HTN- Leah (6) *

Question 1

Basic concept behind auscultatory method

Answer 1

-Turbulent flow between systolic and diastolic pressures is audible. -Laminar flow returns at diastolic pressure.

Question 2

1 COD in the US

Answer 2

CVD

Question 3

Prevalence of hypertension in males vs females and general prevalence at ages 75 and up:

Answer 3

-male greater than female until menopause (55-65) and then reverses -60-75% of those above age 75

Question 4

-Risk factors for atherosclerosis/ HTN (6)

Answer 4

-smoking -sedentary lifestyle -DM -dyslipidemia (^^ LDL/ HDL ratio) -sex hormones -renal failure *Note, HTN is also a risk factor for atherosclerosis and vice versa

Question 5

Hypertension predisposes patients to what four conditions?

Answer 5

-Coronary Artery Disease (CAD) -CHF -MI -Stroke/ CVA

Question 6

Definition of HTN

Answer 6

Blood pressure at which the benefits of therapy outweigh the risk

Question 7

Most beneficial effect/ strongest correlation to HTN treatment? One other?

Answer 7

1: reduces risk of stroke by 35% quickly! -also reduces CHF/MI rates

Question 8

Define Pre-HTN, HTN1, and HTN2 (and what are the very basic treatment reccomendation guidelines for each?)

Answer 8

Pre-HTN: 120-139/ 80-89; no drugs HTN1: 140-159/90-99; mono therapy HTN2: 160/100+; combo therapy *Always recommend lifestyle changes

Question 9

5 Compelling Indications to treat HTN:

Answer 9

-CHF -CAD -Hx of CVA -DM esp w/ proteinuria -Renal Insufficiency

Question 10

MAP- CVP is equal to?

Answer 10

BP= CO x TPR … so increasing BP must increase either CO, TPR, or both

Question 11

Guyton’s major discovery?

Answer 11

BP is proportionate to Na excretion levels; to maintain hypertension, altered renal setpoint is required

Question 12

Without an altered renal setpoint, what would happen in the presence of HTN?

Answer 12

increased BP = pressure diuresis = urine excretion = decreased BV and therefore BP

Question 13

Important (but uncommon) causes of secondary hypertension? (5)

Answer 13

-hyperaldosteronism -pheo -renovascular/ chronic renal failure -hypothyroid -aortic coarctation

Question 14

Basis of hyperaldosteronism/ how it causes HTN (2) Describe the electrolyte changes the condition induces:

Answer 14

-non-supressible aldo (^^^ aldo even in presence of high blood volume) -non-stimulatable renin (low renin even in presence of diuretic/ low blood volume) **Leads to ^ Na/ ECF and BP **DECREASE K+, as aldo induces K+excretion

Question 15

How does a pheo cause HTN? Where is it located?

Answer 15

Pheochromocytoma= adrenal medulla tumor Produces NE/Epi, leading to vasoconstriction and ^^TPR

Question 16

Three ways in which chronic kidney failure produces hypertensive state:

Answer 16

-increased renin –> ^ blood volume -inhibited Na pumps –> ^^ serum Na levels -sympathetic activation = vasoconstriction

Question 17

Of the secondary causes of hypertension, which is most common?

Answer 17

chronic renal failure

Question 18

Essential hypertension is responsible for what percentage of cases?

Answer 18

90-95%

Question 19

When is an evaluation for secondary HTN warranted? (3)

Answer 19

-early hypertension -hypertension with no family history -very severe or refractory hypertension

Question 20

Causes of “essential” hypertension? (6)

Answer 20

-Genetics -Diet: Na intake, maybe K+/ Ca? -stress -sedentary lifestyle -ETOH -smoking

Question 21

What is malignant hypertension and how is it detected?

Answer 21

-Blood pressure level at which there is evidence for acute vascular injury. -Most easily detected on retinal fundoscopic exam -BP level may not be what is expected (may be higher or lower than expected HTN state)

Question 22

Possible causes of hyperaldosteronism: (3)

Answer 22

-Conn’s/ adrenal tumor -adrenal hyperplasia (may be glucocorticoid sensitive or insensitive) -pseudohypoaldosteronism

Question 23

What exactly is pseudohyperaldosteronism? What are two causes?

Answer 23

-Liddle’s disease: Na channel mutation; causes excessive reabsorption of Na by kidney (^ blood volume) -Black licorice + Tobacco: enable activation of Aldo receptors by glucocorticoids (more common than Liddle’s) *There was something about inactivation of glucocorticoids after liddles written here, but I really think it is a Na channel mutation–Shapiro may have said that, but the review books contradict him*

Question 24

What is a very good indicator that a patient should be evaluated for hyperaldosteronism? How is it diagnosed?

Answer 24

-hypokalemia esp in the presence of ACEi drugs -diagnosed mainly by supression/ stimluation tests -cannot supress aldo with volume increase -cannot stimulate renin with diuretic/ volume decrease

Question 25

What are two causes of renovascular HTN? In what population would you expect to see these? Which responds well to correction?

Answer 25

-fibromuscular dysplasia- young, white, female w/ fhx -atheromatous- older person w/ peripheral vascular disease **Fibromuscular dysplasia responds very well to correction

Question 26

What is the gold standard for diagnosis of renovascular HTN?

Answer 26

arteriogram

Question 27

How is a pheochromocytoma appropiately diagnosed (2 steps)?

Answer 27

-1st: screen urine and blood If extremely high catechols/ metabolites are found… -2nd: get CT of adrenals

Question 28

Describe the fundoscopic changes seen in hypertension (grades 1-4)

Answer 28

stage 1: low AV ratio (normal is 2:3), arterioles are narrow stage 2: AV nicking stage 3: hemorrhages and exudates stage 4: papilledema *May be worth taking a peek at the corresponding pictures before exam, Ill try to remember to add them to our path slides.**

Question 29

Medication class most commonly prescribed for uncomplicated hypertension (w/o compelling indications)

Answer 29

diuretics

Question 30

Drugs used to treat HTN in combination with systolic heart failure or DM?

Answer 30

ACEi/ARB *ARB= angiotensin receptor blocker (ie losartan)

Question 31

Drugs used to treat HTN in patient with a history of MI?

Answer 31

B-blockers