Cv System - Lec.8 & 11 Essential Htn

Front 1

Q: 8,11

How is hypertension defined for those age 18 or greater?

Back 1

-The average of two or more diastolic measurements on each of two or more visits being 90 mmHg or higher

-The average of two or more systolic measurements on each of two or more visits being 140 mmHg or above.
(note: readings should be at least 2 min apart, and within 5mmHg of each other).

Front 2

Q: 8,11

How is hypertension defined for children and adolescents?

Back 2

BP at or above the 95th percentile for age, height and gender

Front 3

Q: 8,11

What is the difference between essential and secondary HTN?

Back 3

Essential HTN, is HTN with no Identifiable cause (90% of all HTN).

Where as secondary is being cause by some identifiable pathology.

Front 4

Q: 8,11

What is the prevelence of essential HTN in America?

Back 4

- 50 million Americans have hypertension (those that are 55 with normal BP, have a 90% lifetime risk of developing it)
-i billion are affected worldwide, the prevelence increases with age 1:4 above age 18.

Front 5

Q: 8,11

What things are important to remember when taking a bloodpressure?

Back 5

- the subject should be comfortablly seated for 5 minutes with their feel on the floor and their arms supported
- cuff should encircle 80% of the arm
- cuff width should be 2/3rds of the arm width.

Front 6

Q: 8, 11

What are two other things that should be kept in mind when taking a BP?

Back 6

- no smoking or caffine for 30 minutes prior

Front 7

Q: 8,11

How is HTN detected?

Back 7

two or more readings at least two minutes apart and averaged. If greater than 5mm difference between the two then more readings must be done.

Front 8

Q: 8,11

What is the difference between pre-hypertension, normal, stage 1 and stage 2 HTN

Back 8

Normal:
Systolic <120
Diastolic <80
Prehypertension:
Systolic 120-139
Diastolic 80-89
Stage1 HTN
Systolic 140-159
Diastolic 90-99
Stage 2 HTN
Systolic 160+
Diastolic 100+

Front 9

Q: 8,11

What are the goals of treatment of HTN treatment?

Back 9

Achieve a SBP of <140 / 90
If they are diabetic or renal disease <130/80mmHg

Wt Reduction (BMI 18.5-24.9)
DASH Diet
Physical Activity
Moderate alcohol consumption
(if they are older than 50 the systolic becomes more important than the diastolic)

Front 10

Q: 8, 11

Discuss the use of ambulatory blood pressure monitoring and
home monitoring in the diagnosis and treatment of hypertension

Back 10

- Self measurement helps distinguish white coat hypertension, it assesses response to antihypertensives, improves complience and reduces cost

Front 11

Q: 8,11

What must be kept in mind from ambulatory blood pressure monitoring?

Back 11

- usually lower than clinic readings
- individuals with hypertension have an average reading of greater than 135/85 mmHg awake or 120/75 mmHg asleep
-ABPM correlates better than office readings with target organ damage.
- individuals with BP more than 135/85 mmHg at home are generally considered hypertensive.

Front 12

Outline the treatment of HTN including lifestyle modificatoin and pharmacologic therapy.

Back 12

- Diuretics are unsurpassed in preventing cardiovascular complications of HTN

Front 13

What drugs are indicated for stable angina?

Back 13

Beta Blocker
CCB

Front 14

Acute Coronary Syndrome (unstable aangina or myocardial infarction)

Back 14

beta blocker
ACEI

Front 15

What drugs are indicated for postmyocardial infarction?

Back 15

ACEI
B-Blocker
Aldosterone antagonists

Front 16

When treating a diabetic with HTN, what drug types are indicated?

Back 16

- ACEI & ARBs (favorably affect the progression of diabetic nephropathy and reduce albuminuria)
ARBs have been shown to reduce the progression to macroalbuminuria
(Thiazides, B-Blockers, ACEI, ARB, CCB)

Front 17

Recurrent stroke rates lowered with the combined usage of what types of drugs?

Back 17

ACEI and Thiazide Diuretics

Front 18

HTN occurs in what percentage of those greater than 65?

Back 18

2/3rds

Front 19

Thiazides are unfavorable for use in what Pt. population?

Back 19

those with gout or hyponatremia

Front 20

B-blockers are unfavorable for use in what Pt. populations?

