Screening and Diagnosis
Age USPSTF recommends starting HTN screening in adults
18
Diabetes, HLD, Smoking, Increased age, physical inactivity, unhealthy diet
Lifestyle and CV risk factors
The duration a pt must sit quietly before measuring the blood pressure
5 minutes
First line therapy in management of newly diagnosed stage 1 HTN
Lifestyle modification
Can cause hyponatremia especially in older adults
Diuretics
*first line therapy in medication management of HTN
A pt with this has chronically higher blood pressure readings with no underlying identifiable cause
Essential hypertension
The 5 organs usually affected with poorly controlled HTN
Heart
Brain
Kidneys
Blood vessels
Eyes
Heart level
Goal blood pressure for patients with HTN
<130/80 mmHg
Contraindicated in pt with hx of gout
Thiazides - because they can cause a state of hyperuricemia
High blood pressure readings only in a health care setting
White coat hypertension
The three goals when evaluating a pt for possible HTN
1) assess for end organ disease
2) assess for cardiovascular risk factors/concomitant disorders
3) consider evaluation for secondary causes
Fundoscopic exam
Refer to specialist after failure to achieve blood pressure goal despite this amount of drug regimen
three-drug regimen
*some family physicians feel comfortable treating with 4 anti-HTN
Contraindicated in pt with hx of angioedema
ACEi or ARBs
*if pt has history of angioedema with an ACEi, can receive ARB beginning 6 weeks after ACEi is discontinued
Number of readings (and how far apart) needed to accurately diagnose someone with hypertension
Two readings at least 5 minutes apart
Presence of cotton-wool spots, flame hemorrhages, and exudates on PE
Hypertensive retinopathy
Labs to assess for CV risk factors (and what you are looking for)
Lipid Panel - HDL, LDL, triglycerides,
BMP - creat, fasting blood glucose, K, Na, Calcium
TSH - hypo/hyper-thyroidism
EKG - LVH
Echo - heart failure
Reduces systolic blood pressure by ~11mmHg
DASH eating plan
Combining these two classes of drugs can worsen kidney function and increase risk of hyperkalemia
ACEi and ARBs
Phenomena where the left arm blood pressure is diminished relative to the right arm blood pressure.
Bonus: why is this important?
Coarctation of the aorta
Left subclavian artery originates distal to coarctation and subsequent pulse differentials. This is why it is important to measure blood pressure (initially) in each arm.
Stress causes release of these two substances which can cause high blood pressures
cortisol and norepinephrine
Important prognostic factor for death in EVERYONE regardless of HTN
left ventricular hypertrophy
Appropriate if HTN increases in severity or has poor response to treatment
Testing for Secondary cause
Associated with does-related pedal edema
Calcium channel blockers