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37 Cards in this Set
- Front
- Back
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Most frequent reason for office visits
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HTS
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Leading cause of CHF and left ventricular hypertrophy
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HTS
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When should bp readings begin?
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At age 3
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Dx of HTS is 2 or more high BP readings on 2 or more office visits unless what?
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BP is severe or associated with compelling indications (DM, CRF, HF, post-MI, CVA, increased risk of coronary ds)
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When should antihypertensive therapy start, according to JNC 7
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At stage 1 of HTS, or prehypertension when there are compelling indications
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what are the JNC 7 main points?
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-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 |
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what are factors to consider in HTN?
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genetic- FmHx, race, gender, age (>55 men, >65 women), DM, dyslipedemia, smoking, overweight, stress/depp, white coat synd., BP cuff too small
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what are the categories for HTN?
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primary, secondary, isolated systolic, isolated diastolic, systolic and diastolic, "wide pulse pressure"
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What are exarcerbating factors in primary HTN?
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obesity, N+ intake, ETOH, cigarette smoking, lack of exer., polycythemia, NSAIDS, low K+ intake
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How does one evaluate for HTN?
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PT hx, PE, Labs/xray/EKG, special studies when indicated
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What do we check in the physical exam?
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B/P both arms, eye exam, cardiovascular evaluation, abdominal evaluation for bruits, adequacy of pulses throughout
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during the PE, what do we look for in the eye exam?
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retinal arteriolar narrowing with "silver-wiring", AV nicking, flame-shape hemorrhages
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what do we look for in the cardiovascular evaluation during PE?
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LVH/CHF, loud A2
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What are the basic studies done for a PT with HTN?
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CBC, electrolytes (K+), serum uric acid, BUN/Cr, UA, fasting blood glucose, EKG, lipid profile, and in severe: renal dysfxn & hemolysis
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What are more advances studies for HTN?
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ambulatory B/P recording, home B/P monitoring
When secondary cause suspected: chest xray, EKG for LVH/function, catecholamine levels, aldosterone levels, urine electrolytes |
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what are some adrenal causes of secondary HTN?
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primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma
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what are some renal causes of secondary HTN?
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Chronic renal disease, renal artery stenosis, (atherosclerotic or fibromuscular dysplasia)
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what are other causes of secondary HTN?
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oral contraceptives, ETOH, NSAID's, pregnancy ass., hypercalcemia, hyperthyroidism, obstructive sleep apnea, obesity, coarctaction of the aorta, acromegalysm, increased intracranial pressure
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what is the most common cause of secondary HTN?
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Renal parenchymal disease
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what is the most common cause of pheochromocytoma?
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adrenal tumor
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what are S/SX of pheochromocytoma?
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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
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What is the tx of choice for pheochromocytoma?
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Removal, however, p removal of tumor, severe hypotension/shock may ensue & resistnant to epi & norepi
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what is the tx for pre-HTN?
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lifestyle modification
no drugs unless indicated drug indication: chronic kidney disease or diabetes, goal of <130/80 |
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what is the tx for stage 1 HTS?
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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 |
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what is the tx for stage 2 HTS?
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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 |
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Mention some lifestyle changes
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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 |
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what are the "old" drugs?
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Diuretics and B-blockers
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what are the "new" drugs?
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Ace inhibitors, ARB's and calcium channel blockers
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Which is the preferred first choice of diuretic for antiHTN drug?
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Thiazide diuretics
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Diuretics are most effective in whom?
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blacks, elderly, obese, and smokers
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adverse effect of diuretic
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adversely effects lipid levels
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what should you do with diabetics with HTN
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tx aggressively, aming for target BP <130/80
-given high risk of CV events -ACE-I or ARB's should be part of regimen |
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What are the four S&S of preeclamsia/eclampsia?
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proteinuria, edema, HTN, seizures
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what are the S&S of metabolic syndrom (syndrome x)?
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central obesity, insulin resistance, high triglycerides, HTN, low HDL, high catecholamines, +inflammatory markers; c-reactive protein
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why are thiazide diuretics preferred over loop?
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b/c loop diuretics tend to cause more electrolyte (k+)& volume depletion.
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B-blockers are more effective for whom?
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young, white, post MI, stable CHF, migraine HA, anxiety
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what are the side effects of b-blockers?
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brady, SA/AV blocks, nasal congestion, Raynaud's phenomenon, CNS sx (nightmares, depression, confusion), fatigue, adverse lipid level effects
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