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41 Cards in this Set
- Front
- Back
What is the risk associated with each 20/10 mmHg over a BP of 115/75 mmHg?
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Each 20/10 mmHg DOUBLES the risk of CVD
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How many people in the US have HTN?
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72 million
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The BP relationship to risk of CVD is ...
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continuous, consistent, and independent of other risk factors.
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What is Blood Pressure?
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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 |
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What conditions occur when your Blood Pressure is too low?
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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 |
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What conditions occur when your Blood Pressure is too high?
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1. Intracranial hemorrhage
2. Stroke 3. Vascular disease 4. Kidney damage (proteinuria) 5. Hypertensive heart disease (HF with preserved EF) 6. Retinopathy |
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What should you do "in-office" to obtain a good blood pressure?
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Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm.
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What is normal BP?
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SBP< 120
DBP<80 |
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What is a prehypertension BP?
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SBP = 120-139
DBP = 80-89 |
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What is a Stage 1 Hypertension BP?
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SBP = 140-159
DBP = 90-99 |
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What is a Stage 2 Hypertension BP?
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SBP >= 160
DBP >= 100 |
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What drug should be used for initial therapy for BP control?
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Thiazide-type diuretics
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What are the benefits of lowering BP?
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35-40% decrease in stroke incidence
20-25% decrease in MI incidence 50% decrease in Heart Failure incidence |
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How much should your BP decrease during the night?
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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
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What are your goals for evaluating patients with HTN?
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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. |
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CVD Risk Factors
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- 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) |
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What are the components of the metabolic syndrome?
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HTN
Obesity Dyslipidemia Diabetes Mellitus |
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What are Identifiable Causes of Hypertension
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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 |
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Target Organ Damage associated with HTN
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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 |
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What laboratory tests should you use on a new hypertension patient?
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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 |
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What are the goals of HTN therapy?
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- 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. |
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Followup and Monitoring after beginning HTN therapy
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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. |
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Heart Failure
and Treatment of HTN |
Thiazide
Beta Blocker ACE Inhibitor ARB Aldosterone Antagonist |
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Postmyocardial Infearction
and Treatment of HTN |
Beta Blocker
ACE Inhibitor Aldosterone Antagonist |
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High CAD risk
and Treatment of HTN |
Thiazide
Beta Blocker ACE Inhibitor Calcium Channel Blocker |
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Diabetes
and Treatment of HTN |
Thiazide
Beta Blocker ACE Inhibitor ARB Calcium Channel Blocker |
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Chronic Kidney Disease
and Treatment of HTN |
ACE Inhibitor
ARB |
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Recurrent Stroke Prevention
and Treatment of HTN |
Thiazide
ACE Inhibitor |
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HTN Control in
Minority Populations |
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. |
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Left Ventricular Hypertrophy
and HTN |
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. |
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Postural Hypotension
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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. |
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Effect of Hormone Replacement Therapy and Oral Contraceptives on BP...
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Oral contraceptives can increase BP
HRT does not raise BP |
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HTN and Pregnant Women
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Methyldopa, BBs, and vasodilators, preferred for the safety of the fetus.
Contraindicated: ACEI and ARBs |
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Which anti-hypertensive drug is useful in slowing DEMINERALIZATION IN PSTEOPOROSIS?
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Thiazide-type diuretics
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Which HTN drug is useful in the treatment of:
A- Tach, A- Fib migraine thyrotoxicosis (short-term) essential tremor periorbital HTN? |
Beta Blockers
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Which HTN drug is useful in Raynaud's syndrome and certain arrhythmias?
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Calcium Channel Blockers
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Which HTN drug is useful in prostatism?
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Alpha - Blockers
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Which HTN drug should be used cautiously in GOUT or a history of significant HYPONATRIEMIA?
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Thiazide diuretics
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Which HTN drug should be generally avoided in patients with:
asthma reactive airway disease second or third degree heart block? |
Beta Blockers
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Which HTN drug should not be used in individual with a history of angioedema?
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ACE Inhibitors
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Which HTN drugs can cause HYPERKALEMIA?
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Aldosterone Antagonists
Potassium-sparing diuretics |