CM- Cardio -3- Treating HTN CHAN

Question Answer
What is the most common primary dx in the US hypertension
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
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
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
What are some key questions from the history to help evaluate for cardiovascular risk factors Do you smoke
Are you active
High Cholesterol
FX of premature CVD
what other disease processes can impact HTN sleep apnea
chornic kidney disease
primary aldosteronism
Renovascular disease
Chronic Steroid Therapy and Cushings synd
Coarctation of the aorta
Thyroid or parathyroid disease
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
During the PE what should you check in HTN Measure BP
Check Optic Fundus
Calculate BMI
-LE for edema
What labs may be useful in HTN patient EKG
Lipid profile
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
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
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
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
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
when do you normally see peak pressure in blood 6am
what does non dipping correlate to increased risk of CVD
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
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
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
What b/p is considered prehypertension bp is 120-139/80-89
what b/p is considered hypertension stage 1 b/p is 140-159/90-99
what b/p is considered hypertension stage 2 b/p is >160/>100
IF patient is prehypertensive what actions should you take encourage patient to make lifestyle modifications
If your patient is in stage 1 hypertension category what should you do encourage lifestyle modifications
-thiazide diuretic
may consider ACEI, ARV, BB, CCB, or combo
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

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
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
generally what is your first drug of choice to combat hypertension thiazides
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,
What initial therapy options would you use for heat failure with hypertension thiaz, bb, acei, arb, or aldo ant
What initial therapy options would you possibly use for post mi w/ hypertension bb, acei, aldoant
if patient has high CAD (coronary artery disease) risk w/ hypertension what drugs would you likely start them on thiaz, bb, acei, ccb
If you patient is diabetic and has hypertension what drugs will you usually use to start therapy thiaz, bb, acei, arb, ccb
IF our patient has chronic kidney disease what drugs would you use to treat their hypertension start with acei, arb
if patietn has recurrent stroke prevention and hypertension what drug do you want to start therapy with for the hypertension thiaz, acei
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
what is one favorable effect in using thiazide diuretics to control hypertension increase Ca+ and slows demineralization in osteoporosis
apart from hypertension what else can BBs help with useful for atrial tachyarrhythmias, fibrillation, migraine, thyrotoxicosis (short term), essential tremor, or perioperative HTN.
Apart from HTN what else can CCBs be useful for Raynaud's syndrome and certain arrhythmias
If you were using alpha-blockers for HTN what other benefits do Alpha-blockers give useful for prostatism
What is a negative to using thiazides caution in gout or history of hyponatremia
When should you probably avoid BBs for HTN patient has asthma, reactive airway disease, second or third degree heart block
When should you not use ACEI or ARBs for HTN contraindicated in pregnant women or those likely to become pregnant
Apart from pregnancy when else wouldn't you use ACEIs don't use if patient has hx of angioedema
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
What treatments for HTN in diabetics acutually help prevent diabetic nephropathy progression and reduce albuminuria ACEI and ARB
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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