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46 Cards in this Set
- Front
- Back
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Incidence & Prevalence of HTN
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-50 Million in US
-1/3 don't even know -31.3% of population-higher in AA |
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Mechanisms that control BP
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CO (HRxSV) & PVR (A tone, Neuro, hormonal)
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JNC7 Classification of BP
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Normal <120/<80
PreHTN 120-139/80-89 Stage 1 HTN 140-159/90-99 Stage 2 HTN >160/>100 |
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Non-Modifiable risk factors for HTN
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-Age: >55-Men; >65-Women
-FH |
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Modifiable risk factors for HTN
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-Smoking
-BMI>30 -Dyslipidemia -DM -Microalbuminuria or GFR<60cc/min |
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Essential/Primary HTN
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-Change in Volume +/- change in PVR that is not attributable to another cause/Dz process
-90% |
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Secondary HTN
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-HTN due to underlying Dz process such as renal Dz, hyperaldosteronism, etc.
-10% |
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Suspect Secondary HTN when:
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-Onset <20 or >50
-Previously stable HTN is now out of control -HTN refractory to intensive multiple drug Tx -Lab findings suspicious for secondary cause |
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DDx for Secondary HTN: ABCDE
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-Accuracy
-Apnea (OSA): Do you snore? Wake up feeling tired? -Aldosteronism: HTN + Hypokalemia -Bruits (RAS/FMD): Epigastric or renal bruits; usually Fe -Bad kidneys: Most common cause of Secondary HTN -Catecholamines (pheochromatoma): -Coarctation (Pedi's): High BP-upper ext + low BP-lower ext -Cushing's: Full, moon shaped face -Drugs: NSAIDs, decongestants, BCPs, steroids, cocaine -Diet: High Na+ -Erythropoietin -Endocrine (Thyroid): Hyper or Hypo |
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Accelerated Labile HTN
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-Progressive HTN w/ fundoscopic vascular changes of malignant HTN but w/out papilledema
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Malignant HTN
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-Encephalopathy or nephropathy w/ accompanying papilledema
-A Hypertensive emergency |
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Approach to PE in pt w/ HTN or suspected HTN
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-Assess lifestyle & ID risk factors
-Reveal identifiable causes -Assess for target organ damage & CVD |
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Evaluation of target organ damage
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-Heart: LVH, angina, MI, CHF, prior revascularization
-Brain: CVA or TIA -Kidney Dz -PAD -Retinopathy (fundoscopic exam) |
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Classification of BP
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-Based on mean of 2+ properly measured, seated BP readings on each of 2+ office visits
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Diagnostic studies used to evaluate risk factors & evaluate target organ damage
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-CBC w/ Dif
-Lytes -Bun/Cr -FBS -Ca+ -FLP -Spot urine -TSH -EKG -24 Hr urine -CXR |
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Lifestyle modifications for Tx of HTN
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-Weight reduction (5-20mmHg/10Kg loss)
-DASH diet (8-14mmHg loss) -Decrease dietary Na+ (2-8mmHg loss) -Exercise (4-9mmHg loss) -Quit Smoking -Moderation of EtOH (2-4mmHg loss) |
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Classes of drugs used to Tx HTN
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-Thiazides, ex. HCTZ,Metolazone
-Loop diuretics, ex. Furosem'ide' -K+ sparing diuretics, ex. Spironolactone Triamterene -Central alpha agonists, ex. Clonodine, 'Guana' -Alpha blockers, ex. Doxa'zosin' -Beta blockers, ex. Aten'olol' -Direct vasodilators, ex. Hydralazine, Minoxidil -Ca+ channel blockers, ex. Dilt & Verapamil, Felod'ipine' -ACEI, ex. Capto'pril' |
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Side effects of Thiazides
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-High glucose
-High uric acid (Contraindicated in Gout!) -Hypokalemia |
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Side effects of Loop diuretics
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-Hypokalemia
-Hyponatremia -Ototoxicity |
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Side effects of K+ sparing diuretics
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-Hyperkalemia, esp. Spironolactone
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Side effects of Central alpha agonists
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-Dry mouth
-Sedation -Bradycardia, esp. Clonodine |
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Side effects of alpha blockers
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-Postural HOTN...must give at night
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Side effects of Beta blockers
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-Bradycardia
-Contraindicated in COPD |
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Side effects of direct vasodilators
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-Fluid retention
-Tachycardia |
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Side effects of Ca+ channel bockers
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-Peripheral edema
-HA -Flushing |
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Side effects of ACEI
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-Hyperkalemia
-High BUN/Cr -Dry cough -Angioedema |
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BP goal in uncomplicated HTN
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<140/<90
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BP goal in DM
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<130/80
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BP goal in kidney failure
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125/75, or 135/80 if proteinuria <1gm/day
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Effects of HTN on the retinal vessels, heart, cerebral vessels, & kidney
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-Retinal-papilledema
-Heart-USA, MI, CHF, aortic dissection -Cerebral-AMS, intracranial hemorrhage, encephalopathy -Kidney-Renal failure, hematuria |
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JNC 7 says in ppl >50....
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Systolic BP >140 is a higher risk factor for CVD than Diastolic BP
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JNC 7 says the risk of CVD ____ with each incremental increase of ____ above a baseline of ____ in pt's ____ y/o
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-Doubles
-20/10 -115/75 -40-70 |
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JNC 7 says to Tx Prehypertension with....
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Lifestyle modifications
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JNC 7 says uncomplicated HTN should be Tx with....
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-Thiazide diuretics +/- drugs from another class
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JNC 7 says most ppl with HTN will require....
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-2 drug Tx to get to a BP of <140/90
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JNC 7 says if BP >20/10 above goal, then....
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Starting Tx with 2 drugs (including a Thiazide diuretic) should be considered
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Tx of HTN in DM
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-BB
-ACEI -ARB -CCB -Thiazides contraindicated in DM b/c it raises glucose levels |
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Tx of HTN in CAD
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-BB
-LA CCB |
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Tx of HTN in CHF
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-ACEI
-BB -ARB -ALDO Loop diuretic |
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Tx of HTN in AA
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-CCB
-Diuretic |
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Tx of HTN in Pregnancy
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-Vasodilators
-BB |
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Tx of HTN in Kidney Dz
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-ACEI
-ARB -Loop diuretic |
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Role of self monitoring BP
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-Improve pt compliance
-Help evaluate white coat HTN -Mean BP at home >135/85=HTN |
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24 Hr Ambulatory monitoring
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-Helpful in drug resistant pts
-Evaluates pt's w/ HOTN episodes w/ meds -Awake >135/85=HTN -Asleep >120/75=HTN |
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Causes of resistant HTN
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-Underlying Dz process
-Non-compliance -Drug use |
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To obtain an accurate BP....
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-Pt mest be seated w/ feet on floor x 5min
-Arm at heart level -Cuff bladder encircles 80% of arm -First HS to disappearance of all sound |
