Card Set Information
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
What is the breaking age when female have a higher % of htn?
what race has the highest percent of htn?
what is the major determinant of SBP?
what is the major determinant of DBP?
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
What is essential htn?
indentifying exact underlying abnormality not usually possible
with a variety of contributors
peripheral autoregulatroy components
vascular endothelial mechanisms
electrolytes and other chemicals
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
What are the neuronal regulation mechanisms?
B1 inc rate and contractility
A2 inhibitory effect on the vasomotor center to decrease BP
(Ang II increases outflow from vasomotor center)
What are the DZ that cause secondary HTN?
coartation of the aorta
Obstructive sleep apnea
What are the drug that cause secondary HTN?
Ma Huang, other herbals
Some Heavy Metals
What is htn a strong predictor of?
What are the risk factors CV dz?
Microalbuminuria grf <60
Age 55men 65women
What are the target organ damage of htn?
heart dz,(mi, coronary revascularization,hf, left ventricular hypertrophy
peripheral artieral dz
What are the goal bp?
60 and older?
59 and younger?
What are the dz states that should have bp <130/80
according to American heart association
What are the lifestyle modification?
increase aerobic physical activity
reduce na intake
maintain adequate K
maintain catt mgtt
reduce dietary saturate fate and cholesterol
What are the medications that are first line tx for htn?
Tell me about the thiazide diuretics
HCTZ, chlorthalidone, indapamide, metolazone
moa Distal tubule, reduces peripheral vascular resistnace
: dec Na, K, Mg, Water
inc Ca uric acid glucose, lipids, photosensitivity
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
What is considered the backbone of antihypertensive regimens in previous JNC?
When should thiazides be avoided?
low CrCl (which ones are preferred in low CrCl?)
Avoid high dose in hyperlidiemia and DM
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
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
What is acei place in therapy?
first line in most pts
dec mortality in DM type I, II, CHF
also appropriate in hypertensive nephropathy
When should acei be avoided?
bilateral renal artery stenosis
use caution in
: renal insufficiency (can tolerate SCr of 0.5mg/dL to 1
What is arb place in therapy?
typically utilized in those intolerant to acie
When should you avoid arbs
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
When should ccb be avoided?
: bb, possibly contribute to CHD,