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62 Cards in this Set
- Front
- Back
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What defines HTN?
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systolic BP >140
or diastolic BP >90 |
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Which population has the highest BP risk for HTN?
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african americans - 71%
Mexican americans - 61% non-Hispanic whites - 60% Prevalence increases with age over the age of 60 |
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Which is more common primary or secondary HTN?
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primary HTN = 90-95% of cases
secondary HTN = 5-10% of all adult HTN |
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What is primary htn?
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complex process from a variety of physiological and environmental factors
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what is 2ndary htn?
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includes exogenous substances sicj as alcohol or NSAIDS, renal failure, dleep apnea, primary aldosteronism, pheochromocytoma, and cushing syndrome
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How is insulin related to arterial BP?
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Insulin resistance is ass/ with increased arterial BP
Hyperinsulinemia can increase vascular tone by 4 mechanisms: 1. Na retention 2. hypertrophy and hyperplasia of vascular smooth muscle 3. increases Calcium intracellularly 4. activates the SNS |
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How are CV risks correlated with BP?
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risk of CV complications correlates with the degree of BP elevation
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Why is htn referred to as the silent killer?
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it is asymptomatic until it causes end stage organ disease
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How do you Dx htn?
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SBP >140
or DBP > 90 at least 2 consecutive visits 2 weeks apart exception is one time visit SBP > 210 or presence of sig end organ damage |
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These are the essential of blood pressure measurement
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1. seated at rest for at least 5 minutes
2. no caffeine or cigs in last 30 min 3. bladder of cuff encircles 80% of arm 4. arm is supported at heart level 5. inflate cuff and listen for obliteration of radial arm pulse 6. auscultate over the brachial a. 10-20mmg past the palpable SBP 7. Systolic Pressure = onset of Korotkoff sounds 8. Diastolic = muffling or cessation of Korotkoff sounds |
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What are some eye pathologies you might see on fundoscopic examination?
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retinal hemorrhages
AV nicking Vascular tortuosity |
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Is primary htn genetic?
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primary htn tends to run in fam hx
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what is white coat htn?
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pt does not truely have htn, but bp is elevated under the present conditons
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what is pseudoHTN?
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found in elderly
calcified, rigid blood vessels causes an increase in intra arterial BP the actual BP is less then what the cuff is reading |
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what does a high fasting serum glucose mean?
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indicates diabetes mellitus
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what does unprovoked hypokalemia <3.5 meq/L mean?
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hyperaldosteronism
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what does an elevated creatine level mean?
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renal insufficiency
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what does proteinuria or microalbuminuria mean?
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renal end-organ damage
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what does hypercalcemia mean?
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may preclude thiazide diuretics or hyperparathyroid disease
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What are the different stages of HTN?
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Optimal:
SBP < 120 DBO < 80 PreHTN: SBP: 120-139 DBP: 80-89 Stage 1: SBP: 140-159 DBP: 90-99 Stage 2: SBP: >160 DBP: >100 |
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what is the bp goal of a diabetic
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BP <130/80
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WHAT IS THE FIRST STEP IN TX OF PTS WITH NL RENAL FUNCTION AND NON-DIABETIC PTS WITH PRE-HTN
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LIFESTYLE MODIFICATION
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WHAT % OF PEOPLE ARE SALT SENSITIVE HTN
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60%
RESTRICT SALT <2.4g/d |
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WHAT ARE SOME LIFESTYLE MODIFICATIONS ONE CAN MAKE?
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AEROBIC EXERCISE 30-60 min 3-4x/wk
LIMIT ALCOHOL: <24oz/d BEER & <8oz/d WINE |
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WHAT % OF PEOPLE CAN BE HELPED BY LIFESTYLE MOD ALONE?
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10%
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WHEN SHOULD YOU START A PERSON ON MEDICATION?
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AFTER 3-6 MO OF LIFESTYLE MOD AND NO RESULT
OR PTS WITH STAGE 2 HTN AND DIABETIC PTS WITH SBP OVER 130 OR DBP OVER 80 |
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WHAT IS THE THERAPEUTIC GOAL IN ALL PTS BP?
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BP 120/80mmHg or less
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what is isolated systolic HTN?
