NR 667 VISE STUDY
GUIDE
1. Hypertension (HTN)
Presentation
Often asymptomatic
Possible symptoms:
Occipital headaches (especially in the morning)
Blurred vision
Dizziness
Signs of target organ damage:
Microvascular: AV nicking, papilledema
Macrovascular: S3 or S4 heart sounds, LVH on EKG, carotid bruits, absent peripheral
pulses, neurological deficits (stroke)
Diagnostics
,Confirm diagnosis: BP ≥ 130/80 mmHg on ≥ 2 separate occasions
Tests:
Fundoscopic exam
EKG (look for LVH)
Lipid profile
Fasting glucose / HbA1c
TSH
CMP, CBC, urinalysis (proteinuria)
ASCVD risk calculation
Chest X-ray (if cardiac enlargement suspected)
Management
Lifestyle: DASH diet, sodium < 2 g/day, weight loss, 150 min/week moderate activity,
limit alcohol (≤ 1 drink/day women, ≤ 2 drinks/day men), avoid
NSAIDs/decongestants if possible
Pharmacologic therapy:
First-line agents:
Thiazide diuretics (e.g., Hydrochlorothiazide 25 mg daily, max 50 mg)
, CCBs (e.g., Amlodipine 5 mg daily) – watch for peripheral edema
ACE inhibitors (e.g., Lisinopril 10 mg daily) – avoid in pregnancy, monitor potassium
& creatinine
ARBs if ACE intolerant
Stage 2 HTN (≥ 140/90): Usually start with combination therapy
African American patients: Thiazide + CCB preferred
Secondary causes: CKD, renal artery stenosis, hyperthyroidism, hypothyroidism,
Cushing’s syndrome, pheochromocytoma, sleep apnea, certain medications (OCPs,
steroids, NSAIDs, decongestants)
2. Hyperlipidemia
Screening
Adults ≥ 20 y: lipid panel every 4–6 years if low risk; more often if high risk
Goals
LDL < 100 mg/dL (optimal)
High-intensity statin if LDL ≥ 190 mg/dL, or age 40–75 with diabetes, or 10-year
ASCVD risk ≥ 7.5%
Management
Lifestyle: Reduce saturated/trans fats, increase soluble fiber & plant sterols, exercise,
smoking cessation
GUIDE
1. Hypertension (HTN)
Presentation
Often asymptomatic
Possible symptoms:
Occipital headaches (especially in the morning)
Blurred vision
Dizziness
Signs of target organ damage:
Microvascular: AV nicking, papilledema
Macrovascular: S3 or S4 heart sounds, LVH on EKG, carotid bruits, absent peripheral
pulses, neurological deficits (stroke)
Diagnostics
,Confirm diagnosis: BP ≥ 130/80 mmHg on ≥ 2 separate occasions
Tests:
Fundoscopic exam
EKG (look for LVH)
Lipid profile
Fasting glucose / HbA1c
TSH
CMP, CBC, urinalysis (proteinuria)
ASCVD risk calculation
Chest X-ray (if cardiac enlargement suspected)
Management
Lifestyle: DASH diet, sodium < 2 g/day, weight loss, 150 min/week moderate activity,
limit alcohol (≤ 1 drink/day women, ≤ 2 drinks/day men), avoid
NSAIDs/decongestants if possible
Pharmacologic therapy:
First-line agents:
Thiazide diuretics (e.g., Hydrochlorothiazide 25 mg daily, max 50 mg)
, CCBs (e.g., Amlodipine 5 mg daily) – watch for peripheral edema
ACE inhibitors (e.g., Lisinopril 10 mg daily) – avoid in pregnancy, monitor potassium
& creatinine
ARBs if ACE intolerant
Stage 2 HTN (≥ 140/90): Usually start with combination therapy
African American patients: Thiazide + CCB preferred
Secondary causes: CKD, renal artery stenosis, hyperthyroidism, hypothyroidism,
Cushing’s syndrome, pheochromocytoma, sleep apnea, certain medications (OCPs,
steroids, NSAIDs, decongestants)
2. Hyperlipidemia
Screening
Adults ≥ 20 y: lipid panel every 4–6 years if low risk; more often if high risk
Goals
LDL < 100 mg/dL (optimal)
High-intensity statin if LDL ≥ 190 mg/dL, or age 40–75 with diabetes, or 10-year
ASCVD risk ≥ 7.5%
Management
Lifestyle: Reduce saturated/trans fats, increase soluble fiber & plant sterols, exercise,
smoking cessation
