NR 667 VISE Assignment
-No known cause in 90% of cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal artery stenosis, Cush
Etiology: Hypertension syndrome, hyper/hypo thyroidism, increased ICP, sleep apnea, oral
contraceptives, steroids, cocaine, NSAIDs, decongestants, sympathomimet
alcohol, antidepressants, caffeine
-Modifiable: smoking, DM, high cholesterol, obesity (single most important
factor in children), physical inactivity, poor diet, excessive sodium intake,
Risk Factors: Hypertension excessive alcohol consumption
-Non-modifiable: CKD, family hx, increased age (>55 men, > 65 women), low
socioeconomic status, low educational status, male sex, OSA, stress, pregn
-Most are asymptomatic; occipital headache, headache upon waking, blurr
vision, fundoscopic exam (AV nicking, exudates, papilledema), left vent.
Assessment: Hypertension
hypertrophy, pregnancy w/HTN and proteinuria, edema, and excessive we
gain
-Secondary HTN, white coat HTN (artificial elevation d/t medical environm
Differential Diagnosis: Hypertension
anxiety)
, NR 667 VISE Assignment
-Urinalysis = proteinuria
-Electrolytes, creatinine, calcium
-Fasting lipid profile and BS
Final Diagnosis: Hypertension
-ECG
-Measure BP twice, 5 mins apart
-Patient should be seated; use proper cuff size and application
-Maintaining healthy weight and BMI
-Smoking cessation
-Regular aerobic exercise
Prevention: Hypertension -Alcohol in moderation (< 1 oz/day)
-Stress management
-Medication compliance
-Assess for and treat OSA
, NR 667 VISE Assignment
-Stage 1: Risk score < 10% =lifestyle modification
-Stage 2: lifestyle + medication
-DASH eating plan: high fruit, veggies, grains; low fat dairy, fish, poultry, be
nuts
-Reduce dietary sodium to 2,300mg/day, increase K+
Non-pharm management: Hypertension
-Reduce sat. fat intake
-Body weight reduction; 1kg of weight reduction = 1 mm/hg bp reduction
-150 mins of aerobic exercise and/or 3 sessions of isometric resistance per
-Treat other underlying diseases
-Check bp 2x/week during pregnancy
-Start medication for primary prevention of CVD if pt. has ASCVD risk ≥ 10%
stage 1 HTN or if ASCVD is < 10% with bp >140/90
-Stage 2: start 2 bp-lowering medications
Pharmacological management: -African Americans: 2+ medications recommended; thiazide and CCBs are t
Hypertension most effective
*DO NOT use ACE and ARB concurrently
-Beta blockers are NOT first line
-Thiazides, CCBs, ACEIs, and ARBs can be used alone or in combo
-Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine)
Pregnancy considerations: Hypertension
-AVOID ARBs and ACEIs
, NR 667 VISE Assignment
-Inquire about adherence and any side effects
Follow-up: Hypertension
-Reassess monthly until patient reaches goal, then every 3-6 months as nee
-Only 54% of treated patients are at goal treatment; expect complications i
Expected course: Hypertension under treated
-Most patients require more than one medication to reach goal bp
-Stroke, CAD, MI, renal failure, heart failure, eclampsia (seizures), pulmonar
Possible Complications: Hypertension
edema, hypertensive crisis, hypertensive retinopathy, ED
-Inherited disorder, high dietary intake, obesity, sedentary lifestyle, DM,
hypothyroidism, anabolic steroid use, hepatitis, cirrhosis, uremia, nephrotic
Etiology: Hyperlipidemia
syndrome, stress, drug-induced (thiazide diuretics, beta blockers, cyclospo
alcohol, caffeine, metabolic syndrome
-Family history, physical inactivity, smoking, age (men > 45, women > 55 or
Risk factors: Hyperlipidemia premature menopause without estrogen replacement), obesity, diet high in
fat, DM
-Few physical findings; xanthomata (fat deposits in the skin), xanthelasma (y
Assessment findings: Hyperlipidemia plaques on the eyelid), corneal arcus prior to age 50 (arc of cholesterol aro
the iris), bruits, angina pectoris, MI, stroke
Differential diagnosis: Hyperlipidemia -Secondary causes: hypothyroidism, pregnancy, DM, non-fasting state
-No known cause in 90% of cases of primary HTN
-Secondary causes: renal failure, kidney disease, renal artery stenosis, Cush
Etiology: Hypertension syndrome, hyper/hypo thyroidism, increased ICP, sleep apnea, oral
contraceptives, steroids, cocaine, NSAIDs, decongestants, sympathomimet
alcohol, antidepressants, caffeine
-Modifiable: smoking, DM, high cholesterol, obesity (single most important
factor in children), physical inactivity, poor diet, excessive sodium intake,
Risk Factors: Hypertension excessive alcohol consumption
-Non-modifiable: CKD, family hx, increased age (>55 men, > 65 women), low
socioeconomic status, low educational status, male sex, OSA, stress, pregn
-Most are asymptomatic; occipital headache, headache upon waking, blurr
vision, fundoscopic exam (AV nicking, exudates, papilledema), left vent.