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common in elderly
Systolic BP in elderly over age 60 can be managed with low-dose diuretics and beta blockers - these can significant reduce chance of strokes and MIs |
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What is the 1st line agent for htn?
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diuretics
BB CCB ACEi |
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When should you consider giving a person 2 medications to manage htn?
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if thier bp is more than 20/10 the inital goal
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What is the 1st major drug used to manage htn?
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thiazides
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What is the MOA of thiazides?
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inhibit Na reabs from renal tubules
reduces total blood vol reduces PVR |
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What should the kidney function be for thiazide use?
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DO NOT GIVE TO RENAL IMPAIRED PTS!!!!!!!!!!!!!!!!!!
GFR> 25 Creatinine levels <2 and <1.5 in elderly |
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what are some adverse side effects of thiazides?
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hypokalemia
hyperurecimia carbohydrae intolerance hyperlipidemia |
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What dosage of thiazide daily should you give someone to avoid side effects?
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keep below 25mg/d
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What can you give someone who has renal impairement?
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Cr > 2-2.5
Loops - furosemide*** are more effective produce more diuresis and hypokalemia |
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What must you tell your pts to avoid with loops?
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NSAIDS***
interferes with delivery of loops |
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How can calcium levels change with thiazides and loops?
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thiazides - hyper-calemia
loops - hypO-calcemia |
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What is the MOA for Beta blockers?
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decreases heart contractility
decrease release of renin for juxtaglomerular apparatus |
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What are NON-selective BB?
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block both Beta 1 and beta 2 receptors
selective only block Beta 1 |
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When would you use a beta 1 blocker?
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Hx of reactive airway disease
if you want to reduce the risk of bronchospasm |
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What are beta blockers with intrinsic sympathomimetic activity (ISA)
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Less likley to increase triglyceride levels or lower HDL levels
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What are some side effects of BB?
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bradycardia
fatigue depression insominia sexual dysfunction adverse effects on lipid profile |
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What pts should you avoid BB?
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asthma
COPD 2nd or 3rd degree heart block insulin dependent diabetes mellitus |
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What can happen if you suddenly take a person off a BB?
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tachyarrhythmias
rebound htn upregulation of beta receptors |
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What are ACEi?
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inhibits the enzyme that converts angiotensin I into angiotensin II
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What pts benefit most from ACEi?
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CHF
Diabetics great for renal protection |
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In what pts might ACEi not be effective?
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Low renin states
elderly and african americans |
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what is a common side effect of ACEi?
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cough from increased bradykinin
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what can happen if you give ACEi to a person with renal a stenosis
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may cause acute reversible renal failure
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What are ARBs used for?
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do not cause a cough nor skin rashes
great medication but not as effective in tx CHF and diabetic nephropathy |
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What are CCB?
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diltiazem
verapamil dihydropyridines lower BP via peripheral vasodilatory action |
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how does diltiazem and verapamil work?
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depress the AV node and myocardial contractility
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how does duhydropyridine work?
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more vasodilatory effect but less effect on cardiac contractility
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What are some side effects of CCB?
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dizziness
edema constipation headache flushing |
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In what pts would NOT give diltiazem or verapamil?
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anyone with a 2nd or 3rd degree heart block
CHF anyone already taking a BB |
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What are centrally acting agents?
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clonidine
methydopa guanfacine reserpine lower bp by stimulating alpha-adrenergic receptors in the CNS, which in turn reduces peripheral sympathetic outflow these are usually 2nd line tx since they have many side effects |
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what are alpha blockers?
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alpha adrenergic receptor blockers
relax smooth muscle and decreases PVR Prazosin terazosin doxazosin |
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what are some common side effects of the alpah blockers?
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tachyphylaxis
headache postural hypotension - to avoid give a small 1st dose and at bed time |
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What is a good drug to give men who are elderly with high BP and BPH?
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alpha blockers
these relax smooth muscle in the prostate |
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What are some good diets for people with HTN?
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DASH diet - The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats
Sodium restriction |
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What should initial drug Tx be for htn?
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Stage 1: 140-159/90-99
thiazide, may also consider and ACEi, ARB, BB, CCB, or combination Stage 2: >160/100 2-drug combo, thiazide + ACEi, ARB, BB, or CCB |
