Term
|
Definition
| end organ damage, coronary artery disease, heart attack, stoke, peripheral vascular disease, retinopathy, liver problems |
|
|
Term
| ethnic group most affected by hypertension |
|
Definition
|
|
Term
| for every 20/10 mmHg increase in BP... |
|
Definition
| double risk of cardiovascular mortality, 4 fold up another 20/10 and 8 fold up another 20/10 (small increases in BP can cause significant increase in cardiovascular risk) |
|
|
Term
| what are the benefits of lowering blood pressure |
|
Definition
| reduce stroke incidence by 35-40%, reduce MIs by 20-25%, reduce heart failure by 50%, and reduce renal failure by 35% to 50% |
|
|
Term
| hypertension diagnosis requires |
|
Definition
|
|
Term
|
Definition
| too big of a cuff will lower, too small will elevate |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| to rule out secondary causes of HTN, screen for |
|
Definition
|
|
Term
|
Definition
| >40/high risk, annually. 18-39 w/o risk factors 3-5 years |
|
|
Term
| to assess for peripheral vascular disease |
|
Definition
|
|
Term
| to assess carotid or aorta w HTN |
|
Definition
|
|
Term
|
Definition
| 24 hr urine or creatinine |
|
|
Term
|
Definition
|
|
Term
| lifestyle modifications for HTN |
|
Definition
| weight loss, for every lb 1mmHg, healthy diet, dec sodium intake, physical activity,<2 drinks/day for men <1drink/day for women |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| standard drop in BP from medications |
|
Definition
| 9-10mmHg (thiazides, beta blockers, ace inhibitors) |
|
|
Term
| when to start BP medications? |
|
Definition
| anyone w BP >140/90 or if >80 >160/90 |
|
|
Term
| nonblack or Caucasian HTN treatment |
|
Definition
| thiazide-type diuretic, or ACE or ARB or calcium channel blocker alone or in combo (never give ACE and ARB together) |
|
|
Term
| black or African American HTN treatment |
|
Definition
| thiazide-type diuretic or calcium channel blocker alone, if they have CKD w/wo diabetes should be on ACE or ARB alone or in combo |
|
|
Term
| drug if HTN and history of heart failur |
|
Definition
| beta blocker or ACE inhibitor |
|
|
Term
|
Definition
|
|
Term
|
Definition
| add ACE or ARB early on bc renal protective |
|
|
Term
|
Definition
|
|
Term
|
Definition
| don't put on potassium-sparing diuretic |
|
|
Term
| HTN and pregnancy or renal artery stenosis treatment |
|
Definition
|
|
Term
| non-dihydro calcium blockers contraindicated in |
|
Definition
| heart block or systolic heart functon, has neg inotropic affect-worsens heart failure |
|
|
Term
| beta blockers contraindicated in |
|
Definition
| second and third degree heart block, certain asthmatic patients, depression |
|
|
Term
| alpha blockers contraindicated in |
|
Definition
|
|
Term
| some causes of secondary hypertension |
|
Definition
| alcohol ingestion, obesity, prenancy, coarctation of the aorta, endocrine diseases, renal diseases, certain medications- oral contraceptives, anabolic steroids, corticosteroids, NSAIDS-cause sodium retention, renal diseases |
|
|
Term
| when to think secondary etiology for HTN |
|
Definition
| new onset <25 or >55, severe 180/110 or higher, sudden onset, not responding to treatment |
|
|
Term
| praoxysmal small attacks of hypertension with palpitations pale or perspiration, or tremor |
|
Definition
| pheochromocytoma (secondary) |
|
|
Term
| Multiple system complaints on initial evaluation, asymmetry of peripheral pulses |
|
Definition
| coarctation of aorta (secondary) |
|
|
Term
| abdominal bruit indicates |
|
Definition
| possible renal artery stenosis (secondary) |
|
|
Term
|
Definition
| could be kidney mass or kidney tumor (secondary) |
|
|
Term
| lab tests that can indicate secondary causes |
|
Definition
| hyperglycemia, hypokalemia, hypercalcemia- evidence of end-organ damage |
|
|
Term
| the most common correctable cause of secondary hypertension |
|
Definition
| renovascular hypertension, unilateral or bilateral0 causes activation of renin-angiotensin system. 2 major causes: fibromuscular dysplasia (string of beads in renal arteries, more in young females) and atherosclerosis. look for elevated renin levels |
|
|
Term
| most common cause of renovascular hypertension |
|
Definition
| atherosclerosis, generally >50 proximal portion of renal arteries and other arteries in the body, causes activation of renin-angiotensin system due to dec renal perfusion (causes elevation in your renin, your angiotensin II, and aldosterone) |
|
|
Term
| clinical manifestations of atherosclerosis |
|
Definition
