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62 Cards in this Set

  • Front
  • Back
definition of hypertension
multiple readings with systolic >140mmHg or diastolic >90mmHg in the absence of specific identifiable underlying cause
hypertension in those with diabetes or renal disease
defined as pressure > 130/80
hypertension stages
preHTN --> systolic 120-129, diastolic 80-89
stage I --> systolic 140-159, diastolic 90-99
stage II --> systolic >160, diastolic > 100
long term cardiac complications of hypertension
myocardial ischemia or infarction
CHF
left ventricular hypertrophy
aortic aneurysm
dissection
long term cerebrovascular complications of hypertension
transient ischemic atack or stroke
long term renal complications of hypertension
microscopic hematuria, elevation of BUN/creatinine which may need dialysis
long term eye complications of hypertension
retinopathy
hemorrhages
exudates
arteriolar narrowing
papilledema
results in blurred vision, scotomata, sometimes blindness
hypertension diagnosis
allow patient to sit quietly for 5 minutes before pressure is measured
repeat reading 3-6 times over several months before labeling as hypertensive and giving treatment
hypertension routine laboratory analysis
urinalysis for protein, glucose or red blood cells
cretinine/BUN
hematocrit
glucose and lipids (for athersoclerosis risk)
serum potassium (exclude hyperaldosteronism)
ECG for LVH
who to treat
diastolic >90 after 3-6 months of nonpharmacologic therapy
what to use for hypertension
best initial treatment is diuretic such as hydroclorothiazide; stage III add ACEI, ARB, CCB or beta blocker; if not enough add another drug
specific antihypertensives for diabetics
ACEIs
goal is <130/80 (as in renal insufficiency, CHF, retinopathy or stroke)
specific antihypertensives for post MI
beta blockers
specific antihypertensives for CHF or left ventricle dysfunction post MI
ACEIs and/or betablocker
specific antihypertensives for pregnant
alpha methyldopa, labetalol, hydralazine or CCB
ACEIs and ARB are absolutely contraindicated
diuretics relatively contraindicated
hypertensive emergency definition
diastolic >120 with end-organ damage
malignant hypertension definition
has encephalopathy or nephropathy with accompanying papilledema
hypertensive emergency neurologic presentation
encephalopathy
headache
confusion
seizures
subarachnoid or intracerebral hemorrhage
hypertensive emergency cardiac presentation
chest pain
MI
palpitations
dyspnea
pulmonary edema
jugular venous distention
gallops
hypertensive emergency nephropathy presentation
acutely progressive hematuria, proteinuria, renal dysfunction
hypertensive emergency retinopathy presentation
papilledema, hemorrhages, blurred vision
hypertensive emergency diagnosis
no concern for white coat artifact; EKG is first initial test to exclude MI; head CT to exclude hemorrhage
hypertensive emergency treatment
IV nitroprusside and labetalol
if MI, nitroglycerin is preferred
IV enalaprilat is also being used
do not reduce pressure more than 25% in 1-2 hours to not compromise cerebral or myocardial perfusion (keep it above 95-100 diastolic)
causes of secondary hypertension
renal artery stenosis
Conn
pheochromocytoma
Cushing
also oral contraceptives, acromegaly, glomerulonephritis
renal artery stenosis
2dary hypertension
presents with upper abdominal bruit radiating laterally
best initial screen is abdominal ultrasound
captopril renogram is noninvasive to confirm
best confirmation is arteriogram
treat with percutaneous transluminal angioplasty or surgical resection
secondary hypertension due to Conn syndrome
presents with hypertension + hypokalemia
muscular weakness
nephrogenic diabetes insipidus
diagnosis --> high aldosterone levels in blood and urine
surgical resection of adenoma or spironolactone if hyperplasia
secondary hypertension in pheochromocytoma
episodic hypertension with headaches, sweating, palpitations and tachycardia
best initial test is VMA, metanephrines and free urine catecholamines
then do CT or MRI to locate tumor
treat with alpha adrenergics blockers followed by surgery
secondary hypertension in Cushing
present with hypertension, truncal obesity, buffalo hump, menstrual abnormalities, striae, etc… best initial tests are dexamethasone suppression test and 24-hour urine cortisol; treat with surgery
thiazide drugs
hydrochlorothiazide, chlortalidone, metolazone, indapamide
loop diuretic drugs
furosemide, bumetanide, torsemide
potassium sparing diuretics
spironolactone, amiloride, triamterene
specific indications of diuretics
CHF, edematous states, african-american patients, least expensive
side effects of diuretics
↓potassium
↓ magnesium
↑calcium
↑uric acid
hyperglycemia
↑LDL
gynecomasia
relative contraindications of diuretics
diabetes, gout, hyperlipidemia
specific indications of beta blockers
myocardial infarction or ischemic heart disease
supraventricular arrhythmias
migraines
glaucoma
anxiety
diastolic heart failure
side effects of beta blockers
bronchospasm
heart block, bradycardia, conduction defects
depression
impotence
fatigue
↓HDL, ↑triglycerides
masking of hypoglycemia
relative contraindications of beta blockers
asthma or COPD
conduction defects
systolic heart failure
diabetes
specific indications of ACEIs
diabetics (prevents neuropathy)
CHF (decreases afterload)
postmyocardial infarction with systolic failure
side effects of ACEIs
cough, angioedema, neutropenia, hyperkalemia, taste disturbance, anaphylactoid reaction
relative contraindications of ACEIs
less effective in african americans
absolute contraindications of ACEIs
bilateral renal artery stenosis, pregnancy
specific indications of calcium channel blockers
angina
supraventricular arrhythmia
migraines
Raynaud
esophageal spasm
side effects of calcium channel blockers
peripheral edema
constipation
heart block
reflex tachycardia
relative contraindications of calcium channel blockers
AV conduction defects, CHF from systolic dysfunction
angiotensin receptor blocker specific indications
those intolerant to ACEIs (specially due to cough)
angiotensin receptor blockers side effects
fewer than ACEIs
angiotensin receptor blockers absolute contraindications
pregnancy
first-line drugs for hypertension
diuretics, betablockers, ACEIs, ARBs
second-line drugs for hypertension
central acting sympatholytics
direct vasodilators
alpha adrenergic blockers
central-acting sympatholytics drugs
clonidine, guanabenz, guanfacine, methyldopa
specific indications of central-acting sympatholytics
clonidine in opiate detox
central-acting sympatholytics side effects
depression
fatigue
dry mouth
impotence
bradycardia
heart block
memory loss
methyldopa specific side effects
hepatitis, Coombs+ hemolytic anemia
relative contraindications of central-acting sympatholytics
elderly or depressed patients
direct vasodilator drugs
hydralazine, minoxidil
specific indications of direct vasodilators
hydralazine in eclampsia; minoxidil in baldness
minoxidil specific side effects
fluid retention, pericardial effussion, hirsutism
hydralazine specific side effects
lupus-like syndrome
direct vasodilator relative contraindications
angina
alpha adrenergic blocker drugs
doxazosin, prazosin, terazosin
specific indications of alpha adrenergic blockers
lipid disorders (they ↓LDL and ↑HDL)
prostatic hypertrophy
side effects of alpha adrenergic blockers
first-dose syncope, dizziness, headache