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97 Cards in this Set
- Front
- Back
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What is HTN?
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persistant elevation of the SB at 140 or higher and the DB at 90 or higher
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What is the treatment goal for patients with renal disease or diabetes?
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130/85
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What is the treatment goal for patients with renal disease and severe proteinuria?
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125/75
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What % of adults have essential HTN?
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90-95%
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What is the cx of essential HTN?
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no identifiable cx, most likely due to multiple factors in 4 control mechanisms
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What % of adults has secondary HTN?
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fewer than 5-8%
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What is secondary HTN?
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BP elevation with an identifiable cx
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What is the definition of essential/primary HTN?
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any factor producing an alteration in peripheral vascular resistance, heart rate, or stroke volume affecting arterial BP
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What 4 control mechanisms can be cx of essential/primary HTN?
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arterial baroreceptor and chemoreceptor mechanisms
regulation of body fluid system renin-angiotensin system vascular autoregulation |
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How many people have E HTN?
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1 in 4
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When does E. HTN usually appear?
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between 30-55
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Who is E. HTN more common in?
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elderly and non-white races
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What % of people have BP within target range?
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25%
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What is the risk of developing E. HTN if you are normotensive at 55?
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90% risk
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How does E. HTN happen?
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there is an increase in peripheral arterial resistance because of inappropriate renal retention of salt and water OR increased endogenous pressor activity
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What precedes increased peripheral resistance?
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increased cardiac output
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How should BP be measured?
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by taking 2 or more BP's with pt. in chair & arm supported at heart level
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What should you do before taking BP?
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make sure pt is seated for 5 min prior to check
no caffeine or nicotine 30 min prior to check |
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How should the BP cuff fit?
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Bladder of cuff should encircle 80% of arm
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When measuring blood pressure, how do you know what the systolic is?
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When first of 2 or more sounds is heard
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When measuring BP, how do you know what the diastolic is?
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It is the point before the disappearance of sounds
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When do you measure BP standing?
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when pt. is at risk for postural hypotension (esp. with some types of meds)
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What are the modifiable environmental risk factors for HTN?
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obesity
psychogenic stress High fat/sodium diet OC's Alcohol intake sedentary lifestyle diabetes/dyslipidemia |
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What are some non modifiable risk factors?
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Family Hx
African American Elderly Diabetes/dyslipidemia |
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With a family Hx of HTN, what are some things that are high risk?
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Women who have had a stroke under age 65
Men who have had stroke under age 55 |
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What is a circadian BP change?
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When BP rises in the morning and decreases at night with sleep
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How much does BP decrease with sleep?
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10-20%
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What is "white coat" syndrome?
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When BP rises only when in dr. office
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What causes "white coat' syndrome?
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A vaso-vagal response that increases systolic. (fight or flight)
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What happens if you treat BP and it is actually only "white coat" syndome?
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can lead to significant hypotension
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How should a practitioner monitor BP in a person with "white coat" syndrome?
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Teach them how to take BP at home and report results
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Why should chronic intermittent vaso-vagal response with high BP be treated?
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to prevent possibility of a stroke
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How should you treat the vaso-vagal with increased BP?
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low dose beta blocker and antianxiety drugs.
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What is the JNC 7 classifycation for BP based on?
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impact of risk if not on hypertensive meds and no acute disease
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How do you put a pt in a classification?
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by averaging 2 or more BP's on 2 or more visits AFTER the initial screen
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What do you do if systolic and diastolic fall into 2 catagories?
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Take the higher of the two and place it in that catagory
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What is considered normal BP?
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<120/<80
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What is prehypertension?
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120-139/80-89
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What is stage 1 hypertension?
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140-159/90-99
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What is stage 2 hypertension?
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greater than or equal to 160/ 100
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What is an initial high blood pressure?
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one elevated systolic or diastolic
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What is a stage 1 initial BP?
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140-159/90-99
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When do you recheck someone with a Stage 1 initial BP?
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within 2 months
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What is a stage 2 initial BP?
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160-179/100-109
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When should you recheck someone with a stage 2 initial BP?
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within 1 month
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When are transient high BP's often seen?
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in emergency or initial evaluation
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What is someone at risk for when they have transient high BP or normal high BP?
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developing sustained hypertension
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What qualifies as chronic BP?
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140/90 at multiple visits
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What is accelerated HTN?
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HTN with clinical evidence (organ targeted)
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What are some organs targeted with accelerated HTN?
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Kidneys & Eyes
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How does accelerated HTN affect the eyes?
