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37 Cards in this Set

  • Front
  • Back
Most frequent reason for office visits
Leading cause of CHF and left ventricular hypertrophy
When should bp readings begin?
At age 3
Dx of HTS is 2 or more high BP readings on 2 or more office visits unless what?
BP is severe or associated with compelling indications (DM, CRF, HF, post-MI, CVA, increased risk of coronary ds)
When should antihypertensive therapy start, according to JNC 7
At stage 1 of HTS, or prehypertension when there are compelling indications
what are the JNC 7 main points?
-Don't ignore systolic HTS
-most older pts will become HTS
-preHTS begets HTS: think prevention
-use thiazides
-most pts will need more than 1 med.
-for some pt with high BP= start with 2 meds
-work with pt to build compliance
what are factors to consider in HTN?
genetic- FmHx, race, gender, age (>55 men, >65 women), DM, dyslipedemia, smoking, overweight, stress/depp, white coat synd., BP cuff too small
what are the categories for HTN?
primary, secondary, isolated systolic, isolated diastolic, systolic and diastolic, "wide pulse pressure"
What are exarcerbating factors in primary HTN?
obesity, N+ intake, ETOH, cigarette smoking, lack of exer., polycythemia, NSAIDS, low K+ intake
How does one evaluate for HTN?
PT hx, PE, Labs/xray/EKG, special studies when indicated
What do we check in the physical exam?
B/P both arms, eye exam, cardiovascular evaluation, abdominal evaluation for bruits, adequacy of pulses throughout
during the PE, what do we look for in the eye exam?
retinal arteriolar narrowing with "silver-wiring", AV nicking, flame-shape hemorrhages
what do we look for in the cardiovascular evaluation during PE?
LVH/CHF, loud A2
What are the basic studies done for a PT with HTN?
CBC, electrolytes (K+), serum uric acid, BUN/Cr, UA, fasting blood glucose, EKG, lipid profile, and in severe: renal dysfxn & hemolysis
What are more advances studies for HTN?
ambulatory B/P recording, home B/P monitoring
When secondary cause suspected:
chest xray, EKG for LVH/function, catecholamine levels, aldosterone levels, urine electrolytes
what are some adrenal causes of secondary HTN?
primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma
what are some renal causes of secondary HTN?
Chronic renal disease, renal artery stenosis, (atherosclerotic or fibromuscular dysplasia)
what are other causes of secondary HTN?
oral contraceptives, ETOH, NSAID's, pregnancy ass., hypercalcemia, hyperthyroidism, obstructive sleep apnea, obesity, coarctaction of the aorta, acromegalysm, increased intracranial pressure
what is the most common cause of secondary HTN?
Renal parenchymal disease
what is the most common cause of pheochromocytoma?
adrenal tumor
what are S/SX of pheochromocytoma?
sustianed or paroxysmal HTN, sudden onset HTN, HA, sweating, palpitations, anxiety, tremor, wt. loss, heat intolerance, N, abd pain, CP, marked orthostatic hypotension associated with severe supine hypertension
What is the tx of choice for pheochromocytoma?
Removal, however, p removal of tumor, severe hypotension/shock may ensue & resistnant to epi & norepi
what is the tx for pre-HTN?
lifestyle modification
no drugs unless indicated
drug indication: chronic kidney disease or diabetes, goal of <130/80
what is the tx for stage 1 HTS?
lifestyle modification
Thiazide-type diuretics for most with goal of <140/90
May consicer ACE inhibitors, ARB, beta-blocker, Ca-blocker, or combination
add therapy for compelling conditions
what is the tx for stage 2 HTS?
lifestyle modification
goal 140/90
two-drug combination for most(thiazide and ACE or ARB or B-blocker or Ca-blocker
use caution for PTs prone to orthostatic hypotension
add therapy for compelling indications
Mention some lifestyle changes
optimize weight (5-10 mm/Hg/10kg wt loss)
DASH diet (incr. fruit/veg & low fat dairy)
adequate K+/Ca++
exercise, quit smoking, limit ETOH, optimize lipid profile, stress managment
what are the "old" drugs?
Diuretics and B-blockers
what are the "new" drugs?
Ace inhibitors, ARB's and calcium channel blockers
Which is the preferred first choice of diuretic for antiHTN drug?
Thiazide diuretics
Diuretics are most effective in whom?
blacks, elderly, obese, and smokers
adverse effect of diuretic
adversely effects lipid levels
what should you do with diabetics with HTN
tx aggressively, aming for target BP <130/80
-given high risk of CV events
-ACE-I or ARB's should be part of regimen
What are the four S&S of preeclamsia/eclampsia?
proteinuria, edema, HTN, seizures
what are the S&S of metabolic syndrom (syndrome x)?
central obesity, insulin resistance, high triglycerides, HTN, low HDL, high catecholamines, +inflammatory markers; c-reactive protein
why are thiazide diuretics preferred over loop?
b/c loop diuretics tend to cause more electrolyte (k+)& volume depletion.
B-blockers are more effective for whom?
young, white, post MI, stable CHF, migraine HA, anxiety
what are the side effects of b-blockers?
brady, SA/AV blocks, nasal congestion, Raynaud's phenomenon, CNS sx (nightmares, depression, confusion), fatigue, adverse lipid level effects