| refractory or malignant hypertension, episodes of flash pulmonary edema, significant rise in creatinine w the use of drugs that blocked the renin-angiotensin system, elevated renin and aldosterone, maybe a secondary aldosteronism |
|
|
Term
| diagnostic testing for atherosclerosis |
|
Definition
| renal ultrasound w doppler studies to look for renal artery stenosis. maybe CT or MRI or percutaneous catheter placement to measure intravascular pressure. but usually initial eval is to check renin, aldosterone and serum creatinine |
|
|
Term
| treatment for atherosclerosis |
|
Definition
| first line: anti-hypertensive meds, renin-angiotensin blocking agents, calcium channel blockers or diuretics, revascularization in pts w refractory HTN, worsening renal funciton, or flash pulmonary edema. can do angioplasty w or w/o stenting, surgical revascularizaiton may be indicated in complicated cases |
|
|
Term
| renal parenchymal hypertension |
|
Definition
| hypertension almost always present w moderate to severe renal failure, results from positive soidum balance, inc in renin-angiotensin activity, and overactivity of the sympathetic nervous system |
|
|
Term
| treatment for renal parenchymal hypertension |
|
Definition
| salt restriction/diet, renin-angiotensin blocking agents or ACE inhibitors or ARBS, beta blockers (slows sympathetic nervous system), dialysis |
|
|
Term
|
Definition
| primary aldosteronism, Cushing's pheochromocytoma, some renin-secreting tumors, hyperthyroidism, acromegaly |
|
|
Term
|
Definition
| produced in adrenal glands, physiologic stimulation of aldosterone through angiotensin 2 can lead to hypokalemia. aldosterone inc's BP by inc sodium retention in teh kidneys, direct vasoconstricxtion and upregulation via CNS of sympathetic nervous system (want to use aldosterone blockers to lower BP) |
|
|
Term
|
Definition
| classic primary hyperaldosteronism, get unregulated aldosterone release from adrenal gland leading to refractory hypertension, hypokalemia and a metabolic acidosis. aldosterone plasma renin activity ratio should be greater than 25 to 1, confirm by repeating test after salt loading, do CT scan bc can be a tumor inside the adrenal gland, do renal vein sampling to determine if unilateral or bilateral. surgery is only effective treatment in pts w unilateral disease. drug of choice is spironolactone for aldosterone competitive inhibition, calcium channel blockers and ACE inhibitors can be helpful |
|
|
Term
|
Definition
| glucocorticoid excess from adrenal gland due to overproduction of Acth from pituitary adenoma, problem w central obesity- buffalo hump (fat pad in between scapula and back), abdominal strae or markings on abdomen, moon like faces, hirsuitism and easy bruising |
|
|
Term
| testing for cushing's syndrome and treatment |
|
Definition
| dexamethasone suppression test- give dexamethasone which in a normal pt would shut down cortisol production bc now have a substitute but in Cushing's will still produce cortisol, elevated cortisol after this test is a pos. treatment is to remove the adenoma |
|
|
Term
|
Definition
| rare neuroendocrine tumor that produces catecholamine- production of norepinephrine, epinephrine, and dopamine, mostly adrenal gland 90% benign tumors. get persistent HTN w headaches, sweating, flushing, tachycardia, palpitations due to the sudden release of catecholamines (fight/flight). can be triggered by trauma. measure free catecholamine metabolites, can look for norepinephrine or adrenaline, CT scan or MRI. treatment is to surgically remove the tumor |
|
|
Term
|
Definition
| extremely rare tumors of the kidney |
|
|
Term
|
Definition
| excessive growth hormone in somebody who's already had their long bones fused from a pituitary adenoma -> sodium retention and HTN. enlargement of jaws, wide spacing between teeth. hands, hat, shoe size get bigger, skull gets bigger |
|
|
Term
|
Definition
| elevated thyroid hormone released from thyroid gland leads to stimulation of the sympathetic nervous system and HTN. test to screen is TSH |
|
|
Term
|
Definition
| recurrent episodes of apnea during sleep leads to hypoxia and hypercapnia -> frequent arousals from sleep (dozens every hr), HTN due to activation of sympathetic nervous system during these awakenings. suspect in pts who snore, have thick necks, are obese, or report daytime sleepiness. diagnosis w sleep study. treatment is CPAP (continuous positive airway pressure) |
|
|
Term
|
Definition
| congenital narrowing of the aortic lumen, often just distal to the left subclavian vein. HTN noted in upper extremities w reduced BP in lower extremities, >10mmHg difference, feel for delayed femoral pulse compared to radial pulse, diagnose w aortic imaging- CT or MRI |
|
|