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They have arteriosclerosis that leads to grade 3 or 4 hypertensive retinopathy
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How does accelerated HTN affect the kidneys?
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Renal insufficiency, there is no other cause of this disease
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What happens if accelerated HTN goes untreated?
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95% die within 5 years
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What do pts with untreated accelerated HTN usually die from?
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cardiac, renal, and CNS complications
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What are some cardiac, renal and CNS complications of untreated HTN?
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Stroke, kidney disease, CHF
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What is hypertensive urgency?
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asymptomatic, severe hypertension
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What is usually true of those patients with hypertensive urgency?
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They have had undiagnosed chronic high BP
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What is the usual BP of hypertensive urgency?
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>210/>120
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Do they have evidence of target organ disease?
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Sometimes
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How should the clinician get hypertensive urgency under control?
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Within a few days rather than hours
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What is an hypertensive emergency?
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a marled elevation of BP that will produce a catastrophic event in a few hours or days
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What is the BP of a hypertensive emergency?
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Same as BP urgency, 210/120
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What are 2 types of hypertensive emergency?
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hypertensive encephalopathy
dissecting aneurysm |
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What is hypertensive encephalopathy?
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cerebral edema that develops gradually over 1 or more days
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What are some sx of encephalopathy?
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headache,
confusion irritablity that is present and progressive possible papilledema |
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What needs to be ruled out?
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intracerebral mass or hemorrhage by CT
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What is a Thoracic aortic aneurysm?
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expanding hematoma in wall of the aorta
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What are some sx of an aneurysm?
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sudden anterior chest pain or tear pain in back
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How is an aneurysm dx?
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CT or MRI
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What are the 5 steps in a HTN baseline evaluation?
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assess status of target organs
identify clues for treatable etiology guide selection of initial treatment establish pretreatment status detect presence of additional cardiovascular risk factors |
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What are some treatable etiologies of HTN?
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Alcoholism, underlying kidney disease
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What are the target organs to be evaluated?
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heart, kidney, CNS, eyes
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What labs should you order for HTN?
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CBC, Calcium, Creatnine, Potassium, Sodium, FBS, Cholesterol, Uric Acid, UA, EKG
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What types of meds can cx HTN or counteract HTN meds?
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OCP, Tricyclic antidepressants, decongestants, appetite suppressants, corticosteriods, illicit drugs
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What are cx of secondary HTN?
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Chronic ETOH
use of meds renovascular HTN kidney disease Cushings pheochromocytoma coarction of aorta |
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With alcohol detox, how long does it take for BP to become normal?
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about 1 week
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In renovascular HTN, what % is unilateral?
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0.5% d/t unilateral stenosis of renal artery
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What is a common cx of this?
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smoking
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What does unilateral stenosis of the renal artery do to BP?
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raises it using renin/angiotensin to increase bloodflow to the kidney
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How does cushing's raise BP?
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because of unexplainable low potassium
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What does coarctation of the aorta do to BP?
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HTN usually in young pt with decrease in BP in lower extremities
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What is seen in a pt in pheochromocytoma?
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hypermetabolic state with severe headaches
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What are the goals of treatment with HTN?
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reduce the risk of future cardio disease by restoring BP
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How much of an increase in BP doubles the risk for CVD?
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20/10 mm Hg
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What is the treatment for prehypertension?
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Theraputic lifestyle changes (TLC)
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What is the treatment for stage 1 HTN?
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TLC plus meds
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What is the treatment for stage 2 HTN?
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TLC plus meds
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What are 6 TLC a pt can do?
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Reduce Weight
DASH diet Sodium reduction Daily exercise ETOH Adequate intake of potassium Smoking Cessation |
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How much of a wt loss can help BP?
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10-12lbs can show a reduction of 5-20mm Hg
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How much can the DASH diet drop blood pressure?
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8-14 mmHg
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How much sodium is allowed on a low sodium diet?
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no more than 100mmol/day/ 2.4g per day
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What are some TLC's that have unproven efficacy?
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Calcium 1000-1200mg/day
Fish oil with omega 3's relaxation therapies |
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How should you treat prehypertension?
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with TLC, no antihypertensives needed
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When are drugs indicated for prehypertension?
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chronic kidney disease/diabetes to keep bp <130/80
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How is stage 1 treated?
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TLC, thiazide diuretic, may consider ACE inhibitor, ARB, B blocker, Calcium channel blocker, or combo
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What drugs are compelling indications in stage 1?
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Other hypertensives (diuretics, ACE, etc)
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What is tx for stage 2?
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2 drug combonation for most pts (Thiazides, ACE, ARB, Beta Blocker, CCB)
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