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Summary NR667 / NR 667 VISE STUDY GUIDE (LATEST UPDATE)

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1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision. Look for these clinical findings to rule out organ damage: Microvascular  Eyes (HTN retinopath ...

1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision. Look for these clinical findings to rule out organ damage: Microvascular  Eyes (HTN retinopathy): AV nicking (causes when arteriole crosses on top of vein), papilledema  Kidneys: microalbuminuria and proteinuria, elevated serum creatinine and abnormal eGFR, peripheral or generalized edema Macrovascular  Heart: S3 (CHF), S4 (LVH), carotid bruits, decreased or absent peripheral pulses  Brain: TIA or hemorrhagic stroke Assessment/Exam:  Asymptomatic  Occipital headache  Blurry vision  Headache upon wakening  Exam of optic fundi: Look for AV nicking, hemorrhage, papilledema  LVH (long standing HTN)  Perform exam of symmetrical pulses  Auscultate for Carotid bruits, abdominal bruits, and kidney bruits Diagnostic studies: EKG, fasting lipid profile, fasting blood glucose, TSH, CXR to R/O cardiomegaly. CBC, CMP, and urinalysis. Measure BP 5 minutes apart. Assess the patients 10- year risk for heart disease (ASCVD) Diagnosis: > 140/90 mm Hg start on B/P medication. Pharmacologic Management:  FIRST LINE DIURETIC: Hydrochlorothiazide (HCTZ) 25 mg/day (max 50mg/day) *May worsen gout and elevate lipids and glucose  ALTERNATIVE CCB: Amlodipine besylate 5 mg /day. (Watch for lower extremity edema)  ACE: lisinopril 10mg/day complicated HTN first line  Consider ACE/ARB in patient with DM, proteinuria, HF. CONTRAINDICATED IN PREGNANCY  If stage 2, initiate 2 drug classes (Diuretic & CCB most effective in African American) Follow up:  2-4weeks Referral:  Cardiology if EKG is abnormal Secondary HTN causes to consider:  CKD, renal artery stenosis, hyperthyroidism, phenochromocytoma, OSA, coartication of the heart (SBP higher in the legs), oral contraceptives, corticosteroids, cocaine, NSAID, decongestants Differential:  Secondary hypertension  White coat syndrome  Pregnant  Pregnancy induced hypertension Education:

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