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 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
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 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
Hypertension Intervention
- Weight Reduction and Exercise
- Diet Changes
- Relaxation Techniques
- Smoking Cessation
- Medications
- Encourage Self Monitoring
Hypertension Medications
- Diuretics
- ACE Inhibitors
- Angiotensin Receptor Blockers (ARBs)
- Beta Blockers
- Dihydropyridine Calcium Channel Blockers
Supine Hypotension (Vena Cava Syndrome)
- Compression of the Vena Cava and Descending Aorta
- Hypotension
- Dizziness
- Tachycardia
- Decreased Renal Perfusion
- Decreased Uteroplacental Perfusion
- Side-lying Position
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
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
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