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What perecentage of people w/ stroke, MI, CHR have antecedent hypertension
> 70%
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73.6 million in US have HTN. What percentage of these are aware? treated? controlled?
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What percentage of deaths are related to HTN?
1/5
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Prehypertension
120-39/ 80-89
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Stage 1 HTN
140-159/90-99
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Target BP for diabetes
<130/80
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Target BP for Left Ventricular Dysfunction
<120/80
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Reduction in BP by how many points:
Wt. loss
DASH Diet
Sodium Restriction
Alcohol Reduction
- Wt. loss: 5-20
- DASH Diet: 8-14
- Sodium Restriction: 2-8
- Alcohol Reduction: 2-4
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DASH Diet
Fruits and vegetables, low fat dairy, reduce cholesterol, rich in potassium and calcium
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USDA recommends less than ____mg sodium/day. For at risk population less than ____ mg/day
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Stage 1 HTN tx:
- Thiazides
- Consider adding ACEI, ARB, BB, CCB, or combo
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Stage 2 HTN tx
Two-drug combo; thiazide and ACEI (or ARB, BB, CCB)
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Resistant hypertention
Hypokalemia
Alkalosis
Suppressed PRA
Excessive aldosterone production
Primary Hyperaldosteronism
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Plasma aldo: PRA
>75
Aldosterone producing adenoma
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Plasma aldo: PRA
20-75
Bilateral zona glomerulosa hyperplasia
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Plasma aldo: PRA
<20 essential hypertension
essential hypertension
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Caucasians > AA
Unilateral of bilateral renal ischemia
Causes: Atherosclerosis, fibromuscular dysplasia, or uncommon (external compression, thrombosis, vasculitis)
RAAS dependent renal perfusion
Renal artery stenosis
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Fibromuscuar dysplasia
- Young caucasian women
- Most common medially (85%)
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Atherosclerosis
- Older men
- Tobacco smoke exposure
- Associations: Sever HTN retinopathy, sys-dias bruit, generalized atherosclerosis, recurrent pulmonary edema
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Worsening of renal failure after ACEI or ARB
Atherosclerosis
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What is the strongest risk factor fo systolic or diastolic dysfunction?
HTN
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Impaired LV relaxation
Diastolic dysfunction
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Signs and symptoms of classic sys heart failure w/ or w/o sys LV dysfunction
Diastolic dysfunction
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Symptoms of Diastolic dysfunction
- 1) DOE, reduced exercise tolerance
- 2) Resting dypsnea and orthopnea later
- 3) PND (Paroxysmal Nocturnal Dypsnea) late
- 4) Pulmonary edema is common
- 5) Exacerbated by anemia, fever, sepsis, and tachycardia
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Diastolic Dysfunction tx
- CCB, BB
- Diuresis,Aggressive BP control
- Evaluation for CAD
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