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LS test 2, BP, HTN

Blood Pressure and HTN notes

QuestionAnswer
What is the BP range for NORMAL classification? SBP: <120mmHg and DBP: <80mmHg
What is the BP range for PREHYPERTENSION classification? SBP: 120-139mmHg OR DBP: 80-90mmHg
What is the BP range for STAGE I HYPERTENSION classification? SBP: 140-159mmHg and DBP: 90-99MMhG
What is the BP range for STAGE II HYPERTENSION classification? SBP: > OR = 160 and DBP: > OR = 100
The risks of developing this increases with obesity Hypertension, DMII, Coronary heart disease, Gallbladder disease, Certain cancers, Dyslipidemia, Stroke, Osteoarthritis, Sleep apnea
Definition of Obese BMI>30
Evaluate these things when determining Absolute Risk Status Disease conditions, Other obesity-associated diseases, Cardiovascular risk factors, other factors
How does Physical Activity impact comorbidities? Enhances cardiorespiratory Fitness, Improves lipid profile, Reduces BP, Increass insulin sensitivity, Improves blood glucose control.
What is a realistic Goal for weight loss Short-term: 5-10% weight loss, 1-2 lbs/week.
Which diet has been shown to be most effective?Lowfat/low cal/low carb? All the same in the long term. Overall: lower calories is key.
Sibutramine (Meridia) (PO) Weight loss drug that works by inhibiting norephinephrine, dopamin and serotonin reuptake. (SE: Increase in heart rate and BP)
Orlistat (Xenical) (PO) Weight loss drug that inhibits pancreatic lipase, decreass fat absorption. SE: decreased vitamin absorption, soft stools, anal leakage)
What is JNC7? Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Created for publication of many new studies, need for a new, clear and concise guideling useful for clinicians. Need to simplify classification of BP.
What is the initial drug therapy for most persons with HTN? Thiazide-type diuretics (HCTZ)
If BP is >20/10mmHg above goal, what should you prescribe? Initiate with two agents, one of which should be Thiazide diuretic.
How should you manage a patient with a blood pressure of 125/85? Patient is PREHYPERTENSIVE. 1) Treat as the signal for need of increased education to reduce BP and prevent HTN.
What are the benefits of lowering BP? Reduces stroke incidence, MI and Heart failure.
Name CVD Risk Factors. HTN, smoking, obesity, physical inactivity, dyslipidemia, DMII, microalbuminuria or estimated GFR <60ml/min, Age (older than 55 for men, 65 for women), Family Hx of premature CVD.
What are identifiable causes of HTN? Sleep apnea, Drug-indused, Chronid kidney disease, primary aldosteronism, Renovascular disease, Chronic steroid therapy, Cushing's syndrome (overproduction of cortisol), Pheochromocytoma, coarctation of the aorta, Thyroid or parathyroid disease.
When would you screen for SECONDARY CAUSES of HTN? With abrupt onset, for a person with family Hx, when BP >210/140, no response to medication, with symtoms.
Name symptoms of Cushing's. truncal obesity, facial plethora, abdominal striae, proximal muscle thinning and weakness, buffalo hump, moon facies
Name symptoms of Primary aldosteronism. Weakness, polyuria, polydipsia and muscle pain.
Name symptoms of Pheochromocytoma. Flushing, diaphoresis, paroxysmal headache, palpatations.
Name sympoms of Hyperthyroidism. Heat intolerance, excessive sweating, increased appetite, weightloss.
Name the steps of the HTN work-up. Rule-out secondary causes, determine severity of pressure elevation, determine degree of target-organ damage, determine presenc eof cardiovascular risk factors.
How do you test for Cushing's (secondary cause)? 24h urine for free cortisol.
How do you test for Primary Hyperaldosteronism. If hypokalemia, get ratio of plasma aldosterone to plasma renin.
How do you test for Phochromocytoma? 24h urine for catecholamines if abnormal CT scan of adrenals.
How do you test for Hyperthyroidism? Thyroid function tests.
Name the target organ damage by HTN. Heart: LVH, angina, MI, coronary revascularization, heart failure. Brain: Stroke or TIA. Chronic kidney disease. Peripheral arterial disease. Retinopathy.
Name routine laboratory tests for someone with HTN. EKG, UA (for protein, glucose), Blood glucose, HCT, serum potassium, creatinine, or GFR, Lipid profile after fast. Urinary ablumin or albumin/creatinine ratio.
What are the goals of therapy for HTN? Reduce CVD and renal morbidity and mortality. Treat to BP<140/90, or BP<130/80 in patients with DM or Chronic kidney disease. Achieve SBP goal especially in persons >50 years.
Name lifestyle modifications for controlling HTN in order of effectiveness. Losing weight, DASH diet, salt reduction, Physical activity, moderation of alcohol intake.
Besides Thiazide diuretic, what should be prescribed for a patient with HTN that also has DMII? ACE-I.
What are the Initial Therapy Options for HTN pt with Heart failure? Thiazide, BB, ACEI, ARB, Aldosterone antagonist
What are the Initial Therapy Options for HTN pt with Previous MI? BB, ACEI, Aldosterone antagonist
What are the Initial Therapy Options for HTN pt with High CAD? Thiazide, BB, ACE, CCB
What are the Initial Therapy Options for HTN pt with DM? Thiazide, BB, ACEI, ARB, CCB
What are the Initial Therapy Options for HTN pt with Chronic kidney disease? ACEI, ARB.
What are the Initial Therapy Options for HTN pt with recurrent stroke prevention? Thiazide, ACEI.
What are compelling indications for Beta Blockers? MI, Angina, Heart failure. *Not as effective as diuretics in lowering BP, but not as well tolerated. Negative effects on glucose and lipid metabolism are amplified when given with diuretic.
What are compelling indications for ACEI? First line for diabetes. Heart failure, MI, CAD, diabetic nephropathy, stroke prevention.
What are compelling indications for ARBs? ACEI intolerance, Type 2 diabetic nephropathy, HTN with LVH.
What are compelling indications for CCB? Elderly patients, Angina, Isolated systolic HTN.
Which HTN meds are contraindicated for Asthma/COPD patients? Betablockers.
Thiazide diuretics. Chlorothiazide (Diuril), Chrolothialidone, Hydrochlorothiazide (Microzide, HydroDiuril), Polythiazide (Renese), Indapamide (Lozol), Metolazone (Mykrox), Metolazon (Zaroxolyn)
Loop diuretics. Bumetanide (Bumex), Furosemide (Lasix), Torsemide (Demadex).
Potassium-sparing diuretics. Amiloride (Midamor), Triamterene (Dyrenium).
Aldosterone-receptor blockers. Eplerenon (Inspra), Spironolactone (Aldactone)
Beta blockers. Atenolol (Tenormin), Betaxolol (Kerlone), Bisoprolol (Zebeta), Metoprolol (Lopressor), Nadolal (Corgard), Propranolol (Inderal), Timolol (Blocadren)
ACE-I Benazepril(Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Prinivil, Zestril), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), etc.
Angiotensin II antagonists. Candesartan (Atacand), Eprosartan (Tevetan), Irbesartan (Avapro), Losartan (Cozaar), Olmesartan (Benicar), Telmisartan (Micardis), Valsartan (Diovan)
Calcium channel blockers--non-dihydropyridines Diltiazem, Verapamil
Calcium channel blockers--dihydropyridines Amlodipine, Felodipine, Isradipine, Nicardipine, Nifedipine, Nisoldipine.
Created by: kennjratzer
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