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PHRM 844 > Therapeutics of Hypertension 1 > Flashcards

Therapeutics of Hypertension 1 Flashcards

1
Q

essential HTN - elevated alterial BP with an ___ etiology

Can result from
- ___ abnormalities
- ___ mechanisms
- vascular ___ mechanisms
- peripheral ___ defects
- ___ disturbances

A

unknown
- humoral
- neuronal
- endothelial
- autoregulation
- electrolyte

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2
Q

secondary HTN - elevated arterial blood pressure due to concurrent medical conditions or medications ( ___ cause)

A

identifiable

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3
Q

Isolated systolic HTN - ___ BP values are elevated and ___ BP are not

A

systolic, diastolic

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4
Q

Resistant HTN - fail to attain goal BP while adherent to regimen that includes at least ___ agents at max dose (including ___ ) or when ___ or more agents are needed

A

3, diuretic, 4

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5
Q

Orthostatic hypotension - a systolic BP decrease of > ___ mmHg, a diastolic BP decrease of > ___ mmHg within 3 minutes of positional change, and/or increase in HR > ___ bpm

A
  • 20
  • 10
  • 20
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6
Q

Hypertension risk factors

modifiable
- high ___ intake
- obesity
- low ___ intake
- excess ___ intake

non-modifiable
- age
- ethnicity
- ___ predisposition
- gender

A
  • Na
  • K
  • alcohol
  • genetic
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7
Q

Hypertension risk factors - non-modifiable

  • age < 55: male ___ female
  • age 55-64: male ___ female
  • age > 64: male ___ female
A
  • >
  • <
  • «
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8
Q

BP = ____ x ____

A

CO x TPR

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9
Q

CO = ____ x ____

A

SV x HR

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10
Q

Secondary HTN

  • CKD
  • ___ disease
  • primary ___
  • obstructive sleep apnea
  • drug induced
  • ___ and ___consumption
  • pheochromocytoma
  • ___ syndrome/chronic steroid use
  • thryoid or parathyroid disease
  • ___ coarctation
A
  • renovascular
  • aldosteronism
  • Na, EtOH
  • Cushing’s
  • aortic
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11
Q

Substances that can increase BP

  • cocaine, ecstasy
  • caffeine
  • nicotine
  • pseudoephedrine, phenylephrine
  • amphetamines
  • antidepressants (___, ___, ___)
  • atypial antipsychotics (___, ___)
  • OC (estrogens, androgens, progesterone)
  • NSAIDs
  • oncology agents ( ___ inhibitors, ___ inhibitors)
A
  • MAOIs, SNRIs, TCAs
  • olanzapine, clozapine
  • angiogenesis, tyrosin kinase
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12
Q

BP measurement Techniques

In-office - ___ readings, ___ min apart, and sitting in a chair. Confirm elevated reading in opposite ___

Ambulatory - indicated for evaluation of ___ HTN, ___ HTN, and nighttime BP ___

Home BP monitoring - indicated for evaluation of ___ HTN, ___ HTN, response to therapy, and may improve ___

A
  • 2, 5, arm
  • white coat, masked, dipping
  • white coat, masked, adherence
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13
Q

BP Classifications

Normal

A

< 120
AND
< 80

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14
Q

BP Classifications

Elevated

A

120-129
AND
< 80

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15
Q

BP Classifications

HTN Stage 1

A

130-139
OR
80-89

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16
Q

BP Classifications

HTN Stage 2

A

greater than or equal to 140
OR
greater than or equal to 90

17
Q

ACC/AHA BP Strategies based on BP Class

Normal BP ( < ___ / ___ )
1) promote ___
2) reassess in ___ year

A

120/80
- healthy lifestyle
- 1

18
Q

ACC/AHA BP Strategies based on BP Class

Elevated BP ( ___ - ___ / < ___ )
1) ___ treatment
2) reassess in ___ - ___ months

