Primary Hypertension Risk Factors
- Excessive Alcohol Consumption
 - High Sodium Diet
 - Dyslipidemia
 - Obesity
 - People of African Descent
 - Advanced Age
 - Vitamin D Deficiency
 - Reduced Nephron Number
 - Diabetes
 - Lack of Physical Activity
 
Hypertension Assessment
- Essential Hypertension
 - Secondary Hypertension
 - Headache
 - Vision Changes
 - Nosebleed (Epistaxis)
 - Chest Pain
 - Syncope (Fainting)
 - Average 2 Sets, 2 Minutes Apart
 - After 2 or More Visits (within 1-4 weeks)
 - Take BP Both Arms
 - Common in African Americans
 
Blood Pressure Classification (JNC 7)
- Normal
 - Systolic (<120)
 - Diastolic (< 80)
 - Prehypertension
 - Systolic +20 (120-139)
 - Diastolic +10 (80-89)
 - Stage 1 Hypertension
 - Systolic +20 (140-159)
 - Diastolic +10 (90-99)
 - Stage 2 Hypertension
 - Systolic + > 20 (160)
 - Diastolic + > 10 (100)
 - Hypertensive Crisis
 - Systolic > 180
 - Diastolic > 110
 
Blood Pressure Classification (ACC/AHA 2017)
- Normal
 - Systolic Less than 120
 - Diastolic Less than 80
 - Elevated
 - Systolic +10 (120-129)
 - Diastolic Less than 80
 - Stage 1 Hypertension
 - Systolic +10 (130-139)
 - Diastolic +10  (80-89)
 - Stage 2 Hypertension
 - Systolic +40 (140-179)
 - Diastolic +30 (90-119)
 - Hypertensive Crisis
 - Systolic greater than or equal to 180
 - Diastolic greater than or equal to 120
 
Hypertension Management (JNC-8)
- Age Over 60 years (and Healthy)
 - 150/90
 - Age Under 60 years (and Healthy)
 - Any Age with Diabetes or CKD
 - 140/90
 - ARB/ACE-I/Thiazide/CCB (Primary or Combo)
 - CKD (w/wo Diabetes)
 - ARB or ACE-I Primary
 - African American
 - Thiazide or CCB Primary
 
Hypercholesterolemia Disease
- Diabetes
 - Smoking
 - Family History
 - Hypertension
 - HDL < 40
 - Men Older than 45 Years of Age
 - Women Older than 55 Years of Age
 - Atheromas
 - Plaques in Blood Vessel Walls
 - Tissue Ischemia
 - Xanthomas
 - Lipemia Retinalis
 
Hypercholesterolemia Risk Stratification
- 0 - 1 Risk Factors
 - < 160 mg/dl LDL goal
 - greater or equal to 2 Risk Factors and 10-year Risk ≤ 20%
 - < 130 mg/dL LDL Goal
 - Coronary Heart Disease OR >/= to 2 Risk Factors AND 10-Year Risk > 20%
 - < 100 mg/dL LDL Goal
 
Hypercholesterolemia Treatment
- Lifestyle Modifications  (Diet, Exercise, Smoking Cessation)
 - Statins
 - Niacin
 - Ezetimibe
 - Fibrates
 - Bile Acid Resins
 - PCSK9 Inhibitors
 - Omega 3 Fatty Acids
 - Pooled Cohort Test
 
Metabolic Syndrome
- Dyslipidemia
 - Central Obesity
 - Insulin Resistance
 - Hypertension
 - Increased C-Reactive Protein (CRP)
 - Increased Fibrinogen
 - Increased Risk Cardiovascular Disease
 
Peripheral Artery Disease (PAD)
- Atherosclerosis
 - Intermittent Claudication
 - Pain with Exercise
 - Paresthesias
 - Arterial Ulcers
 - Critical Limb Ischemia
 - Amputation
 - Ankle-Brachial Index (ABI)
 
