HTN

5.0(1)
studied byStudied by 9 people
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/76

encourage image

There's no tags or description

Looks like no tags are added yet.

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

77 Terms

1
New cards

HTN

A progressive cardiovascular syndrome with many causes that results in both functional and structural changes to the heart and vascular system

2
New cards

primary (essential)

What type of HTN is most common (95%) and has an idiopathic cause?

3
New cards

secondary

What type of HTN has a defined cause where we can treat the culprit and cure the patient?

4
New cards

accurate measurements and average of 2+ readings on 2+ occasions

HTN definition determined by ACC/AHA is based on

5
New cards

age, obesity, family hx, race, reduced nephron number, high sodium diet, excessive EtOH, physical inactivity, insufficient sleep, social determinants

What are some things associated with primary HTN - NOT the cause?

6
New cards

eye

What is one of the 1st places effected by HTN and the only place where you can see the damage?

7
New cards

HTN diagnosis (do not pass go, do not collect $200)

Any patient presenting with a hypertensive emergency

8
New cards

Ambulatory BP monitoring

basically a halter monitor for BP for episodic hypertension

9
New cards

ambulatory BP monitoring, patient self-check, home blood pressure

What are some strategies for diagnosing hypertension (how do you exclude white coat syndrome)?

10
New cards

improper cuff size, recent nicotine intake, recent caffeine, amount of rest prior to BP measurement, not checking same time of day, recent exercise, recent dietary intake, white coat

What things might cause change a BP’s accuracy?

11
New cards

2 years, yearly

When does USPSTF recommend screening for normal BP (120/80)? Prehypertension (120-139/80-89)?

12
New cards

We can’t control it, they are young

When do we do a work-up for secondary hypertension?

13
New cards

12 lead EKG, blood glucose, serum potassium, creatinine, UA, hematocrit, calcium, fasting lipid profile

What are some additional studies to consider for the diagnosis of HTN?

14
New cards

thiazide/ACEI/ARB/CCB alone or in combo

For non-black patients with HTN without CKD or DM what is our treatment plan?

15
New cards

thiazides/CCB alone or in combo

For black patients with HTN without CKD or DM what is our treatment plan?

16
New cards

thiazide/ACEI/ARB/CCB alone or in combo

For nonblack patients with HTN and DM without CKD what is our treatment plan?

17
New cards

thiazides/CCBs alone or in combo

For black patients with HTN and DM without CKD what is our treatment plan?

18
New cards

ACEI/ARB alone or in combo with another drug class

For all patients with HTN and CKD without DM, what is the treatment plan

19
New cards

thiazides, ACEI, ARBs, CCB

What are 1st line therapies for HTN - generally additive?

20
New cards

Chlorthalidone (thalitone), Indapamide (lozol), HCTZ

What are the thiazides used for HTN?

21
New cards

Benazepril (lotensin), lisonpril (prinivil, zestril), captopril

What are some of the ACEI are used for HTN?

22
New cards

telmisartan (Micardis), Losartan (Cozaar)

What are some of the ARBs used for HTN?

23
New cards

amplodipine (Norvasc - DHP), Verapamil (Calan, Isoptin - NDHP)

What are some of the CBBs used for HTN?

24
New cards

depression, gout

Beta blockers might worsen which conditions

25
New cards

Ease it in

If we are going to use beta-blockers like labetalol, atenolol, carvedilol, or metoprolol tartate what do we need to do for the patient?

26
New cards

beta blockers, K+ sparing diuretics, loop diuretics, central alpha 2 agonist, blood vessels dilator

2nd line treatments for HTN

27
New cards

labetolol, hydralazine, Nifedipine ER, methyldopa

What drugs are safe to use for HTN with pregnancy?

28
New cards

requires 3+ drugs

When should we refer our HTN peeps to a specialist like a nephrologist, cardiologist, endocrinologist, or IM?

29
New cards

losing weight, reducing salt intake, DASH diet, self-monitoring/appointment reminders, co-management with pharmacist, treating OSA, exercise, reducing EtOH intake, stop smoking

What are some lifestyle modifications HTN patients can make that kinda help?

30
New cards

age at onset, severity, abrupt nature of onset, family history

What are some red flags for secondary HTN?

31
New cards

chronic kidney disease

What is the most common cause of secondary hypertension?

32
New cards

primary aldosteronism

What is the second most common cause of secondary hypertension?

33
New cards

coarctation of the aorta, cushings, drug induced, obstructive uropathy, Pheo, renovascular HTN, sleep apnea, thyroid/parathyroid

What are some of the other causes for secondary HTN?

34
New cards

Do they have DM? estimate GFR, renal US, elevated serum creatinine/abnormal

How can we screen for Renovascular disease?

35
New cards

24 hr urine checking for VMAs, plasma fractionated metanephrines

How do you screen for pheos?

36
New cards

24 hr urinary aldosterone, unexplained hypokalemia, serum aldosterone:renin ratio

How do you screen for primary aldosteronism?

37
New cards

dexamethasone suppression test, 24 hour urine cortisol levels

How does one screen for Cushing’s syndrome?

38
New cards

sleep study

How does one screen for sleep apnea?

