CM- Cardio -3- Treating HTN CHAN
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| What is the most common primary dx in the US | hypertension
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| Why is hypertension so bad | Relationship between BP and risk of CVD is continuous, consistent, and independent of other risk factors
The higher the BP, the higher the chance of heart attack, heart failure, stroke, and kidney disease
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| What are the benefits of controlling HTN | stroke incidence reduces 35-40%
MI incidence decreases 20-25%
Heart Failure reduced by more than 50%
one death in 11 will be prevented from stage 1 HTN and cardiovascular risk factors
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| What are the three objectives when evaluation your patient for HTN | asses lifestyl and ID cardiovascular risk factors or concomitant disorders
-reveal indentifiable cause of BP
-Assess presence or absence of target organ damage and CVD
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| What are some key questions from the history to help evaluate for cardiovascular risk factors | Do you smoke
Are you active
High Cholesterol
Diabetes
FX of premature CVD
age
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| what other disease processes can impact HTN | sleep apnea
chornic kidney disease
primary aldosteronism
Renovascular disease
Chronic Steroid Therapy and Cushings synd
Pheo
Coarctation of the aorta
Thyroid or parathyroid disease
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| What should you always check in diabetics and HTN patients that you may not always do in all patients because your not an ophthalmologist | Fundoscopy to look at optic disc
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| During the PE what should you check in HTN | Measure BP
Check Optic Fundus
Calculate BMI
Auscultate
-pulses
-heart
-lungs
Palpate
-thyroid
-abdomen
-pulses
-LE for edema
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| What labs may be useful in HTN patient | EKG
UA
FBS
K
BUN/Creatinine
Calcium
Lipid profile
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| What is the appropriate measure of BP in office | use AUSCULTORY meathod with Calibrated cuff
sit quietly for 5 min in a chair
arm at heart level
appropriate sized cuff
2 measurements
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| what is ambulatory blood pressure monitoring | B/P monitor that patient wears throughout the day this lets you see the average blood pressure of the person over the day
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| Why is ambulatory blood pressure monitoring useful | lets you dx borderline hypertension
Correlates better with patients actual B/P because less white coat artifact present
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| What are you supposed to see in diurnal blood pressure rhythm | B/P should drop while the person is asleep and then go up when they wake up
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| what is meant by a non-dipper | person who has an abnormal dirunal pattern of b/p where the b/p actually raises during sleep rather than dropping
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| when do you normally see peak pressure in blood | 6am
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| what does non dipping correlate to | increased risk of CVD
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| when should you start b/p therapy w/ measurements from amublatory vs office checkups | when daily b/p average is 135/85 or nightly b/p is 120/75 with ambulatory measurements
office when b/p is 140/90 or greater
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| why would you want a patient to do self measurement of blood pressure | it can improbe adherence with therapy
helpful in evaluating white coat hypertension
to avoid medicating based on abnormal b/p from office readings
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| if your patient is diabetic when should you start hypertension treatment vs non diabetic patient | 130/85 for diabetics vs 140/90 for non diabetics
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| What b/p is considered prehypertension | bp is 120-139/80-89
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| what b/p is considered hypertension stage 1 | b/p is 140-159/90-99
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| what b/p is considered hypertension stage 2 | b/p is >160/>100
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| IF patient is prehypertensive what actions should you take | encourage patient to make lifestyle modifications
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| If your patient is in stage 1 hypertension category what should you do | encourage lifestyle modifications
prescribe
-thiazide diuretic
may consider ACEI, ARV, BB, CCB, or combo
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| If your patient is in stage 2 hypertension category what should you do | Encourage lifestyle modification
prescribe- two-drug combination
thiazide + ACEI or ARB or BB or CCB
other antihypertensive drugs as needed
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| What are the goals in tx hypertension | reduce mortality and morbidity
get a stable b/p below 140/90 in non diabetsc
130/80 in diabetics or renal compromised
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| What lifestyle modifications are you going to recomment in patients with hypertension | weight reduction
DASH (dietary approach to stop hypertension)
restrict dietary sodium
aerobic physical exercise
reduce alcohol cosumption
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| generally what is your first drug of choice to combat hypertension | thiazides
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| what are the compelling factors in hypertension that may indicate you may want more drug therapy to treat the compelling factors as well as the hypertension | heart failure, postmyocardial infarction, high CAD risk, diabetes, chronic kidney disease,
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| What initial therapy options would you use for heat failure with hypertension | thiaz, bb, acei, arb, or aldo ant
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| What initial therapy options would you possibly use for post mi w/ hypertension | bb, acei, aldoant
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| if patient has high CAD (coronary artery disease) risk w/ hypertension what drugs would you likely start them on | thiaz, bb, acei, ccb
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| If you patient is diabetic and has hypertension what drugs will you usually use to start therapy | thiaz, bb, acei, arb, ccb
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| IF our patient has chronic kidney disease what drugs would you use to treat their hypertension | start with acei, arb
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| if patietn has recurrent stroke prevention and hypertension what drug do you want to start therapy with for the hypertension | thiaz, acei
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| what do you need to account for in minority populations when treating for hypertension | African Americans have reduced BP response to monotherapy with BBs, ACEIs, or ARBS compared to diuretics or CCBs
should consider starting cotherapy of diuretic with bb, ACEI, or ARB
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| what is one favorable effect in using thiazide diuretics to control hypertension | increase Ca+ and slows demineralization in osteoporosis
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| apart from hypertension what else can BBs help with | useful for atrial tachyarrhythmias, fibrillation, migraine, thyrotoxicosis (short term), essential tremor, or perioperative HTN.
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| Apart from HTN what else can CCBs be useful for | Raynaud's syndrome and certain arrhythmias
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| If you were using alpha-blockers for HTN what other benefits do Alpha-blockers give | useful for prostatism
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| What is a negative to using thiazides | caution in gout or history of hyponatremia
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| When should you probably avoid BBs for HTN | patient has asthma, reactive airway disease, second or third degree heart block
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| When should you not use ACEI or ARBs for HTN | contraindicated in pregnant women or those likely to become pregnant
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| Apart from pregnancy when else wouldn't you use ACEIs | don't use if patient has hx of angioedema
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| What should you be aware of if using AlDO ANT or potassium sparing diuretics to treat HTN | these can cause hyperkalemia so monitor for s/sx of it
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| What treatments for HTN in diabetics acutually help prevent diabetic nephropathy progression and reduce albuminuria | ACEI and ARB
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| IF your patients B/P is resistant to therapy what may be something you want to check | adherence/compliance with therapy
dose may be to low titrate up
check if taking NSAIDS, Elicite drugs, sympathomimetics, licorice, birth control or chewing tobacco
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