Abdominal Aortic Aneurysm (AAA) Assessment
- Atherosclerosis
 - Bruit
 - Pulsation in Abdomen
 - Abdominal or Lower Back Pain
 - Tearing Pain
 - Ultrasound
 - Rupture
 - Shock
 - Surgical Repair
 
Gestational Hypertension
- New-Onset Hypertension
 - > 20 Weeks Gestation
 - Nulliparity
 - Obesity
 - African American Females
 - > 35 years Old
 - Multiple Gestations
 - Family History of Gestational HTN (or Preeclampsia)
 - IUGR
 - Prematurity
 - Abruptio Placentae
 - Fetal Monitoring
 -  Alpha-Methyldopa
 -  Beta-Blockers (Labetalol)
 - Calcium Channel Blockers
 - Hydralazine
 
Subarachnoid Hemorrhage
- Bleeding into Subarachnoid Space
 - Trauma
 - Aneurysm Rupture
 - AVM Rupture
 - Vasospasm causes Ischemia
 - "Worst Headache Of My Life"
 - Noncontrast Head CT
 - Lumbar Puncture
 - Angiography
 - Surgery
 - Blood Pressure Control
 - Intracranial Pressure Control
 - Nimodipine for Vasospasm Prophylaxis
 
Abdominal Aortic Aneurysm
- Screen Males 65-75 Who've Ever Smoked
 - Ultrasound
 - Observation
 - Screen Males 65-75 Who've Ever Smoked
 - Surgical Repair
 - > 5.5 cm in Abdomen
 - Emergent Surgery
 - Ruptured or Symptomatic
 
Cardiac Tamponade
- Fluid in the Pericardial Sac
 - Pericarditis
 - Decreased Cardiac Output
 - Beck's Triad
 - Hypotension
 - Jugular Venous Distention (JVD)
 - Distant Heart Sounds
 - Pulsus Paradoxus
 - Electrical Alternans
 - Pericardiocentesis
 
Dysbetalipoproteinemia (Type III Familial Dyslipidemia)
- Autosomal Recessive
 - Defective Apolipoprotein E (Apo E)
 - Increased Chylomicrons
 - Increased VLDL
 - Premature atherosclerosis
 - Tuberoeruptive xanthomas
 - Palmar xanthomas
 
Hypertriglyceridemia (Type IV Familial Dyslipidemia)
- Autosomal Dominant
 - Hepatic Overproduction of VLDL
 - Related to Insulin Resistance
 - Increased VLDL
 - Increased Triglycerides (> 1000 mg/dL)
 - Acute Pancreatitis
 - Eruptive Xanthomas
 - Increased Risk for Coronary Artery Disease (CAD)
 - Increased Risk of Peripheral Vascular Disease
 
Hyperchylomicronemia (Type I Familial Dyslipidemia)
- Autosomal Recessive
 - Lipoprotein Lipase Deficiency (LPL)
 - Altered Apolipoprotein C-II (Apo C-II)
 - Increased Chylomicrons
 - Increased Cholesterol
 - Increased Triglycerides
 - Pancreatitis
 - Hepatosplenomegaly
 - No Increased Risk for Atherosclerosis
 - Eruptive/Pruritic Xanthomas
 - Milky White Appearance of Blood When Drawn
 
Familial Hypercholesterolemia (Type IIa Familial Dyslipidemia)
- Autosomal Dominant
 - Defective or Absent LDL Receptors
 - Defective Apolipoprotein B-100 (ApoB-100)
 - Increased LDL
 - Decreased HDL
 - Type IIb also has Increased VLDL
 - Accelerated Atherosclerosis
 - Achilles Tendon Xanthomas
 - Xanthelasma
 - Corneal Arcus
 
