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Cardio 18: Clinical Hypertension
Terms in this set (34)
Primary vs. Secondary Hypertension
1. What is the difference
2. What are indicators of secondary hypertension
1. Primary or Essential is most common 90-95% and has unclear etiology
-secondary is due to a drug resistance
2. Drug-resistant, abrupt onset, less than 30, excessive hypokalemia, accelerated hypertension
1. What are some common causes?
2. Uncommon Causes?
1. Renal parenchymal disease - kidney damage, renovascular disease - altered blood supply, primary aldosteronism, Obstructive sleep apnea - hidden clue you should screen for
2. Uncommon causes are
-pheochromocytoma, cushing's hypo/hyperthyroid, aortic coarctation, mineralocorticoid excess
String of beads on angiography. Common in females - is a form of renovascular secondary hypertension
RAAS Review Picture:
Explain the RAAS and it's components/organs/signlaing molecules/enzymes
What are some risk factors for hypertension?
1. family history
3. Sleep Apnea
4. Prengnayc induced HTN/preeclampsia
5. Psychological Stress
6. Socioeconomic/education status
What are some modifiable Risk Factors of Hypertension
4. sodium intake
5. Diabetes mellitus
6. Physical inactivity
1. What evidence suggests ASCVD
1. Peripheral vascular, carotid artery disease, AAA, Coronary artery disease
Stages of Blood Pressure
Give the Ranges
3. Stage 1
4. Stage 2
What are some demographic factors associated with hypertension risk?
4. How do African Americans present with Hypertension
4. Younger onset, more severe, greater target organ damage
1. How do you calculate Pulse Pressure
2. What happens with age on PP? Why?
1. SBP-DBP = pule pressure
2. Widens...Arteries become stiffer, the artery itself will harden and the systolic pressure will go higher since artery does not expand, but diastole will be lower since Arteries are not contracting
Severe Hypertension Stages
1. What is the BP value for severe hypertension
2. What is the difference between hypertensive urgency vs. Hypertensive emergency
3. What do you look for in the eyes?
1. Higher than 180/120
2. Urgency is without end organ dysfunction, emergency is with end organ dysfunction
3. Papilladema - loss of defination of optic disk
Most common cause of death due to hypertension...
Myocardial infarction/coronary artery disease
How does Hypertension cause a CVA (cerebrovascular accident)?
1. Ischemic strokes with restriction of blood flow, or you can have hemorrhaging due to rupturing aneurysms or blood vessels
Consequences of Hypertension: Left Ventricular Hypertrophy/Cardiomyopathy
1. How can you tell LVH by listening? How does this sound occur?
2. How can you tell cardiomyopathy by listening? How does this sound occur
1. 4th Heart sound (S4)-atrial gallop during late diastole - atria are contracting into a non compliant ventricle
2. 3rd Heart Sound (S3)
-ventricular gallop, occurs during early diastole/passive ventricular filling
1. Hypertension commonly causes what Rhythm on an EKG?
2. What type of Rhythm is this?
1. Atrial Fibrillation
2. Irregularly irregular heart beat
1. How does Hypertension affect the kidney over time?
2. what molecule will you find in urine during renal failure?
1. Chronic Renal Failure
2. Protein (Creatinine)
1. How can Hypertension severely affect the abdominal aorta?
1. abdominal aortic aneurysm or aortic dissection
How to appropriately measure BP
1. 2-3 x in both arms (use higher reading
2. Patient seated, proper posture (feet on floor, upright)
3. 5 minutes of rest
4. Bare arm/supported limb
5. Correct size cuff
6. Silence, no cell phone
Transient Elevators of BP
3. Physical Activity
4. Full Bladder
What lab tests should be ordered to evaluate hypertensive patients?
What is in the DASH diet?
Veggies, fruits, whole grains
Legumes, non tropical vegetable oils and nuts
limit sweets, and red meats
no alcohol or very little
What ions are important to decrease risk of HTN?
Where are these electrolytes found
1. K+ --> fruits and vegetables
2. Ca2++ --> Low Fat Dairy
3. Mg++ --> Whole grains/plant
What is the value range for a sodium restricted diet for Prevention?
1. <2,400 MG/DAY IS GOOD
2. <1,500 MG/DAY IS BEST
Alcohol consumption increases the risk of what....
How does Obesity independently raise the risk of Hypertension?
1. BMI rises, need more perfusion
2. Sal-sensitivty is increased through rise in insulin level
-along with Na Retention and catecholamine level increase
Treatment Goals for Hypertension per stage
3. Stage 1
4. Stage 2
1. Normal BP assess every 1 year
2. Elevated - make lifestyle changes, reassess 3-6 months
3. Stage 1 -
without ASCVD change lifestyle,
with ASCVD - lifestyle, meds, 1 month
4. Stage 2
-lifestyle, meds, 1 month until it's controlled
Alogrithm for Hypertension Tx
Long-Term Care BP Target
1. Known ASCVD
2. No ASCVD
1. less than 130/80
2. 130/80 is reasonable
Primary meds for Hypertension Tx
5. What two should you never use together?
1. ACE inhibitors
2. Angiotensin Receptor Blockers
3. Thiazide Diuretics
4. Calcium Channel Blockers
5. ACE inhibitors and Angiotensin Receptor Blockers
Secondary Meds for Hypertension Treatment
1. Beta Blockers
2. Alpha -1 blockers
3. Combined Alpha/Beta
4. Loop and K-Sparing diuretics
Stage 1 vs. Stage 2
Stage 1 - one medication
Stage 2 - 2 medications
African Americans Most Effective drug for BP
1. Thiazide diuretics or Calcium Channel Blockers
-HTN is more resistant and severe
Ischemic Heart Disease Treatment Drugs
1. ACE/ARB and beta-blockers are first line
2. can use Dihydropyridine CCB's, thiazide, mineralcorticoid receptor antagonists
HTN Treatment in CKD
1. ACE preferred
2. then go to ARB
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