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What is hypertension defined as?
- untreated systolic pressure of 140mmhg or higher or a diastolic pressure of 90 mmhg or higher
- taking antihypertensive medication
- being told twice by a physician or other healthcare professional that one has htn
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What is the breaking age when female have a higher % of htn?
60 yo
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what race has the highest percent of htn?
black
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what is the major determinant of SBP?
CO
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what is the major determinant of DBP?
TPR
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What are the four components of blood pressure?
- SBP cardiac contraction
- DBP cardiac relaxation
- Pulse Pressure arterial wall tension
- Mean arterial pressure average pressure throughout the cardiac cycle
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What is essential htn?
- indentifying exact underlying abnormality not usually possible
- with a variety of contributors
- genetics
- humoral mechanisms
- neuronal regulations
- peripheral autoregulatroy components
- vascular endothelial mechanisms
- electrolytes and other chemicals
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What are the humoral mechanisms?
- RAAS (Renin-->angiotensinogen to angiotensin I --> Ang II = VC, stimulates aldosterone Na reabsorption, inc symp nervous system)
- Natriuretic Hormone (inhibits Na and K ATPas and interfers with na transport across cells membranes
- Insulin Resistance
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What are the neuronal regulation mechanisms?
- Stimulation of
- B1 inc rate and contractility
- B2 VD
- A1 VC
- A2 inhibitory effect on the vasomotor center to decrease BP
- (Ang II increases outflow from vasomotor center)
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What are the DZ that cause secondary HTN?
- CKD
- Cushing's syndrome
- coartation of the aorta
- Obstructive sleep apnea
- Parathyroid dz
- pheochromocytoma
- Primary aldosteronism
- Renovascular dz
- thyroid dz
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What are the drug that cause secondary HTN?
- Antidepressants
- Corticosteroid
- Cocaine
- Cyclosporine
- Cox inhibitors
- Estrogens
- Erythropoetin
- Ergots
- Ma Huang, other herbals
- NSAIDS
- PPA, PSE
- Sibutramine
- Some Heavy Metals
- Tacrolimus
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What is htn a strong predictor of?
- stroke
- nephropathy/ESRD
- CAD/MI
- CHF/LVH
- PVD
- retinopathy
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What are the risk factors CV dz?
- HTN
- Cigarette
- Obesity
- Physical inactivity
- Dyslipidemia
- Diabetes Mellitus
- Microalbuminuria grf <60
- Age 55men 65women
- Family history
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What are the target organ damage of htn?
- heart dz,(mi, coronary revascularization,hf, left ventricular hypertrophy
- stroke,tia
- nephropathy
- peripheral artieral dz
- retinopathy
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What are the goal bp?
60 and older?
59 and younger?
DM?
CKD?
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What are the dz states that should have bp <130/80
- CAD
- DM
- CKD
- Framingham >10%
- according to American heart association
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What are the lifestyle modification?
- lose weight
- limit alcohol
- increase aerobic physical activity
- reduce na intake
- maintain adequate K
- maintain catt mgtt
- stop smoking
- reduce dietary saturate fate and cholesterol
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What are the medications that are first line tx for htn?
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Tell me about the thiazide diuretics
- HCTZ, chlorthalidone, indapamide, metolazone
- moa Distal tubule, reduces peripheral vascular resistnace
- AE: dec Na, K, Mg, Water
- inc Ca uric acid glucose, lipids, photosensitivity
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What is thiazides place in tx?
- 1st line option
- considered good add on therapy to almost any other drug
- Indapamaide does not effect lipids
- Metolazone, indapamide work at low CrCl
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What is considered the backbone of antihypertensive regimens in previous JNC?
thiazide
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When should thiazides be avoided?
- low CrCl (which ones are preferred in low CrCl?)
- Gout
- Avoid high dose in hyperlidiemia and DM
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What are loop diuretic place in therapy?
- Most pronounced diuresis of all diuretics but short duration of action does not make ideal antihtn
- most effective for HTN in pts with renal impairment
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What is K sparing diuretics place in therapy?
- combination with thiazides to reduce effect on K
- Spironolactone drug of choice in pt with cirrhosis
- Avoid in renal insufficency
- Use caution when combining with ACei or other K sparing meds
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What is acei place in therapy?
- first line in most pts
- dec mortality in DM type I, II, CHF
- also appropriate in hypertensive nephropathy
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When should acei be avoided?
- bilateral renal artery stenosis
- prego
- use caution in: renal insufficiency (can tolerate SCr of 0.5mg/dL to 1
- volume depletion
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What is arb place in therapy?
typically utilized in those intolerant to acie
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When should you avoid arbs
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What is ccb place in therapy?
- DCCB are first line therapy
- well tolerated add on to other agents
- may be preferred over thiazide type diuretics in combo with acei
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When should ccb be avoided?
- with HF
- caution with: bb, possibly contribute to CHD,
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