Wake Cv Hypertension

Front 1

What is the risk associated with each 20/10 mmHg over a BP of 115/75 mmHg?

Back 1

Each 20/10 mmHg DOUBLES the risk of CVD

Front 2

How many people in the US have HTN?

Back 2

72 million

Front 3

The BP relationship to risk of CVD is ...

Back 3

continuous, consistent, and independent of other risk factors.

Front 4

What is Blood Pressure?

Back 4

Measure of adequacy of circulation
Balance between
- Blood Volume ejected by left ventricle
- Peripheral resistance to blood flow
Adequate BP vital to perfusion of body tissues

Front 5

What conditions occur when your Blood Pressure is too low?

Back 5

1. Shock
2. Kidney failure (acute tubular necrosis)
3. Anoxic encephalopathy (in pts with PVD and confounding low BP condition; or with sudden cardiac death, when heart comes back before the brain)
4. Lactic acidosis

Front 6

What conditions occur when your Blood Pressure is too high?

Back 6

1. Intracranial hemorrhage
2. Stroke
3. Vascular disease
4. Kidney damage (proteinuria)
5. Hypertensive heart disease (HF with preserved EF)
6. Retinopathy

Front 7

What should you do "in-office" to obtain a good blood pressure?

Back 7

Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm.

Front 8

What is normal BP?

Back 8

SBP< 120
DBP<80

Front 9

What is a prehypertension BP?

Back 9

SBP = 120-139
DBP = 80-89

Front 10

What is a Stage 1 Hypertension BP?

Back 10

SBP = 140-159
DBP = 90-99

Front 11

What is a Stage 2 Hypertension BP?

Back 11

SBP >= 160
DBP >= 100

Front 12

What drug should be used for initial therapy for BP control?

Back 12

Thiazide-type diuretics

Front 13

What are the benefits of lowering BP?

Back 13

35-40% decrease in stroke incidence

20-25% decrease in MI incidence

50% decrease in Heart Failure incidence

Front 14

How much should your BP decrease during the night?

Back 14

Your BP should drop by 10-20% during the night, if not, then you are at increased risk for cardiovascular events... this is nocturnal HTN

Front 15

What are your goals for evaluating patients with HTN?

Back 15

1. Assess lifestyle and identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment.

2. Reveal identifiable causes of high BP.

3. Assess the presence or absence of target organ damage and CVD.

Front 16

CVD Risk Factors

Back 16

- Hypertension*
- Cigarette smoking
- Obesity* (BMI >30 kg/m2)
- Physical inactivity
- Dyslipidemia*
- Diabetes mellitus*
- Microalbuminuria or estimated GFR <60 ml/min
- Age (older than 55 for men, 65 for women)
- Family history of premature CVD (men under age 55 or women under age 65)

Front 17

What are the components of the metabolic syndrome?

Back 17

HTN
Obesity
Dyslipidemia
Diabetes Mellitus

Front 18

What are Identifiable Causes of Hypertension

Back 18

1. Sleep apnea
2. Drug-induced or related causes
3. Chronic kidney disease
4. Primary aldosteronism
5. Renovascular disease
6. Chronic steroid therapy and 7. Cushing’s syndrome
8. Pheochromocytoma
9. Coarctation of the aorta
10. Thyroid or parathyroid disease

Front 19

Target Organ Damage associated with HTN

Back 19

1. Heart
- Left ventricular hypertrophy
- Angina or prior myocardial infarction
- Prior coronary revascularization
- Heart failure
2. Brain
- Stroke or transient ischemic attack
3. Chronic kidney disease
4. Peripheral arterial disease
5. Retinopathy

Front 20

What laboratory tests should you use on a new hypertension patient?

Back 20

1. Electrocardiogram
2. Urinalysis
3. Blood glucose, and hematocrit
4. Serum potassium, creatinine, or the corresponding estimated GFR, and calcium
4. Lipid profile, after 9- to 12-hour fast, that includes high-density and low-density lipoprotein cholesterol, and triglycerides

Optional test: Measurement of urinary albumin excretion or albumin/creatinine ratio

Front 21

What are the goals of HTN therapy?

