thiazide type diuretics
consider ACEI, ARB, BB, CCB, or combo
what is hypertension stage 2?
what drugs regimen?
>160 over
two-drug combos
Name five classes of drugs acceptable for heart failure
beta blocker
ACE inhibitor
angiotensin receptor blocker
aldosterone antagonist
Name three classes of drugs for post MI
beta blocker
aldosterone antagonist
Name four classes of drugs for high coronary disease risk
beta blocker
calcium channel blocker
Name five classes of drugs for diabetics
beta blocker
angiotensin receptor blocker
calcium channel blocker
name two classes of drugs for chronic kidney disease
angiotensin receptor blocker
name two classes of drugs for recurrent stroke prevention
treatment goal for HTN is
quantify the lifestyle modification shown to reduce blood pressure
weight reduction by...
regular physical activity of...
reduced alcohol intake to ...
reduced dietary sodium to...
weight 10 lbs or more
work out 30 minutes most days
<1 oz ethanol per day
<2.4 gm sodium per day
Name five components for the HTN treatment algorithm
1. lifestyle modification
2. drug monotherapy
3. substitute new class of drug or add second drug
4. add third drug
5. begin with two drugs if BP stage 2
this class of drug decreases PVR; is good with young athletes, in situations of mild renal failure, but drawbacks include cough, hyperkalemia, and precipitation of acute renal faiulre if used in HTN secondary to renal artery stenosis
(the "ils")
this class of drugs has a low incidence of side effects, no potentiation of bradykinin system, no cough, and may be helpful in young athletes, mild renal failure, CHF, DM, and renal disease
angiotensin II receptor blockers (the "sartans")
this class of drugs decreases heart rate and cardiac output; they are cadioprotective post MI and are also useful in migraine and angina patients because of this physiology; they may however aggravate asthma and CHF or cause impotence and depression
beta blockers
beta blockers
this class of drugs decreases PVR, lowers heart rate and contractility; is useful in the elderly and patients with angina, or dyslipidemia; side-effects include constipation, AV block, and flushing or edema
calcium channel blocker
What did the Puget sound study show
60% increase in MI for hypertensive patients on short acting dihydropyridines (nifedipine, amlodipine)--> long acting agents should be used instead
this class of drugs is one of the original and still among the best for HTN; reduces extracellular fluid volume; works particularly well in African Americans and elderly; BEST DOCUMENTED REDUCTIONS IN MORBIDITY AND MORTALITY; disadvantages include lipidemia, hyperglycemia or gout, and can cause hypokalemia and impotence
this class of drugs is useful in prostatic hypertrophy and dyslipidemia
this class of drugs is not first line but may have other advantages such as a weekly patch
central alpha-2 agonists
Name four common co-morbid ailments found in hypertensives
what class would you give a type I diabetic
what class would you give to patient with heart failure
ACEI, diuretic
what classes would you give with isolated systolic hypertension
diuretic, calcium channel blocker
what classes would you give for MI
beta blocker
___ has been virtually unsurpassed in preventing the CV complication of HTN but remains underutilized
What is normal follow up for HTN
initial follow up in 1-2 mo
then 3-6 mo if HTN well controlled
what is "step-down" care
when BP is well controlled for 1 yr and the patient has no evidence of target organ damage, medication may be tapered and thn stopped if BPs remain below 130 over 85
follow should continue every 2 mo
in hypertensive emergency- which requires immediate control to prevent/reduce target organ damage- what drug is used for MI? for aortic dissection? for eclampsia?
NTG for acute MI
esmolol in aortic dissection
hydralazine in eclampsia
what is the goal of hypertensive emergency treatment
reduce mean arterial pressure by 20-25% within minutes to 2 hours, then gradually to 160/100
what drug is completely unacceptable in treating urgent hypertension
short acting nifedipine- may precipitate acute MI or hypotension
what is defined as inability to lower blood pressure despite maximal doses of 3 antihypertensive agents
refractory hypertension
what causes 43% of refractory hypertension
sub-optimal therapy
in persons older than 50, systolic pressure greater than ___ is much more important CVD risk factor than diastolic BP
risk of CVD beginning at 115/75 doubles with each increment of ___
20/10 mmHg
individuals with systolic BP of 120-139 or diastolic BP of 80-89 should be considered ___ and require ___
health-promoting lifestyle modifications
___ should be used in drug treatment for most patients with uncomplicated HTN
thiazide diuretics
most patients with HTN will require ___ to achieve goal BP (<140/90, or <130/80 for patients with diabetes or chronic kidney disease)
two or more antihypertensive drugs
if blood pressure is ___ above goal BP, consideration should be given to initiating therapy with two agents, one of which usually should be a thiazide type diuretic
>20/10 above goal
the most effective therapy presecribed by the most careful clinician will control hypertension only if patients are ___