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_MS2 Cardio > 8/11- Hypertension > Flashcards

8/11- Hypertension Flashcards

1
Q

Hypertension is a risk factor for what huge cardiovascular disease?

A

Atherosclerosis

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2
Q

What is the most common and treatable coronary risk factor?

A

Hypertension

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3
Q

What is the blood pressure associated with the lowest risk of stroke and CAD?

A. 120/80 (normal BP is less than/= 120/80)

B. 115/75

C. 135/80

D.under 140/90 (“non-hypertensive”)

E. >/= 140/90 (“hypertension”)

A

What is the blood pressure associated with the lowest risk of stroke and CAD?

A. 120/80 (normal BP is less than/= 120/80)

B. 115/75

C. 135/80

D.under 140/90 (“non-hypertensive”)

E. >/= 140/90 (“hypertension”)

B- this is ideal; associated with LOWEST RISK for stroke and CAD (but not proven by studies?)

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4
Q

What increase in BP corresponds to doubling risk of stroke and CAD death?

A

20 mmHg increase doubles risk of STROKE and CARDIAC DEATH

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5
Q

Determinants of blood pressure?

A

Cardiac output

  • Stroke volume
  • Heart rate

Vascular resistance

  • Vessel structure
  • Vessel function
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6
Q

What is mean arterial pressure (equation)?

A

MAP = CO x SVR

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7
Q

How do the following affect CO and BP?

  • Heart failure
  • Decrease in intravascular volume
  • Increase in intravascular volume
A
  • Heart failure: reduces CO and thus decreases BP
  • Decrease in intravascular volume: reduces CO and BP
  • Increase in intravascular volume: increases CO and BP
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8
Q

How is HTN defined?

A

Repeated BP measurements >/= 140/90 mmHg

- Just need systolic >/= 140 OR diastolic >/= 90

(only one number needs to be at or above cutoff)

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9
Q

How does age affect BP? SBP? DBP?

A

Age is a powerful determinant of BP

  • SBP rises with increasing age
  • DBP rises until 4th decade then plateaus and drops in the 6th decade
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10
Q

What is “essential hypertension”?

A

Unknown cause

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11
Q

What is “secondary hypertension”? Causes?

A

Due to a specific cause

Causes:

- Renal artery stenosis (ALWAYS CHECK; can intervene via stenting to reduce BP)**

  • Renal disease
  • Birth control pills
  • Aldosteronism
  • Pheochromocytoma
  • Coarction of aorta

Rare (under 10%)

  • Renal tumors
  • Arteritis of the renal artery (PAN)
  • Cushing’s syndrome (excess cortisol)
  • Acromegaly: excess growth hormone
  • Hypercalcemia due to hyper-PTH
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12
Q

What is pre-hypertension?

A

BP between 120/80 and 140/90

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13
Q

Stages of HTN?

A

(Pre-HTN: under 140/90)

Stage I: under 160/100

Stage II: BP > 160/100 (pic b)

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14
Q

What happens to pulse pressure as SBP rises and DBP decreases in older patients?

A

Pulse pressure increases

(Pulse pressure = systolic - diastolic BP)

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15
Q

How does using a tight cuff affect BP measurements?

A

Cuff too tight “raises” BP

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16
Q

What is signified by the disappearance of Korotkoff sounds?

A

Diastolic BP

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17
Q

What is the clinical significance of pre-hypertension?

A
  1. Increased risk of CV morbidity/mortality
  2. Increased future development of HT
  3. Drug therapy is not recommended EXCEPT in diabetics
  4. Non-pharmacologic therapy is advised
18
Q

What is the GOAL BP in most pts with HTN?

A. under 140/90

B. under 120/80

C. under 115/75

D. As low as tolerated

A

What is the GOAL BP in most pts with HTN?

A. under 140/90

B. under 120/80

C. under 115/75

D. As low as tolerated

A- the reasonable goal

19
Q

What is the goal BP in hypertensives with diabetes or chronic renal disease?

A. under 140/90

B. under 130/80

C. under 120/80

D. under 115/75

A

What is the goal BP in hypertensives with diabetes or chronic renal disease?

A. under 140/90

B. under 130/80

C. under 120/80

D. under 115/75

20
Q

What is isolated systolic hypertension (ISH)?

What percentage of people with HTN have this?

A
  • SBP >/= 140 mmHg
  • DBP under 90 mmHg

This comprises 2/3 of all hypertensives above 65 yo

21
Q

Which is more powerful as a risk factor for stroke and CAD: SBP or DBP?

A

SBP is more powerful than DBP as a risk factor for stroke and CAD (> 50 yo)

  • Reduction of SBP lowers both stroke and CAD
22
Q

Describe the RAAAS system?

A
  • Initial insult
  • BP fails
  • Renin produced by kidney
  • Angiotensin (causes BP rise directly and release of:)

Aldosterone (causes salt retention and increase in BP)

23
Q

What is the target of ARB drug?

