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27 Cards in this Set

  • Front
  • Back
CV mortality relative risk doubles at what BP?

quadruples?
135/85

155/95
What is the treatment goal of HTN?
<140/90

if DM, chronic kidney disease, or "high-risk: <130/80
What decrease in SBP will give a pt a 7% reduced risk of IHD and 10% reduced risk of stroke mortality
2 mmHg
percent of HTN that is idiopathic
90-95%
secondary causes of HTN
POLYCYSTIC KIDNEYS
RENOVASCULAR DISEASE
AORTIC COARCTATION
CUSHING’S SYNDROME
PHEOCHROMOCYTOMA
ALCLH0L ABUSE
ORAL CONTRACEPTIVES
DRUG ABUSE
THYROID DISEASE
OBESITY
HIGH SODIUM INTAKE
prompt (less than 2 years) treatment of HTN can decrease risk of stroke by how much?
28% decrease
typical age of onset of HTN
30-55
80 % of adults with HTN are over what age?
45
"stage" of HTN is determined by systolic or diastolic number?
systolic
what is malignant HTN?
SBP > 210

DBP > 120
Symptoms of malignant HTN
SYMPTOMS MAY INCLUDE: SEVERE HEADACHES, VISUAL DISTURBANCES, PAPILLEDEMA AND RETINAL HEMORRHAGES OR EXUDATES
How is HTN diagnosed?
BASED ON AVERAGE OF AT LEAST 2 OR MORE READINGS TAKEN ON 2 OR MORE OCCASIONS
IF SBP AND DBP ARE IN TWO DIFFERENT CATAGORIES THEN USE THE HIGHER TO DETERMINE CLASSIFICATION
BEST IF TAKEN IN THE MORNING
in pts over 50, which is more important risk factor, SPB or DBP?
SBP
NO CAFFEINE OR NICOTINE FOR ____ MIN PRIOR TO BP MEASUREMENT
30
What circumstances cause arm BP readings to be different from left to right?
coarctation

subclavian steal
Treatment for pt with normal BP
ENCOURAGE LIFESTYLE MODIFICATION
Treatment for pt with pre-HTN BP
LIFESTYLE MOD NO MEDS
Treatment for pt with stage 1 BP
LIFESTYLE MOD THIAZIDES, ACE, ARB, b-BLOCKER, CCB, OR COMBO
Treatment for pt with stage 2 BP
LIFESTYLE MOD COMBINATION MEDICATIONS
CENTRAL ALPHA BLOCKERS ARE CONTRAINDICATED why?
INTITIALTHERAPY AS THEY CAN INCREASE CV RISK BY 25%
MONITOR POTASSIUM CAREFULLY AND ALSO OCCASIONALLY CHECK MAGNESIUM when using what anti-HTN med?
DIURETICS
AVOID what anti-HTN med IN PT’S WITH HISTORY OF KIDNEY STONES AND GOUT ?
DIURETICS
what is anti-HTN med for pregnancy?
methyldopa
URGENCY VS EMERGENCY
in HYPERTENSIVE CRISIS
URGENT---ABSENCE OF TOD BUT MAY HAVE HEADACHES
EMERGENCIES---HYPERTENSIVE ENCEPHALOPATHY, INTRACRANIAL HEMORRHAGE , PAPILLEDEMA, UNSTABLE ANGINA, MI, CHF, PULMONARY EDEMA ANEURYSM, ECAMPSIA
Follow up for HTN pt
RECHECK PT ON ONLY LIFESTYLE MOD IN 3 MONTHS
NEW MEDICATION STARTS OR CHANGES SHOULD BE SEEN IN 2-4 WEEKS TILL AT GOAL
STABLE PATIENTS 3-6 MONTHS
URGENT WITHIN 24 HRS
FOLLOW THOSE WITH TOD OR THE ELDERLY MORE CLOSELY
VITALS HT 69 INCHES, WT. 164 LBS, WAIST 36 INCHES
BP 170/80 PULSE 74/MIN
EXAM- HRRR w GR I/VI SYSTOLIC MURMUR AT LSB, S4 GALLOP, NORMAL JUGULARVENOUS PRESSURE, SOFT RIGHT CAROTID BRUIT, LUNGS CLEAR
ABDOMEN NEGATIVE EXCEPT FOR BRUIT OVER RIGHT FEMORAL AREA
PERIPHERAL PULSES- DECREASED RIGHT PEDAL PULSE AND TRACE PEDAL EDEMA
LAB- CBC NORMAL
CHEMISTRY- NA-142, K 4.1, CO2 25, BUN 24, CREAT 1.3, GFR-43 (NORMAL 60+)
LIPIDS- TC 236, LDLc 144, HDLc 35, TRIG 185
UA-NORMAL
ECG- NON-SPECIFIC ST AND T WAVE, NSR, LVH
TREATMENT GOAL- BP < 140/90 ( MORE REALISTIC 120/70)
NEEDS STRESS TEST, CAROTID U/S, VASUCLAR CONSULT AND POSSIBLY ANGIOGRAM.
CONSIDER ECHO CARDIOGRAM
TREAT LIPIDS TO GOAL
40 Y/O BLACK FEMALE
BOTH PARENTS LIVING AND HAVE HBP, MOTHER DM
PERSONAL HISTORY NEGATIVE
HT. 64INCHES WT. 205 LBS WAIST 38 INCHES
BP 154/94 PULSE 80
LABS NORMAL EXCEPT FOR HIGH TRIGLYCERIDE OF 284 AND FBS OF 120
PHYSICAL EXAM NORMAL EXCEPT OBESITY
DX HBP, METABOLIC SYNDROME AND PRE-DIABETES
TREATMENT GOALS- NORMALIZE BP, TREAT METABOLIC SYNDROME AND HOPE TO AVOID DM