Description

NR 667 / NR667 VISE STUDY GUIDE 2022 (Latest Updated) 1 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awak ening in am, blurry vision, Assessment:  Asymptomatic  Occipital headache  Blurry vision  Headache upon wakening  Look for AV nicking  LVH Exam:  Carotid bruits  Abdominal bruits  Kidney bruits Diagnostic studies: to look for secondary causes of HTN like target organ damage and establish ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC, CMP (electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria). Diagnosis: Measure BP 5 minutes apart. Average of 2 or more BP readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN. If Stage 1 (ASCVD <10%) then non-pharmacologic management only:  First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week.  Limit alcohol  stop smoking  stress management.  DASH  Medication compliance  Reduce sodium intake  Measure BP daily If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic Management:  Alone: hydrochlorothiazide (HCTZ) 25 mg/day (chlorthalidone is preferred over HCTZ)  Alone: lisinopril 10mg/day complicated HTN first line  Combo: thiazide + ACE or ARB  Alternative CB (especially in isolated HTN seen mainly in older adults)  Black population: thiazide + CCB is recommended first line Follow up:  2-4weeks Referral:  Cardiology if EKG is abnormal Differential:  Secondary hypertension  Pregnant  Pregnancy induced hypertension Hollier: page 62