A

“Angiotensin II receptor blocker”

  • AT1 receptor
24
Q

What is the target of ACEI?

A

“Angiotensin converting enzyme inhibitor”

  • Blocks AI -> AII
25
Q

What conditions are associated with hypertension? Via what factors?

A
  1. Obesity (CO increased)
  2. Alcohol (CO increased)
  3. Smoking (NE and SVR increased)
  4. Diabetes (SVR and CO increased)
26
Q

What are three major HT complications?

A
  1. HT heart disease
  2. HT crises
  3. Other target organ damage (TOD)
27
Q

Hypertensive heart disease (HT heart disease) causes what?

A
  • CAD angina or AMI
  • Heart failure
28
Q

CHF may result from what 2 main sources?

A
  1. Diastolic dysfunction due to LVH
  2. Systolic dysfunction due to MI (due to CAD)
29
Q

How is a hypertensive crisis defined? Associated with what?

A
  • Systolic BP > 200
  • Diastolic BP > 120

This is usually associated with vascular damage

30
Q

Hypertensive crisis causes what?

A
  • Hypertensive emergency (requires hospital admission)
  • Hypertensive urgency
31
Q

What are the two key differences between HT urgency and emergency?

A

Emergency is a life-threatening complication and requires immediate hospitalization

32
Q

What are some HT emergencies?

A
  • Hypertensive encephalopathy
  • Acute stroke (hemorrhagic or ischemic)
  • Retinal hemorrhages or papilledema
  • Acute pulmonary edema
  • Acute myocardial infarction
  • Acute renal failure
  • Acute aortic dissection
33
Q

What is included in target organ damage due to HTN?

A
  • Peripheral vascular disease
  • Aortic aneurysm or dissection
  • Nephrosclerosis leading to renal failure
  • Thromboembolic or hemorrhagic stroke
34
Q

Algorithm for treatment of HTN?

A
35
Q

Initial drug choices without compelling indications?

A

Stage I HTN:

  • Thiazide type diuretics for most
  • May consider: ACEI, ARB, BB. CCB, or combo

Stage II HTN:

  • 2 drug combo for most (typ thiazide-type diuretic and ACEI or ARB or BB or CCB)
36
Q

Initial drug choices with compelling indications?

A
  • Drugs from the compelling indications
  • Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed
37
Q

Compelling Indications for specific drug classes

A

ACE inhibitor or ARB must be top choice for use in:

  • Diabetic pt
  • Chronic kidney disease
  • Congestive heart failure
38
Q

All of the following anti-HT drugs reduce CV complications of HT except:

A. Diuretics

B. Beta blockers

C. Calcium channel blockers

D. Alpha blockers

E. ACEI and ARB

A

All of the following anti-HT drugs reduce CV complications of HT except:

A. Diuretics

B. Beta blockers

C. Calcium channel blockers

D. Alpha blockers

E. ACEI and ARB

39
Q

Suffixes to recognize drug class- all of the following are true except:

A. –olol for beta blocker

B. –zosin for alpha blocker

C. –pril for ACEI

D. –sartan for an ARB

E. –retic for a thiazide diuretic

A

Suffixes to recognize drug class- all of the following are true except:

A. –olol for beta blocker

B. –zosin for alpha blocker

C. –pril for ACEI

D. –sartan for an ARB

E. –retic for a thiazide diuretic

40
Q

Which initial drug(s) is/are preferred in a diabetic hypertensive with BP 170/92?

A. Hydrochlorothizide 25 mg every morning

B. Amlodipine 5 mg every morning

C. Lisinopril 10 mcg every morning

D. A and C

E. B and C

A

Which initial drug(s) is/are preferred in a diabetic hypertensive with BP 170/92?

A. Hydrochlorothizide 25 mg every morning

B. Amlodipine 5 mg every morning

C. Lisinopril 10 mcg every morning

D. A and C

E. B and C

  • Diabetic, so
  • Stage II, so need 2 drug combo
41
Q

Which anti-HT drugs are preferred as initial therapy in an uncomplicated TH BP 146/90?

A. Diuretics

B. Beta blockers

C. Alpha blockers

D. ACEI or ARB

E. Ca channel blockers

A

Which anti-HT drugs are preferred as initial therapy in an uncomplicated TH BP 146/90?

A. Diuretics

B. Beta blockers

C. Alpha blockers

D. ACEI or ARB

E. Ca channel blockers

42
Q

How to individualize drug selection for:

  • DM or renal failure
  • Systolic CHF
  • CAD
A
  • DM or renal failure: ACEI or ARB*
  • Systolic CHF: ACEI or ARB
  • CAD: BB or CCB

*These are contraindicated in SEVERE renal failure, but can use in mild (and actually may help prevent HTN/progression of renal disease)

_MS2 Cardio (35 decks)

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