Back 20

Asthma
2nd or 3rd degree heart block

Front 21

What drugs should not be given to women who are pregnant or who intend to become pregnant?

Back 21

ACEIs or ARBs

Front 22

other than pregnant women, who should ACEIs not be used in?

Back 22

those with a history of angioedema

Front 23

in what Pt population are aldosterone antagonists and potassium sparing diuretics unfavorable?

Back 23

In those Pt's with a K+ > 5mEq/L

Front 24

What is resistant HTN?

Back 24

Failure to reach goal on full dose of appropriate three drug regimen that includes a diuretic.

Front 25

What are some possible reasons for resistant HTN?

Back 25

- impropper blood pressure measurement
-volume overload (excess Na intake, volume retention from kidney disease, inadequate diuretic therapy)
- Drug induced (NSAID, illicit drugs, BCP, Steroids, decongestants, licorice, ephedra)
-Associated conditions (obesity, alcoholism)
-Identifiable causes of hypertension

Front 26

What should a follow up visit for a HTN Pt look like?

Back 26

-Monthly until BP goal is reached
- More frequently if stage 2 or complicating conditions
-3-6month visits after goal is reached
-serum creatine and potassium 1-2 times per year
-low dose aspirin only after goal is reached.

Front 27

Discuss the important points of Pt compliance considering hypertension.

Back 27

- must agree upon a goal
- must understand the condition and treatment
-must overcome denial of illness
-cost of medication and of medical care.

Front 28

What should be kept in mind for treating an elderly Pt. with hypertension?

Back 28

start low, go slow

Front 29

What should be kept in mind for treating Blacks with HTN?

Back 29

Diuretics or CCB?

Front 30

Treating HTN can help reduce your risk of the following diseases by how much?
-stroke
-MI
-CHF

Back 30

stroke- 35-40%
MI- 20-25%
CHF- 50%

Front 31

pheochromocytoma, how does this effect bp?

Back 31

they get tachycardia, headache, ect.

Front 32

hyperthyroidism?

Back 32

this will give you secondary htn

Front 33

if you lose 15% of your weight, this will drop your bp about how much?

Back 33

10mmHg

Front 34

what is the DASH diet,

Back 34

Dietary Approach to Stop HTN, high in potassium, calcium, fiber, veg, fruits (this should be equilivent to being started on a drug (so this can be used for someone with stage 1 htn?)

Front 35

moderating alcohol consumption will do what

Back 35

4-9mmHg reduction if they reduce their consumption.

Front 36

how is the identification of HTN different in children and adolescents than adults?

Back 36

in children it is the average of three times, not two

Front 37

Is there a correlation between HTN, and CVD?

Back 37

Yes,
The higher your BP, the more your risk for CVD. Everythime you increase your systolic by 20 or your diastolic by 10 you doule your risk for CVD, until you get to 185/115, but in general the systolic BP is more important.

Front 38

What are the stages of hypertensive retinopathy?

Back 38

look at the fundi (grade 1 retinopathy = arteriosclerosis, that increases the light reflex, you get a copper brown coloring called sopper wireing, which then pregresses to white wireing, which is then called grade 1; Grade 2 retinopathy is then represents av nicking)(when the bloodvessels start braking and bleeding this is grade 3 retinopathy)(grade 3 retinopathy has large exudates)(grade 5 retinopathy papiledema (swelling of the optic edema)

Front 39

List some risk factors for CVD?

Back 39

-Hypertension
-Smoking
-Obesity (BMI >30 kg/m2)
-Physical Inactivity
-Dyslipidemia
-Diabetes Mellitus
-Microalbuminuria or GFR <60ml/min
-Age >55 Male; >65 Female
-Family History CVD (Male <55; Female <65)

Front 40

What are some identifiable causes of secondary hypertension?

Back 40

-Sleep apnea
-Drug-induced or related causes
-Chronic kidney disease
-Primary aldosteronism
-Renovascular disease
-Chronic steroid use or Cushings disease
-Pheochromocytoma
-Coarctation of the aorta
-Thyroid or parathyroid disease

Front 41

What is a pheochromocytoma? can it cause HTN?

Back 41

this is a tumor that produces an adrenaline like substance, yes it can.