39
New cards

CT angiography, HTN in upper extremities, diminished/delayed femoral pulses, low/unobtainable arterial blood pressures

How are we screening for coartaction of the aorta?

40
New cards

TSH

How do we screen for thyroid issues?

41
New cards

Serum PTH, calcium

How do we screen for hyperparathyroidism?

42
New cards

They demanded the blood but get damaged by the increase in pressure

How are the kidneys both the victim and the culprit of secondary HTN due to renal parenchyma disease?

43
New cards

Diabetic nephropathy, glomerulonephritis, Hypertensive renal disease, drug induced renal disease, polycystic kidney disease

What are some of the possible causes for renal parenchyma disease that leads to secondary HTN?

44
New cards

narrowing of one or both renal arteries

On a U/S positive for renovascular disease (renal artery stenosis) what are you going to see?

45
New cards

atherosclerosis, fibromuscular dysplasia

What might cause renal artery stenosis?

46
New cards

rising creatinine after initiation of ACE inhibitor therapy

What is usually considers a sign of potential bilateral renal artery stenosis?

47
New cards

accelerates atherosclerosis and impairs baroreceptors, impaired blood flow leads to impaired renal perfusion

How might a coartation of the aorta increase BP?

48
New cards

systolic HTN UE vs. LE, rib notching on CXR, reduced femoral pulses

What are some of the classic findings for coarctation of the aorta?

49
New cards

episodic HA, sweating, tachycardia, paroxysmal HTN

What is the classic triad of a PHEO

50
New cards

Cushing syndrome

What is a rare cause of secondary hypertension due to too many glucocorticoids (ACTH)?

51
New cards

excessive metabolic activity leads to cardiac hyperactivity and increased blood volume (usually just increases systolic)

Why does hyperthyroidism lead to secondary hypertension?

52
New cards

Uncertain, maybe related to fluid retention (usually diastolic)

Why does hypothyroidism lead to secondary hypertension?

53
New cards

Usually due to hypercalcemia which is associated with an increased prevalence of hypertension, potential coexisting renal dysfunction

Why does hyperparathyroidism lead to secondary hypertension?

54
New cards

no clear cause-effect relationship

Why does sleep apnea lead to secondary hypertension?

55
New cards

estrogen, steroids, cyclosporines, EPO, sympathmimetics, alcohol, cocaine, meth

What are some medications that can lead to secondary hypertension?

56
New cards

treat the underlying disorder (start noninvasive)

How are we treating secondary hypertension?

57
New cards

hypertensive crisis

refers to a clinical situation when a patient’s bp is severely elevated (over 180/120 mmhg)

58
New cards

Hypertensive urgency

Hypertensive crisis with no obvious damage

59
New cards

hypertensive emergency

hypertensive crisis with obvious damage and evidence of impending/progressive target organ damage

60
New cards

uncontrolled essential hypertension, secondary hypertension

What is the main cause of hypertensive crisis?

61
New cards

asymmptomatic, HA, epistaxis, faintness

What are some of the symptoms associated with hypertensive emergencies

62
New cards

accelerated-malignant hypertension, hypertensive encephalopathy

Other names for hypertensive crisis

63
New cards

repeated BPs (consider an A line), fundoscopy, cardiopulmonary status, clinical volume status, neurologic status, vascular/pulse exam

What are some physical exam tools we can use in our diagnostic eval for hypertensive crisis

64
New cards

HA, vision changes, GI complaints, chest pain, dyspnea, neurologic deficit, stroke like symptoms, acute pulmonary edema, encephalopathy, cerebral hemorrhage

What are some S/S seen with hypertensive crisis that are evidence of impending organ damage?

65
New cards

electrolytes, renal function tests, UA, EKG

What labs are we ordering for a hypertensive crisis?

66
New cards

avoid rapid BP drops, do it at a rate the patient can tolerate

What are some basic rules of the road for hypertensive crisis?

67
New cards

ICU admit, parenteral meds, continuous cardiac monitoring, art line,

What will patients with true hypertensive emergencies will require

68
New cards

increase the dose, add another agent, start the meds again in non-adherent patients

How do you manage patients with true hypertensive urgencies and previously treated HTN

69
New cards

foresemide, clonidine, captopril

Oral Meds for HTN urgencies (goals is less than 160/100)

70
New cards

labetalol (most common), captopril, clonidine, nitroprusside, nicardipine

What medications are we using for ER level HTN crisis (I better see no oral meds in this house)?

71
New cards

nifedipine (drops too fast)

What med are we NOT going to use for HTN emergencies?

72
New cards

aortic dissection, acute hypertensive pulmonary edema, acute sympathetic crisis, MI, neurologic emergencies

What are some complications for hypertensive emergencies?

73
New cards

morphine, labetalol (#1), esmolol

What meds can be used for aortic dissection?

74
New cards

nitro (1st line), nicardipine

What meds are we using for acute hypertensive pulmonary edema?

75
New cards

lorazepam, diazepam (decrease sympathetic drive)

How are we treating acute sympathetic crisis (coke and meth abuse)?

76
New cards

Nitro (unless its RV - watch yo self), metoprolol

How are we treating MIs?

77
New cards

Get the head CT (HTN could be a protective measure)

How are we treating neurological emergencies with HTN emergencies?