Hypertension: Another Way to Look at It

Tonight's talk was delivered by Tomi Jun, MS IV on the hypertension areas we can pay attention to specifically in the CCC clinic.

Hypertension cutoffs:

• Stage 1: >140/90
• Stage 2: >160/100

Method:

• 3 measurements, each 1 week apart.
• Consistent pattern.
• Be mindful of activity and white coat measurements.

Primary HTN: treating HTN directly

Secondary HTN: Blood pressure elevated because of secondary causes like a tumor that secretes epinephrine (rare case). The treatment is not to manage the BP but to remove the tumor.

When BP is >180/120:

• Hypertensive urgency: Regular checkup finding asymptomatic HTN. 
• Emergency: when people are showing symptoms like chest pain, altered mental status. If people have a high BP but asymptomatic we still want to send them to the ER.

What we are worried about

•  End organ damage
• Brain
• Heart
• Kidneys
• Vasculature
• Long term damage

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Atherosclerosis: 

• injury to vasculature. 
• plays role in other areas of HTN. 
•  Buildup over time leading to lack of oxygen or rupture
• Achemia and strokes occur. 
• Coronary artery disease occurs, which leads to...

Heart disease: 

• Heart attack leads to heart failure
• Left ventricular hypervole: thickening of left ventricle. The muscle gets bigger and stiffer as it pumps against high systemic resistance.

Kidney disease:

• HTN big risk factor for end stage renal disease --> dialysis. 
• HTN makes substances squeeze through kidney vessels, damaging them.

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Case 1:

• 50 yo F African American with obesity, HTN, DM.
• BP 150/90
• BMI 45.1
• 3 HTN meds: metropolol, losartan, chlotalidone
• Worried about: risk factors such as smoking and DM for kidney disease, heart failure, athero, and stroke.
• Think about changing metropolol to a medication that acts upon calcium channels.

JNC8 Guidelines:

• For people <60, goal is >150/90
• Previously 140/90 from JNC7
• Recently found that there is no additional benefit from goal of 140/90, which takes more meds to achieve.

Lifestyle modification:

• Weight reduction: every 10 kg lost can bring down diastolic BP by 20. 
• Cut dietary salt, reduce alcohol intake, exercise.

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What to ask:

• Meds adherence
• PMH
• Lifestyle (smoking, exercise, diet, alcohol)
• Symptoms (cardiac, neuro)

What to examine:

• Signs of heart failure
• Fundoscopy
• Labs
• basic metabolic panel
• kidney function
• electrolytes
• lipid profile
• urinalysis
• screen/eval DM
• Look for evidence of end-organ damage or other relevant risk factors.