Hypertension

Question 1

Optimal BP

Answer 1

<120/80

Question 2

Elevated BP

Answer 2

120-129/<80

Question 3

Stage 1 HTN

Answer 3

130-139/80-89

Question 4

Stage 2 HTN

Answer 4

> 140/90

Question 5

Masket HTN

Answer 5

<130/80 in office, high ambulatory BP

Question 6

Nocturnal HTN

Answer 6

> =120/70 in sleep

Question 7

Treatment for BP 120-129/<80

Answer 7

Lifestyle, reassess in 3-6 months

Question 8

Treatment of BP 130-139/80-90

Answer 8

ASCVD > 10% or clinical ASCVD -> Treat

Otherwise, lifestyle

Question 9

Treatment of BP >140/90

Answer 9

Medications and lifestyle

Question 10

Anti-HTNs General

Answer 10

Thiazide
CCB
ACE/ARB

Question 11

Anti-HTN Black

Answer 11

1st thiazide / CCB (unless CKD)

2nd ACE/ARB

Question 12

Anti-HTN CKD (>300 mg/d albuminuria)

Answer 12

ACE/ARB

Question 13

Anti-HTN pregnancy potential

Answer 13

CCB

BB

Question 14

Anti-HTN MI or HFrEF

Answer 14

BB

ACE/ARB

Question 15

Anti-HTN Stable CAD

Answer 15

ACE/ARB
BB
CCB

Question 16

BP target in DM

Answer 16

<140/90

<130/80 if high risk or kidney disease

Question 17

Causes of resistant HTN

Answer 17

Excess sodium
Inadequate diuretic
Medication side effect
Excessive ETOH
Secondary HTN

Question 18

Treatment of resistant HTN

Answer 18

Optimize diuretic
Optimize ACE/ARB with CCB
Use MRA if GFR > 30

Question 19

When to screen for secondary HTN

Answer 19

Drug-resistant or drug-induced
Abrupt onset
HTN < age 30
Accelerated / malignant HTN
Diastolic HTN > age 65
Unprovoked or excessive hypokalemia

Question 20

Secondary causes of HTN

Answer 20

OSA
Primary hyperaldosteronism
Renal artery stenosis
Cushing's disease
Renal disease
Thyroid disease
Pheochromocytoma

Question 21

Features of hyperaldosteronism

Answer 21

Normal to low K
High aldosterone > 15
Aldosterone / renin ratio > 20

Question 22

Diagnosis of hyperaldosteronism

Answer 22

Stop MRA and direct renin
PRA < 1, DRC < 10
Aldosterone > 20 = diagnosis
If borderline Aldo 10-20 -> saline suppression test

Question 23

Saline suppression test for hyperaldosteronism

Answer 23

Stop diuretics, ACE ARB 2-3 weeks
Stop MRA 4-6 weeks
Aldosterone >= 10 = adrenal adenoma or hyperplasia

Question 24

Malignant hypertension definition

Answer 24

> 180/120

Question 25

Hypertensive urgency

Answer 25

Malignant HTN with no-end organ damage or sx

Question 26

Hypertensive emergency

Answer 26

Malignant HTN with organ damage or sx

Question 27

BP lowering in aortic dissection

Answer 27

SBP <120 in 1st hour

Question 28

BP lowering in eclampsia or pheochomocytoma

Answer 28

SBP <140 in 1st hour

Question 29

BP treatment in acute ICH < 6 hours

Answer 29

SBP 150-220 no treatment

SBP > 220, lower with IV

Question 30

BP treatment in acute ischemic stroke and lytics

Answer 30

<72 hours

<185/110 before lytics, maintain for 24 hours

Question 31

BP treatment in acute ischemic stroke and no lytics

Answer 31

<72 hours
BP <220/110, no treatment for 48-72 hours
>220/110, decrease BP by 15% within 24 hours

Question 32

Adrenal Insufficiency Testing

Answer 32

AM cortisol >11 excludes, <3 more likely

ACTH stimulation test performed to confirm

Question 33

Primary hyperaldosteronism testing

Answer 33

ARR > 30 suggestive

Confirm with oral sodium loading test, saline infusion test, fludrocortisone suppression or captopril challenge