Front 42

In general how are prehypertension, stage 1 and stage two treated differently?

Back 42

Prehypertension is treated with life style modification
stage1 is treated with one med and lifestyle modification
stage2 is treated with 2 meds in a low dose drug combo (usually a thiazide and another)

Front 43

Outline and explain each portion of the work-up for the patient with
essential hypertension. Include important aspects of the history, physical, lab studies and ECG.

Back 43

General physical exam, how long have they had HTN, and how severe has it been? is it primary or secondary?
Get an ecg, get a UA (tells us if the kidneys are concentrating urine), get hematocrit (anemia often occurs with renal disease, get a wbc count (before acei, because this can effect the whiteblood cell count, get a potassium (to see if they are hypokalemic, this may be due to primary aldosteronism, or too much licorish, creatinine (measure of gfr, more accurate than bun), get a lipid profile, ldl, hdl, and tg levels, optional tests: microalbumin creatinine ratio, follow uric acid if they are on a diuretic, LAH, and LVH look for these to see if the disease has progressed

Front 44

What are some organs common for target organ damage?

Back 44

-Heart:
Left ventricular hypertrophy
Angina or prior MI infarction
Prior coronary revascularization
Heart failure
-Brain:
Stroke or TIA
Chronic kidney disease
Peripheral arterial disease
Retinopathy

Front 45

How does CVD present?

Back 45

-dyspnea
-orthopnea
-edema

Front 46

How does Cerebrovascular disease present?

Back 46

-Dizziness
-headaches
-TIAs
-CVAs

Front 47

How does Renovascular disease present?

Back 47

-Toxemia of pregnancy
-Trauma
-UTIs
-Plelonephritis

Front 48

How does Pheochromocytoma present?

Back 48

-sweating
-tachycardia
-headaches

Front 49

How does Hyperthyroidism present?

Back 49

-Heat intolerance
-Weight loss
-Eye changes (exopthalmos)

Front 50

What procedures should be done when doing a HTN assessment?

Back 50

BP both arms
Optic fundi
BMI
Auscultation for bruits
Palpate thyroid
CV
Respiratory
Abdomen
Lower extremities
Neurological

Front 51

What are some Lab tests that should be run when trying to asses HTN?

Back 51

EKG
UA
FBS
HCT
K+
Cr
Lipid Profile

Front 52

What is the first line of defence against htn, unless there is a compelling reason?

Back 52

Diuretics (thiazides)

Front 53

What do we use for htn in diabetics?

Back 53

acei and arbs (this is because they are protective of the kidneys in diabetics)
(Thiazides increase bloodsugar)
(beta blockers blunt the hypoglycemic response)

Front 54

what do you use in a pt with chronic kidney disease

Back 54

acei or an arb
(if gfr is less than 60, protinuria, or creatinine around 1.5 men, 1.3 women) watch it, if you get hyperkalemia, or microalbumin level

Front 55

if the gfr is less than 30, or their kidney function is not good. to treat their htn you will ...

Back 55

loop diuretic and probably not an ace or an arb

Front 56

what do you use for a person with htn and cerebrovascular disease

Back 56

acei and thiazides,
take them to 160/100mmHg (not down to 130 initially)

Front 57

drugs work differently, in the black populations , explain this.

Back 57

diuretics and ca channel blockers work better

beta blockers, arbs, acei dont work very well (unless you give a diuretic, then you can use acei)

Front 58

What drug dont you use in pregnancy? for htn?

Back 58

acei, or arb

Front 59

what is a favorable side effect of thiazides?

Back 59

thiazides reduce demineralization in osteoporosis

Front 60

In what populations should you think twice about using thiazides in?

Back 60

- pts with gout (it increases uric acid)
-pts with hyponatremia

Front 61

Discuss the use of Osteopathic Manipulation in the treatment of
hypertension.

Back 61

- Emotional state and stress can stimulate the ans and cause htn. You could do cranial OMT to increase the parasympathetic tone (cvIV, correct SBS, OA, Parietal lift)
- sns effects the adrenals and kidneys and that leads to hypertension. This area is around T10-11 (treat thoracolumbar junction, and chapman's reflex
- Rib raising
- OA and cervical tissues

Front 62

review the treatment algorithm

Back 62

yeah!