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27 Cards in this Set
- Front
- Back
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CV mortality relative risk doubles at what BP?
quadruples? |
135/85
155/95 |
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What is the treatment goal of HTN?
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<140/90
if DM, chronic kidney disease, or "high-risk: <130/80 |
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What decrease in SBP will give a pt a 7% reduced risk of IHD and 10% reduced risk of stroke mortality
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2 mmHg
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percent of HTN that is idiopathic
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90-95%
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secondary causes of HTN
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POLYCYSTIC KIDNEYS
RENOVASCULAR DISEASE AORTIC COARCTATION CUSHING’S SYNDROME PHEOCHROMOCYTOMA ALCLH0L ABUSE ORAL CONTRACEPTIVES DRUG ABUSE THYROID DISEASE OBESITY HIGH SODIUM INTAKE |
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prompt (less than 2 years) treatment of HTN can decrease risk of stroke by how much?
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28% decrease
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typical age of onset of HTN
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30-55
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80 % of adults with HTN are over what age?
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45
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"stage" of HTN is determined by systolic or diastolic number?
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systolic
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what is malignant HTN?
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SBP > 210
DBP > 120 |
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Symptoms of malignant HTN
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SYMPTOMS MAY INCLUDE: SEVERE HEADACHES, VISUAL DISTURBANCES, PAPILLEDEMA AND RETINAL HEMORRHAGES OR EXUDATES
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How is HTN diagnosed?
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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 |
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in pts over 50, which is more important risk factor, SPB or DBP?
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SBP
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NO CAFFEINE OR NICOTINE FOR ____ MIN PRIOR TO BP MEASUREMENT
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30
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What circumstances cause arm BP readings to be different from left to right?
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coarctation
subclavian steal |
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Treatment for pt with normal BP
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ENCOURAGE LIFESTYLE MODIFICATION
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Treatment for pt with pre-HTN BP
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LIFESTYLE MOD NO MEDS
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Treatment for pt with stage 1 BP
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LIFESTYLE MOD THIAZIDES, ACE, ARB, b-BLOCKER, CCB, OR COMBO
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Treatment for pt with stage 2 BP
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LIFESTYLE MOD COMBINATION MEDICATIONS
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CENTRAL ALPHA BLOCKERS ARE CONTRAINDICATED why?
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INTITIALTHERAPY AS THEY CAN INCREASE CV RISK BY 25%
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MONITOR POTASSIUM CAREFULLY AND ALSO OCCASIONALLY CHECK MAGNESIUM when using what anti-HTN med?
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DIURETICS
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AVOID what anti-HTN med IN PT’S WITH HISTORY OF KIDNEY STONES AND GOUT ?
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DIURETICS
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what is anti-HTN med for pregnancy?
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methyldopa
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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 |
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Follow up for HTN pt
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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 |
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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 |
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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 |
