Cardio - Dr. Snyder-Money: Resistant Htn

Front 1

what is resistant HTN

Back 1

- BP that does not respond to tx
- BP > 140/90
- optimal tx has failed - 3 drugs, optimal dosing, inc diuretic, or controlled on 4 drugs

Front 2

factors in essential HTN which lead to resistance

Back 2

1. non-adherence - meds/lifestyle
2. inadequate/inappropriate regimen
3. drug intrxn
4. associated condidtions
5. vol expansion
6. pseudoresistance
7. isolated systolic HTN
8. 2ndary causes of HTN

Front 3

non-adherence

Back 3

- due to probs w/ meds or lifestyle of pt
1. meds = cost, dosing, tolerability, complexity, pt education/understanding
2. lifestyle = NaCl restriction, wt reduction, diet (DASH), EtOH red, physical act & excercise, stress reduction

Front 4

inadequate or inappropriate regimen

Back 4

1. ineffective:
-diuretic + CaCB
-ACE + ARB
-b-blocker + ACE (or ARB)
-CaCB + vasodilator
2. negative:
-a-antagonist + clonidine (antag)
3. potentially dangerous
-b-blocker + clonidine (antag)
-b-blocker + non-dydropyridine CaCB (bradycardia)

Front 5

associated conditions

Back 5

- excessive EtOH consumption
- obstructive sleep apnea
- obesity, insulin resistance

Front 6

psuedoresistance

Back 6

1. white coat HTN
2. pseudoHTN
3. cuff inflation HTN
4. caused by inappropriate drug combo - direct vasodilators or adrenergic blockers w/o diuretic
- isolated systolic HTN

Front 7

secondary causes of HTN**

Back 7

1. renal artery stenosis
2. renal parenchymal ds
3. hyperaldosteronism
4. pheochromacytoma
5. thyroid ds
6. Cushing's syndrome
7. aortic coarctation

Front 8

w/up of resistant HTN

Back 8

**check for non-compliance --> get pt to comply
**is regimen adequate and appropriate --> change appropriately

Front 9

STITCH

Back 9

Simplified tx intervention to control HTN
- starts w/ fixed dose combo (ACE/ARB) - including diuretics
- inc to highest tolerated dose
- add CCB, titrate up
- additional agents as needed (b-blocker, a-blocker, spironolactone)
- imp achieving target by 20%

Front 10

w/up of resistant HTN cont'd

Back 10

- r/o drug intrxn --> change if need be

Front 11

w/up of resistant HTN:
- associated conditions

Back 11

- tx obstructive sleep apnea and help pt lose t
- wt loss will also help dec. amt of insulin resistance
- diet (DASH)
- exercise
- reduce stress
- quit tobacco use
- dec. EtOH use

Front 12

w/up of resistant HTN:
- vol expansion

Back 12

is vol expansion present --> hemodynamics
-- measure urinary Na+, plasma vol via bioimpedance, PVR, CO

Front 13

w/up of reistant HTN:
- psuedo-resistance
- secondary causes
- lastly...

Back 13

- consider pseudo-resistance; neurohumoral
- reassess for 2ndary causes -> tx 2ndary causes
--tx hyperaldosteronism w/ aldosterone antag, spironolactone, eplerenone

- modify regimen, targeted therapy