Term
|
Definition
repeated reproductable measurement of BP >90/140
most common cardiovascular disease
+2 properlly measured, seated, BP readings on 2+ office visits |
|
|
Term
| general risk factors of HTN 11 |
|
Definition
smokng
contraception
hyperlipidemia
diabetes
obesity BMI 30
sedentary
microalbuminemia GFR <60mL/min
age men >45 women >55
family hx premature CVD men <55 women <64
race
education |
|
|
Term
| what are the two types of HTN, their definition, their prevelance |
|
Definition
primary/essential 95%: no specific medical cause, normal CO
secondary 5%: result of another condition |
|
|
Term
| 6 risk factors for essential HTN |
|
Definition
HTN parents
Na intake
alcohol intake
obesity
hispanic, AA
hostile attitude, impatience, urgency |
|
|
Term
| clinical clues for secondary HTN 4 |
|
Definition
| severe or refractory HTN
acute rise in BP
<30 yo in non-obese pt with no family hx
proven onset 50yo |
|
|
Term
| causes of secondary HTN 7, most common in adults and kids |
|
Definition
renal: most common overall
oral contraceptives
pheochromocytoma
primary hyperaldosteronism
cushing syndrome
coarctation of aorta (vessel wall compression): most common in kids
sleep apnea |
|
|
Term
| 4 renal diseases causing secondary HTN:, which are most common in elderly, young, female |
|
Definition
fibromuscular dusplasia: most common in young and obese females
renal artery stenosis
atheromatous disease: most common in elderly
primary renal disease |
|
|
Term
| how foes fibromuscular dysplasia cause HTN, how is it diagnosed |
|
Definition
renal HTN leads to HTN
seen as string of beads on CTA/MRA |
|
|
Term
| how does renal artery stenosis cause HTN |
|
Definition
| increases renin from ischemic kidney, aNG II causes vasoconstriction, ALD increases blood volume |
|
|
Term
| how is primary renal disease diagnosed |
|
Definition
elevated CR
abnormal urine analysis |
|
|
Term
| how does pheochromocytoma cause HTN |
|
Definition
| paroxysmal elevation in BP esp with headache, palpations, and sweating |
|
|
Term
| how does primary hyperALD HTN evaluation 2 |
|
Definition
hypokelemia due to urinary K wasting
measure plasma ALD to renin ratio to identify |
|
|
Term
| 5 signs of cushing syndrome |
|
Definition
moon facies
central obesity
proximal muscle weakness
buffalo hump
striae |
|
|
Term
| how can coarctation of aorta be identified |
|
Definition
diminished or delayed femoral pulse
HTN of upper extremities
low BP in LE |
|
|
Term
| sleep apnea: who normally gets, why, signs 4, risks 2 |
|
Definition
obese men
passive collapse of pharyngeal muscle in inspiration
headache, daytime fatigue, depression, snoring
HTN, arrhythmia |
|
|
Term
| what are the 4 stages of blood pressure |
|
Definition
normal <120/80
preHTN 120/80 - 139/89
stage 1 140-90 - 159/99
stage 2 >160/100 |
|
|
Term
| tx options for stage 1 HTN 6 |
|
Definition
thiaide diruetic
ACE I
ARB
B blocker
CCB
combo |
|
|
Term
| tx options for stage 2 HTN 6 |
|
Definition
use two drugs!
