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7 Cards in this Set
- Front
- Back
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causes of HTN and tests you would order to evaluate
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-essential (95%)
-renal/renovascular (RAS most common, CRF, polycystic kidneys)--> renal US and dopplar renal artery US, U+Es for Cr -endocrine (hyperaldosteronism Conn's, thyroid and parathyroid disease, Cushing's syndrome, pheocromocytoma, hyperthyroid, acromegaly --> ask drugs, urine HIAA, ACTH synacthen test, Ca levels, K levels -meds: oral contraceptives, decongestants, estrogen, appetite suppressants, chronic steroids, TCAs, NSAIDs. -coarctation of aorta -cocaine and stimulants -sleep apnoea |
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risk factors of HTN
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-age (both SBP and DBP increase)
-gender (males more common) -obesity and sedentary life -race (african americans and aboriginals more common) -family Hx -increased sodium -alcohol (max recommended for women 1sd drink/day with 2 days off |
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complications of HTN
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-cardiovascular system: CAD leading to MI or angina, CHF as LVH turns into systolic heart failure, PVD, aortic dissection
-eyes --> early: AVnicking, cotton wool spots, visual changes and scotomata, more serious: haemorrhages and exudates, papilloedema -CNS: intracerebral haemorrhage, ischaemic strokes: TIA, lacunar strokes, artery strokes, hypertensive encephalopathy (very rare) -kidney: nephrosclerosis (arteriolosclerosis of efferent afferent and gomerulus), tubular dysfxn and decreased GFR later on. |
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how would you assess HTN end organ damage and complications?
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-BP (lying and standing) ensure no smoking, drinking, or caffeine 30 min before
-target organ damage and CV risk--> urinalysis, U+E, fasting BGL and microalbuminuria if DM, lipid panel (fasting lipids total, HDL, LDL and ratio), ECG, pregnancy test in child bearing age before giving Tx |
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what are the treatment options for HTN?
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-thiazide--> if Na increased cause thiazide is good, it also enhances action of other drug antiHTN effects
-ACEi good for DM, monitor serum K as hypokalemia can occur in high salt intake, also these and ARBs reduce risk of new onset DM in HTN -beta blockers--> reduce BP, HR, CO, and renin release -ARBs (same benefits to kidney as in ACEi in DM -CCB--> vasodilator -vasodilators (minoxidil and hydralazine) give combined with beta-block for refractory HTN -beta blockers and thiazides are shown to reduce mortality and morbidity often first choice - |
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what risk factors play into decision of whether to start Tx in someone with HTN?
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CAD RF:
-current cigarette smoking -HTN -DM -low HDL (<35mg/dL) -age (male >45, female >55) -male gender -FHx premature CAD--> MI or sudden death in 1st degree relative <55yr male or <65 yr female) clinical risk factors: retinopathy, nephropathy, LVH, CAD, PVD, MI, stroke or TIA Hx |
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how to grade HTN
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<120 S <80D --> no Tx
120 - 139 S 80-89 D --> lifestyle (preHTN) 140-159 S 90-99D --> pharm Tx and lifestyle (one drug) stage I HTN >160 S >100 D (lifestyle and two drug therapy for most) stage II HTN |
