Blood Pressure
| Normal | Elevated BP | Stage I HTN | Stage II HTN | HTN Urgency | HTN Emergency | |
| Blood Pressure | Systolic ≤120 Diastolic ≤ 80 | Systolic ≤130 Diastolic ≤ 80 | Systolic ≤ 140 Diastolic ≤ 90 | Systolic >140 Diastolic >90 | Systolic ≥ 220 Diastolic ≥ 120 | Systolic ≥ 220 Diastolic ≥ 120 PLUS end organ damage |
| Treatment | f/u in 1 year | lifestyle modifications and f/u in 6months | life style modifications and f/u in 3 months, or those with 10% risk use life style modifications + meds and f/u in 1 month | life style modifications + 2 meds and f/u in 1 month | IV meds then oral meds | Drip + ICU with 25% reduction of mean arterial pressure |
Lifestyle modifications
- Diet = <2.4g NaCl/day, DASH diet, K+ supplementation (citric fruits), ETOH termination
- Excersize = 30 ins/day, 2 hrs/wk
- Weight = Obese, overweight, BMI > 25
Blood Pressure Medications
| Side Effect | Note | ||
| Thiazides | decreases K+, decreases urinary Ca2+ excretion | + treatment for kidney stones | |
| Ace-i/ARBs | increase creatinine, increase K+, can cause cough or angioedema | Do not use ARBs after ACE-I angioedema, but ok to use after d/c for cough | |
| Calcium Channel Blocker | peripheral edema | + anti-anginal , not useful in heart failure with reserved ejection fraction | |
| Verapamil and Diltiazem | Rate control | can be used for Atrial fibrillation | |
| Beta-Blocker | decreased heart rate | Used for heart failure with reserved ejection fraction and CAD | |
| K+ Blockers | Spirnolactone/ Epleranone | increases K+, gynecomastia | primary and secondary hyperaldosteronism |
| Aortic Dilator | Hydralazine | Reflex tachycardia, drug induced lupus | CKD stage 5, use for CHF |
| Iso-sorbite denigrate | no nitrates with PDE 5 inhibitors | Anti-anginal medication | |
| Alpha agonist | orthostatic hypotension | BPH | |
| Central clonidine | rebound htn | can use transdermal patch to decrease rebound HTN instead of BID dosing |
Statin
- Pts need to be on statin if they meet the following:
- Labs before initiating statin:
- Labs f/u needed after initiating statin:
- STOP statin if:
Statin strength
| Low Intensity | Moderate Intensity | High Intensity |
| Simvastatin 5, 10 Pravastatin 10, 20 Lovastatin 20 | Atorvasatin 10, 20 Rosuvastatin 5, 10 Simbastatin 20, 40 Pravistatin 40, 80 Lovastatin 40 | Atrovastatin 40, 80 Rosuvastatin 20, 40 |
Cholesterol Drugs
| Statin | Fibrates | Ezetimibe | Bile acid resins | Niacin | |
| MOA | decreasing LDL and TG | decreases TG and increases HDL | decreases LDL | decreases LDL | increases HDL and decreases LDL |
| Side Effects | myositis and increases LFT’s | myositis and increases LFT’s | diarrhea | diarrhea | Flushing —> ASA |
Vasculitis – Large Vessels
| Presentation | Diagnosis | Treatment | |
| Giant Cell Arteritis | ->50 y/o -large vessels- external carotid, ophthalmic artery, temporal artery -jaw claudication, vision change, temporal tenderness, unilateral headache -elevated ESR, weight loss, fever, malaise | biopsy show granulomas | high dose steroids |
| Takayasu Arteritis | -<40 y/o -large vessels- aorta and branches (subclavian, renal, femoral) -pulseless -elevated ESR, fever, weight loss | angiogram | high dose steroids |
Vasculitis – Medium Vessels
| Presentation | Diagnosis | Treatment | |
| Kawasaki Disease | medium vessels -strawberry tongue, foot/hand erythema/edema, fever, cervical lymphadenopathy, rash (polymorphous–>desquamating), conjunctival injection | IVIG + aspirin -F/U- vasculitis of coronary arteries leading to MI | |
| Polyarteritis Nodosa | -associated with hepatitis B -medium vessels (gut, kidney, skin) -mesenteric ischemia, renal failure, purpura, subcutaneous painful nodules, mononeuritis multiplex (painful asymmetric motor and sensory deficit that comes and goes), HTN, fever, weight loss, headache | angiogram (aneurysms and stenosis) | steroids + cyclophosphamide |
Vasculitis – Small Vessels
| Presentation | Diagnosis | Treatment | |
| Cryoglobulinemia | -associated with hepatitis C -palpable purpura arthralgia, peripheral neuropathy, renal disease | cryoglobulins, decreased complement, positive RF, elevated ESR | plasmapheresis (severe); steroids + cyclophosphamide; treat underlying disease |
| HSP | -palpable purpura + GI (pain or bleed) + arthralgias | biopsy (leukocytoclastic vasculitis) | steroids |
| Eosinophilic polyangiitis | -eosinophilia, asthma, sinusitis, kidney, peripheral neuropathy (eg. wrist/foot drop) | -p-ANCA | steroids + cyclophosphamide |
| Wegener’s granulomatosis with polyangiitis | -small vessels -hemoptysis, hematuria, sinusitis, saddle nose deformity | c-ANCA, biopsy (vasculitis and necrotizing granulomas) | steroids + cyclophosphamide |
Medium Vessel Vasculitis
Kawasaki Disease
- Strawberry tongue
- Foot/hand Erythema/edema
- Fever
- Cervical lymphadenopathy, rash (polymorphous-->desquamating)
- Conjunctival injection
- Treatment: IVIG + aspirin
- F/U- vasculitis of coronary arteries leading to MI
Polyarteritis Nodosa
- Associated with Hepatitis B (gut, kidney, skin)
- Mesenteric ischemia, renal failure, purpura, subcutaneous painful nodules, mononeuritis multiplex (painful asymmetric motor and sensory deficit that comes and goes), HTN, fever, weight loss, headache
- Dx: angiogram (aneurysms and stenosis)
- Tx: Steroids + Cyclophosphamide