Abetalipoproteinemia
- Autosomal Recessive
 - Deficiency of Apolipoproteins B-48 and B-100
 - MTTP Gene Mutation
 - Malabsorption
 - Steatorrhea
 - Failure to Thrive
 - Ataxia
 - Retinitis Pigmentosa
 - Spinocerebellar Degeneration
 - Lipid-Laden Enterocytes
 - Acanthocytes
 - Decreased Cholesterol and LDL
 - Vitamin E (Alpha-Tocopherol)
 
Arteriolosclerosis
- Small Arteries and Arterioles
 - Thickening of Arteriole Wall
 - Hyperplastic
 - Smooth Muscle Cell Hyperplasia
 - "Onion Skin" Appearance
 - Malignant Hypertension
 - Hyaline
 - Subendothelial Protein Deposits
 - Chronic Hypertension
 - Diabetes Mellitus
 - Aging
 
Central Retinal Artery Occlusion
- Atherosclerosis
 - Atrial Fibrillation
 - Giant Cell (Temporal) Arteritis
 - Sudden Painless Monocular Vision Loss
 - Descending Curtain
 - Retinal Plaques
 - Grayish Retinal Discoloration
 - Cherry Red Spot on Macula
 - Ultrasound
 - Ocular Massage
 - Reduce Intraocular Pressure
 
Thoracic Aortic Aneurysm
- Elderly Men
 - Above the Diaphragm
 - Usually Asymptomatic
 - Hypertension
 - Smoking
 - Connective Tissue Disorders
 - Vasculitis
 - Chest X-Ray
 - Chest CT Angiography
 - Manage Risk Factors
 - Surgery if Rupture or Dissection
 - Observation if Asymptomatic
 
Hypertensive Retinopathy
- Chronic Hypertension
 - Flame Hemorrhages
 - Arteriovenous Nicking
 - Retinal Microaneurysms
 - Cotton Wool Spots
 - Macular Star
 - Papilledema
 - Lower Blood Pressure
 
Abdominal Aortic Aneurysm Rupture
- Acute Tearing Pain
 - Pulsatile Abdominal Mass
 - Grey Turner Sign
 - Cullen Sign
 - Hypovolemic Shock
 - Diagnosis by Clinical Impression
 - Emergent Surgical Intervention
 - Poor Prognosis
 
Aortic Dissection
- Tear in Aortic Intima
 - Stanford Classification
 - Type A: Tear of Ascending Aorta
 - Type B: Tear of Descending Aorta
 - Hypertension
 - Aortic Aneurysm
 - Marfan Syndrome
 - Chest Pain
 - Blood Pressure Difference Between Arms
 - Mediastinal Widening
 - Surgery for Type A
 - Beta Blockers for Type B
 
Central Retinal Vein Occlusion
- Hypercoagulability
 - Hypertension
 - Diabetes Mellitus
 - Non-Ischemic
 - Mild to Moderate Vision Loss
 - Sparse Dot-blot and Flame Hemorrhages
 - Ischemic
 - Sudden, Painless Vision Loss
 - "Blood and Thunder" Appearance
 - Cotton Wool Spots
 - Papilledema
 - Observation if Non-Ischemic
 - Laser Photocoagulation
 - VEGF Inhibitors
 
Hyperlipoproteinemia (Type V Dyslipidemia)
- Increased Cholesterol
 - Increased VLDL
 - Increased Chylomicrons
 - Increased Triglycerides
 - Increased Risk of Cardiovascular Disease
 - Xanthomas
 - Acute Pancreatitis
 - Lipid Panel
 - Lifestyle Changes
 - Statins
 - Fibrates
 
Hypertensive Emergency Diagnosis and Management
- Laboratory Tests
 - Chest X-ray
 - Decrease Blood Pressure Carefully 
 - Antihypertensives
 - Monitor Vital Signs
 
Hypertensive Emergency Characteristics and Presentation
- Acute Increase in Blood Pressure
 - ≥ 180/120
 - End-Organ Dysfunction
 - Stroke
 - Hypertensive Retinopathy
 - Acute Heart Failure
 - Myocardial Infarction
 - Acute Kidney Injury