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What is the definition of hypertension?
Hypertension is blood pressure over 140 over 90 on at least 2 or more occasions
What is the definition of prehypertension?
Prehypertension is defined as a blood pressure between 120 over 80 and 140 over 90
What are some of the risk factors for hypertension?
Risk factors for hypertension include old age, smoking, being a male, being African American, being obese, having a family history of hypertension, having a diet that is high in sodium, drinking, and constantly being stressed out
What is the definition of essential hypertension?
Essential hypertension is hypertension with no underlying cause. Most cases of hypertension are essential hypertension.
What are some of the causes fo secondary hypertension?
Secondary hypertension can be caused be renovascular disease such as renal artery stenosis, or renal disease, by a pheochromocytoma, from Cushing's, thyroid abnormalities, too much aldosterone, aortic coarctation, or as a side effect of drugs
When should be secondary hypertension be considered?
In a patient with new onset hypertension who is either very young or very old, if there is no family history, if it has a very rapid onset, or if the hypertension is refractory to numerous medications and lifestyle changes
What are some of the cardiovascular complications of untreated hypertension?
Untreated hypertension can result in diastolic heart failure, coronary artery disease, and ventricular hypertrophy
What are some of the cerebrovascular complications of untreated hypertension?
What are some of the vascular complications of hypertension?
What are the renal complications of hypertension?
What are some of the eye changes associated with hypertension?
AV nicking, flame hemorrhages, cotton wool spots, and potential blindness
What are the 7 P's of pheochromocytoma?
Pallor, pounding headache, perspiration, pyrexia, pressure elevations, and postural symptoms
In order to accurately measure a patients blood pressure how long do they need to be seated before taking the measurement?
At least 5 minutes
What should be done in a physical exam for hypertension?
There should be a full cardiovascular exam listening for heart sounds, bruits over the carotid and renal arteries, peripheral vascular exam, and an eye exam
What are the initial laboratory tests that should be done for a patient with newly diagnosed hypertension?
Serum creatinine, potassium, and glucose, a lipid profile, UA, and EKG
If a patient has a combination of hypertension and hypokalemia what should be suspected?
What ratio of aldosterone to plasma renin is consistent with primary hyperaldosteronism?
A ratio greater than 20 is suggestive of primary hyperaldosteronism
What is the main cause of primary hyperaldosteronism?
An adrenal adenoma
How is a pheochromocytoma diagnosed?
Generally by looking at levels of plasma metanephrines followed by urinary catecholamines and metanephrines
What are the goals for blood pressure with treatment in a patient with uncomplicated hypertension?
Blood pressures below 140/90
What are the goals for blood pressure with treatment in a patient with complications of hypertension?
Blood pressures below 130/80
What is the difference between a hypertensive urgency and a hypertensive emergency?
A hypertensive urgency is blood pressure greater than 180 over 120, and a hypertensive emergency is a blood pressure greather than 180 over 120 with signs of end organ damage
What are some of the types of problems that are associated with a hypertensive emergency?
Hypertensive encephalopathy, intracranial hemorrhage, myocardian infarction, flash pulmonary edema, and aortic dissection
What are the treatments of choice for hypertensive emergency?
IV antihypertensive medications such as labetalol, nicardipine, nitroprusside and fenoldepam.
What is the definition of stage 1 hypertension?
Blood pressure between 140 and 160 over 90 to 100
What is the first initial management in a patient with prehypertension or stage 1 hypertension?
Lifestyle changes such as losing weight, exercising more, reducing salt in the diet, quitting smoking, and cutting back on stress and alcohol intake
In a patient with stage 1 hypertension, when should medications be started in addition to lifestyle changes?
If the patient is still symptomatic after 6 months with lifestyle changes
What is the initial first line treatment for hypertension?
What is the first line anti-hypertensive agent in patients with diabetes, kidney disease, and cardiovascular disease?
ACE inhibitors or ARBS
What are the first line agents for primary hyperaldosteronism?
Aldosterone antagonists such as spironolactone or eplirinone
In patients with cardiovascular disease what is a common adjunct antihypertensive agent?
What are all the categories of antihypertensive medications?
Diuretics, beta blockers, calcium channel blockers, vasodilators like hydralazine, alpha 2 agonists like clonidine, alpha blockers like terazosin and prazosin, and aces and arbs
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