Back 21

- Reduce CVD and renal morbidity and mortality.

- Treat to BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes or chronic kidney disease.

- Achieve SBP goal especially in persons >= 50 years of age.

Front 22

Followup and Monitoring after beginning HTN therapy

Back 22

Patients should return for followup and adjustment of medications until the BP goal is reached.

More frequent visits for stage 2 HTN or with complicating comorbid conditions.

Serum potassium and creatinine monitored 1–2 times per year.

After BP at goal and stable, followup visits at 3- to 6-month intervals.

Comorbidities, such as heart failure, associated diseases, such as diabetes, and the need for laboratory tests influence the frequency of visits.

Front 23

Heart Failure
and Treatment of HTN

Back 23

Thiazide
Beta Blocker
ACE Inhibitor
ARB
Aldosterone Antagonist

Front 24

Postmyocardial Infearction
and Treatment of HTN

Back 24

Beta Blocker
ACE Inhibitor
Aldosterone Antagonist

Front 25

High CAD risk
and Treatment of HTN

Back 25

Thiazide
Beta Blocker
ACE Inhibitor
Calcium Channel Blocker

Front 26

Diabetes
and Treatment of HTN

Back 26

Thiazide
Beta Blocker
ACE Inhibitor
ARB
Calcium Channel Blocker

Front 27

Chronic Kidney Disease
and Treatment of HTN

Back 27

ACE Inhibitor
ARB

Front 28

Recurrent Stroke Prevention
and Treatment of HTN

Back 28

Thiazide
ACE Inhibitor

Front 29

HTN Control in
Minority Populations

Back 29

In general, treatment similar for all demographic groups.

Socioeconomic factors and lifestyle important barriers to BP control.

Prevalence, severity of HTN increased in African Americans.

African Americans demonstrate somewhat reduced BP responses to monotherapy with BBs, ACEIs, or ARBs compared to diuretics or CCBs.

These differences are usually eliminated by adding adequate doses of a diuretic.

Front 30

Left Ventricular Hypertrophy
and HTN

Back 30

Regression of LVH occurs with aggressive BP management:
- weight loss,
- sodium restriction,
- and treatment with all classes of drugs EXCEPT the direct vasodilators hydralazine and minoxidil.

Front 31

Postural Hypotension

Back 31

Decrease in standing SBP >10 mmHg, when associated with dizziness/fainting, more frequent in older SBP patients with diabetes, taking diuretics, venodilators, and some psychotropic drugs.

BP in these individuals should be monitored in the upright position.

Avoid volume depletion and excessively rapid dose titration of drugs.

Front 32

Effect of Hormone Replacement Therapy and Oral Contraceptives on BP...

Back 32

Oral contraceptives can increase BP

HRT does not raise BP

Front 33

HTN and Pregnant Women

Back 33

Methyldopa, BBs, and vasodilators, preferred for the safety of the fetus.

Contraindicated: ACEI and ARBs

Front 34

Which anti-hypertensive drug is useful in slowing DEMINERALIZATION IN PSTEOPOROSIS?

Back 34

Thiazide-type diuretics

Front 35

Which HTN drug is useful in the treatment of:
A- Tach, A- Fib
migraine
thyrotoxicosis (short-term)
essential tremor
periorbital HTN?

Back 35

Beta Blockers

Front 36

Which HTN drug is useful in Raynaud's syndrome and certain arrhythmias?

Back 36

Calcium Channel Blockers

Front 37

Which HTN drug is useful in prostatism?

Back 37

Alpha - Blockers

Front 38

Which HTN drug should be used cautiously in GOUT or a history of significant HYPONATRIEMIA?

Back 38

Thiazide diuretics

Front 39

Which HTN drug should be generally avoided in patients with:
asthma
reactive airway disease
second or third degree heart block?

Back 39

Beta Blockers

Front 40

Which HTN drug should not be used in individual with a history of angioedema?

Back 40

ACE Inhibitors

Front 41

Which HTN drugs can cause HYPERKALEMIA?

Back 41

Aldosterone Antagonists
Potassium-sparing diuretics