Hypertension

Question 1

Hypertension Diagnosis in Adults

Answer 1

Elevated BP of
≥ 130 sys or ≥80 dia

Diabetics
≥ 140 sys or ≥90 dia

Question 2

Obtaining Readings

Answer 2

• at least 2 measurements, measure in both arms and take higher one, average of two readings
• elderly: also measure with pt standing for 1-3 min

Question 3

HTN Staging

Answer 3

Question 4

Initial stages of therapy for HTN will cause…

Answer 4

Rise in serum creatinine, not reason to stop tx

drop in BP - hyperfiltration - rise in creatinine

eventually will go to baseline, 2 wks, AKI: allow up to 30% increase in SCr

Question 5

BP 120-129/<80 TX

Answer 5

Non-pharm, reassess in 3-6 months

Question 6

Stage 1: 130-139/80-89

Answer 6

ASCVD or 10 yr CVD risk?

NO = non pharm (3-6 mo)

YES = non pharm and BP med (1 mo, OK = 3-6, NOT OK = reassess)

Question 7

Stage 2: ≥ 140/90

Answer 7

Non pharm and BP med (1 mo, OK = 3-6, NOT OK = reassess)

Question 8

Treatment Algorithm for Hypertension

Answer 8

1. First Line
   -Thiazides
   -CCBs
   -ACEI
   -ARBs
2. Initiate 1 (then titrate or combo)
3. ≥160/100, initiate with 2 first-line agents of different classes

Question 9

IHD, MI, stable angina

Answer 9

BB, ACEI or ARB

Question 10

HFrEF

Answer 10

BB and ACEI or ARB, diuretics as needed

Question 11

HFpEF

Answer 11

Diuretics

Question 12

CKD

Answer 12

ACEI

Question 13

Stroke

Answer 13

Thiazide, ACEI, ARB

Question 14

DM

Answer 14

Any first line agent

If protein present in urine
then ACEI or ARB

Question 15

AF

Answer 15

ARB

Question 16

Goals for BP

Answer 16

-Sustain lifestyle modifications
-Treat BP (younger = diastolic, older = systolic)
-Prevent organ damage
-Avoid AE
-Improve adherence

Question 17

Target BP

Answer 17

< 140/90 without comorbidities

<130 if known CVD or high risk, DIA, CKD

Assess monthly until BP at goal, then 3-6 months