Assessment: Hypertension
hypertrophy, pregnancy w/HTN and proteinuria, edema, and excessive we
gain
-Secondary HTN, white coat HTN (artificial elevation d/t medical environm
Differential Diagnosis: Hypertension
anxiety)
, NR 667 VISE Assignment
-Urinalysis = proteinuria
-Electrolytes, creatinine, calcium
-Fasting lipid profile and BS
Final Diagnosis: Hypertension
-ECG
-Measure BP twice, 5 mins apart
-Patient should be seated; use proper cuff size and application
-Maintaining healthy weight and BMI
-Smoking cessation
-Regular aerobic exercise
Prevention: Hypertension -Alcohol in moderation (< 1 oz/day)
-Stress management
-Medication compliance
-Assess for and treat OSA
, NR 667 VISE Assignment
-Stage 1: Risk score < 10% =lifestyle modification
-Stage 2: lifestyle + medication
-DASH eating plan: high fruit, veggies, grains; low fat dairy, fish, poultry, be
nuts
-Reduce dietary sodium to 2,300mg/day, increase K+
Non-pharm management: Hypertension
-Reduce sat. fat intake
-Body weight reduction; 1kg of weight reduction = 1 mm/hg bp reduction
-150 mins of aerobic exercise and/or 3 sessions of isometric resistance per
-Treat other underlying diseases
-Check bp 2x/week during pregnancy
-Start medication for primary prevention of CVD if pt. has ASCVD risk ≥ 10%
stage 1 HTN or if ASCVD is < 10% with bp >140/90
-Stage 2: start 2 bp-lowering medications
Pharmacological management: -African Americans: 2+ medications recommended; thiazide and CCBs are t
Hypertension most effective
*DO NOT use ACE and ARB concurrently
-Beta blockers are NOT first line
-Thiazides, CCBs, ACEIs, and ARBs can be used alone or in combo
-Can use beta blockers (labetalol), methyldopa, CCBs (nifedipine)
Pregnancy considerations: Hypertension
-AVOID ARBs and ACEIs
, NR 667 VISE Assignment
-Inquire about adherence and any side effects
Follow-up: Hypertension
-Reassess monthly until patient reaches goal, then every 3-6 months as nee
-Only 54% of treated patients are at goal treatment; expect complications i
Expected course: Hypertension under treated
-Most patients require more than one medication to reach goal bp
-Stroke, CAD, MI, renal failure, heart failure, eclampsia (seizures), pulmonar
Possible Complications: Hypertension
edema, hypertensive crisis, hypertensive retinopathy, ED
-Inherited disorder, high dietary intake, obesity, sedentary lifestyle, DM,
hypothyroidism, anabolic steroid use, hepatitis, cirrhosis, uremia, nephrotic
Etiology: Hyperlipidemia
syndrome, stress, drug-induced (thiazide diuretics, beta blockers, cyclospo
alcohol, caffeine, metabolic syndrome
-Family history, physical inactivity, smoking, age (men > 45, women > 55 or
Risk factors: Hyperlipidemia premature menopause without estrogen replacement), obesity, diet high in
fat, DM
-Few physical findings; xanthomata (fat deposits in the skin), xanthelasma (y
Assessment findings: Hyperlipidemia plaques on the eyelid), corneal arcus prior to age 50 (arc of cholesterol aro
the iris), bruits, angina pectoris, MI, stroke
Differential diagnosis: Hyperlipidemia -Secondary causes: hypothyroidism, pregnancy, DM, non-fasting state
