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31 Cards in this Set
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120 - 139 systolic or 80 - 89 diastolic Lifestyle modification encouraged. No anti HTN drugs indicated unless compelling risks.
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Prehypertension
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140 - 159s or 90 - 99d.
Lifestyle modification encouraged. Minimum drug recommendations: |
Stage 1 hypertension
Thiazide diuretics for most. May consider ACE Inhibitor ARB Beta blocker CCB or Combo. |
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Stage 2 hypertension
160+s or 100+d. Lifestyle modification. + what would be the Rx Regimen?: |
Minimum drug recommendations:
2 drug combo for most Thiazide type Rx plus ACE ARB CCB or Beta Blocker |
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95% no cause can be identified.
Complex interactions between multiple genetic and environ fctrs Usually between 25 and 55 years of age. What condition? Prevalence among white adults? Prevalence = black adults.? |
Primary hypertension
(aka: Essential Hypertension) . 10-15% of white adults 20-30% of black adults. |
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Exacerbating factors that can elevate blood pressure
7ct H+ |
Cigarette smoking
Excessive alcohol use NSAIDS Obesity Polycythemia Potassium (Low-Intake) Sodium intake (hi-Intake) (controversial) |
CENOPPS
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5% of those with {this type of htn} have definable causes which are revealed by history
physical exam and routine lab tests. |
Secondary hypertension
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MOST-COMMON-CAUSES for Secondary-HTN
11ct H+ |
Aldosteronism (Primary-Hypo-Aldosteronism)
Coarctation of the aorta Cushing syndrome Estrogen use Genetic Syndromes HyperCalcemia Medications. Pheochromocytoma Pregnancy Renal Dz Renal Vascular HTN |
A
C C E G H M P P R R V H |
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What findings might make you suspect
Secondary HTN? |
Early age
First exhibit htn over 50 yoa Well controlled pts ----> become refractory |
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What are the target organs of htn?
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Brain
Heart Renals Vessels |
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What heart diseases are correlated with BP?
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LVH ------)>
CHF Arrhythmias Myocardial Ischemia Sudden death. |
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Is cerebrovascular disease more correlated with systolic or diastolic blood pressure?
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Systolic
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What should you remember about blood pressure control for patients with established cerebral small vessel disease?
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Low blood pressure might exacerbate
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Most Americans with hypertension die of complications of
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Atherosclerosis
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Most frequent symptom is headache
accelerated form is associated with somnolence confusion visual disturbances and nausea and vomiting |
Symptoms of hypertension
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What might an orthostatic drop in hypertension indicate?
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Pheochromocytoma
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Older patients may have falsely elevated readings by sphygmomanometry because of
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Noncompressible vessels
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A palpable brachial or radial artery when the cuff is inflated above systolic pressure.
what is the aka name for this condition? |
Osler sign
+h |
Osler's sign of pseudohypertension falsely elevated blood pressure reading
due to arteriosclerotic, calcified blood vessels which do not physiologically compress with pressure. |
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What is the artery to venous ratio on fundoscopy exam that indicates hypertension?
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Arteries' diameter narrowed to less than 50% of veins'
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A left ventricular heave indicates
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Severe or long-standing hypertrophy.
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Decreased-Compliance of the left ventricle causes this common finding in patients in sinus rhythm.
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S4 gallop
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Radial-femoral delay suggests
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Coarctation of the aorta
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Hemoglobin
UA Renal fctn Studies Why order these labs w/ newly discovered HTN? |
In Order to Detect
Hematuria Proteinuria Casts These Signify: Primary Renal Dz or Nephrosclerosis. |
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Why order a fasting blood sugar in patients with newly discovered htn?
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Hyperglycemia is noted in
diabetes and pheochromocytoma. which both cause HT |
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This Lab ________ is an indicator
of Atherosclerosis risk and an additional target for therapy |
Plasma lipids
Q #2: Serum uric acid which if elevated is a relative contraindication to what Tx: |
Diuretic therapy.
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Serum aldosterone/renin ratio
is indicated to screen for mineralocorticoid excess in hypertensive pts w hypokalemic alkalosis resistant HTN or adrenal "incidentaloma". What lab might prompt you to order this? |
Serum electrolytes
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24-hour urine
Free Cortisol Plasma Metanephrines Plasma/renin ratio are all labs one might order for what condition? |
NEWLY DISCOVERED HTN
What imaging tests might you also order? |
Echocardiography
Renal US maybe also order: CT MRI Renal Arteriography |
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Situations requiring BP Reduction
w/in a few hours. Systolic >220 or Diastolic >125 Persisting after a period of observation. Optic disc edema progressive target organ complications and severe perioperative HTN |
Hypertensive urgencies
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Require reduction of blood pressure within 1 hour. Diastolic pressure > 130
hypertensive encephalopathy nephropathy intracranial hemorrhage aortic dissection preeclampsia-eclampsia pulmonary edema unstable angina or myocardial infarction. |
Hypertensive emergencies
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Characterized by
encephalopathy or nephropathy w accompanying papilledema. Progressive renal failure usually ensues if treatment is not provided. |
Malignant hypertension
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Parenteral drug therapy is not usually required
partial reduction of BP w relief of symptoms is the goal. |
Hypertensive urgencies
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Parenteral therapy is indicated in most.
The goal is to reduce the pressure by no more than 25% (within minutes to 1 or 2 hours) & then toward a level of 160/100 mm Hg w\in 2-6 hours. |
Hypertensive emergencies
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