thiazide diruetic
ACEI
ARB
B blocker
CCB |
|
|
Term
|
Definition
in isolation is asymptomatic
headache
fatigue
dizzy
blurred vision
facial flushing
tinnitus |
|
|
Term
| who should get checked for HTN |
|
Definition
| every office visit in pt >21yo |
|
|
Term
| what are the parts to a HTN office visit 14 |
|
Definition
assess lifestyle
identify risk factors
reveal cause of HTN
assess absence of target organ damage and CV damage
measure BP with verification in other arm
examine fundi
BMT
ascultation of carotid
ascultation of abdomen
ascultation of femoral bruis
palpate thyroid
abdomen exam for kidney and masses
palpate LE for edema and pulses
neurological exam |
|
|
Term
| labs you should get in a HTN exam 8 |
|
Definition
creatnin
Na
K
glucose
cholesterol
urine
EKG
CXR |
|
|
Term
| why do you get CXR in HTN exam |
|
Definition
| signs of cardiac enlargement or evidence of heart failure |
|
|
Term
| why do you get urine in HTN exam |
|
Definition
| proteinuremia can identify kidney cause of HTN or HTN caused kidney damage |
|
|
Term
| why do you get CR in HTN exam 3 |
|
Definition
identify renal cause of HTN or HTN caused kidney damage
baseline for latern monitoring of disease
check effects of anti-HTN medications (often renal SE) |
|
|
Term
| what are the follou up recommendations for 6 levels of BP in HTn |
|
Definition
<130/85 recheck in 2y
130/85-139/89 recheck in 1y
140/90 - 159/99 confirm in 2mo
160/100 - 170/109 evaluate in 1mo
180/110 - 109/119 evaluate in 1wk
>210/120 tx immediatly |
|
|
Term
| once you initiate anti-HTN drugs what is the follow up procedure |
|
Definition
retrn to adjust med smonthly until BP goal reached
comorbid conditions or stage 2: return more than monthly
measure serum K and CR 1-2x/y |
|
|
Term
| what is the severity of complications of HTN determined by |
|
Definition
|
|
Term
|
Definition
short term: HTN emergency
cerebravascular accident: CVA, stroke
MI: heart attack
hypertrophic cardiomyopathy
HTN retinopathy: damage to retina
HTN nephropathy: chronic reinal failure due to high BP |
|
|
Term
| why is hypertrophic cardiomyopathy a result of HTN |
|
Definition
| heart failure due to chronic high BP causes LV hypertrophy |
|
|
Term
| below what level of BP are CV complaints reduced |
|
Definition
|
|
Term
| what is inc recommendation 8 |
|
Definition
| >18yo with chronic kidney disease tx with ACEI/ARB to improve kidney outcomes regardless or race or DM |
|
|
Term
| what is JNC recommendation 1 |
|
Definition
general population >60 yo initiate drugs to lower BP when >150/90 with a goal of <150/90
strong recommendation: grade A
if tx lowers it <140 then you dont need to back off on the BP meds. if what it is doing is working dont change it
expert opinion grade E |
|
|
Term
| what is the BP goal in someone with HTN and recent stroke |
|
Definition
| only initiate meds if BP >220/110 because the body is using pressure to improve flow to infarct |
|
|
Term
| what is the jNC recommendation 2 |
|
Definition
| general population <60yo initiate drugs when diastolic > 90 and treat until <90 |
|
|
Term
| what is jnc recommendation 3 |
|
Definition
| <60yo treat when systolic >140 and treat to get less than 140 |
|
|
Term
| what is jnc recommendation 7 |
|
Definition
AA with DM or wo DM initial therapy choose one
thiazide diruetic and CCB |
|
|
Term
| what is jnc recommendation 4 |
|
Definition
| >18yo with chronic kidney disease start meds when >140/90 and treat until under that |
|
|
Term
| what is jnc recommendation 5 |
|
Definition
| >18yo with DM use drugs when >140/90 and treat until under that |
|
|
Term
| what is jnc recommendation 6 |
|
Definition
non AA initial therapy should include one...
thiazide, CCB, ACEI, or ARB |
|
|
Term
| what is jnc recommendation 9 |
|
Definition
main objective of HTN tx is to maintain a goal BP if it is not reached within 1 mo increase initial drug or add a second drug from list of recommendation for that patient
assess BP and adjust until you achieve goal. if not controlled add 3rd drug
never use ACEI/ARB together. that can worsen hyperkalemia and renal function
if cannot be achieve by 3 drugs or due to contraindications in pt to drugs then other clases can e used (nitrates, hydrolazine)
refer to a HTN specailist |
|
|
Term
| what are the non-pharmacological tx for HTN 8 |
|
Definition
diet
avoid alcohol
weight loss
low Na diet
aerobic exercise
stop smoking
relieve stress
sleep more |
|
|
Term
| what amt of drinking is associated with HTN |
|
Definition
| >2 drinks a day have 1.5x increase |
|
|
Term
| what is the associatio of weight loss with htn |
|
Definition
| lowers BP 0.5-2mmHg/1kg weight lost |
|
|
Term
| what is the benifit of a low Na diet, what does low Na mean |
|
Definition
lower BP
prevent HTN onset
100mew/d (6g sald, 100 mew/d) |
|
|
Term
| what are the goals of HTN tx |
|
Definition
reduce CV morbidity and mortality
achieve systolic goal, diastolic will usually follow |
|
|
Term
| what is the benifit of exercise in someone with HTN |
|
Definition
|
|
Term
| how is smoking associated with HTN |
|
Definition
| smoking dosent cause HTN but causes transient vasoconstrictive effect and increase CV risk in HTN |
|
|
Term
| what is the biggest non-pharmalogical bang for buck in reducing BP |
|
Definition
|
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