A

120-129 / < 80
non-PCOL
3-6

19
Q

ACC/AHA BP Strategies based on BP Class

Stage 1 HTN ( ___ - ___ / ___ - ___)

WITH ASCVD risk greater than or equal to ___ % or a specific ___ : ___ treatment and ___
- reassess in ___ month

WITHOUT: ___ treatment
- reasses in ___ - ___ months

A

130-139/80-90
10%, comorbidity
Non-PCOL, medication
- 1

Non-PCOL
- 3-6

20
Q

ACC/AHA BP Strategies based on BP Class

Stage 2 HTN ( greater than or equal to ___ / ___ )
1) ___ treatment and ___ medications
2) reassess in ___ month

A

140/90
Non-PCOL, 2
1

21
Q

HTN patients at goal should have follow up every ___ - ___ months

A

3-6 month

22
Q

ACC/AHA: BP Thresholds for Treatment Initiation

General
- clinical CVD or 10 year ASCVD risk greater than or equal to 10%: ___
- no clinical CVD and 10 year ASCVD risk < 10%: ___
- patients 65 and older (non-institutionalized): ___

A
  • 130/80
  • 140/90
  • 130
23
Q

ACC/AHA: BP Thresholds for Treatment Initiation

Specific Comorbidities
- DM: ___
- CKD: ___
- HF: ___
- stable ischemic heart disease: ___
- secondary stroke prevention: ___
- peripheral arterial disease: ___

A
  • 130/80
  • 130/80
  • 130/80
  • 130/80
  • 140/90
  • 130/80
24
Q

BP Goals

ACC/AHA: ___
- may consider < ___ / ___ in elderly frail pts with high comorbidity burden and limited life expectancy

ADA: ___

KDIGO: SBP < ___ for adults with elevated BP and CKD, if tolerated

A

130/80
140/90
130/80
120

25
Q

Systolic BP Interventional Trial - SPRINT

intensive group < 120; standard group < 140
- patinets without ___ or prior ___
- majority met goal in ___ group
- intensive group saw ___ % lower risk in MI, SCS, stroke, HF, and CV death, and ___ % reduced risk of death
- however, intense group saw increase risk of ___ abnormalities, ___ , and AKI

TAKEAWAY - good to be ___ intense in patients without diabetes

A
  • diabetes, stroke
  • standard
  • 25%, 27%
  • electrolyte, hypotension
  • more
26
Q

Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP Arm

  • pts with ___ ages 40-79 with CVD/multiple risk factors
  • primary composite outome (MI, stroke, and CV death) saw no benefit.
  • increased risk of ___

TAKEAWAY - better to be ___ intense in patients with diabetes

A
  • T2DM
  • AEs
  • less
27
Q

Non-PCOL

  • weight loss: 5 mmHG
  • ___ diet: ___ mmHg
  • decreased ___ intake (< 1500 mg/day or 1000 mg reduction per day): 5-6 mmHg
  • enhance dietary ___ intake (3500-5000 mg/day): 4-5 mmHg
  • physical activity: 4-8 mmHg
  • modration in alcohol intake: 4 mmhg
A
  • DASH, 11
  • Na
  • K
28
Q

DASH Diet

recommend
- vegetables and fruits
- whole grains
- fat free or low-fat dairy products
- fish , poultry, beans
- nuts and vegetable oils
- foods rich in ___ , ___ , ___ , fiber, protein, and lower in Na ( ___ mg/day)

Limit foods that are:
- high in ___ fat (fatty meats, full-fat dairy, tropical oils)
- sugar sweetened beverages and sweets

A
  • K, Ca, Mg, 1500
  • saturated
29
Q

Pharmalogic Treatment Options (9)

A

1) ACE-i
2) ARBs
3) CCB
4) direct renin inhibitors
5) Beta Blockers
6) diuretics (thiazide, loop, K+ sparing, aldosterone antagonists)
7) alpha 1 blockers
8) central alpha 2 agonists
9) vasodilators

PHRM 844 (52 decks)

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