OnlineMedEd: Cardiology - "Hypertension"

Question 1

What are the JNC-8’s recommendations for the two tiers of BP control?

Answer 1

• Over 60 and without other diseases: less than 150/90

* Everyone else: less than 140/90

Question 2

The three medications that you should use to control HTN are _____________.

Answer 2

CCBs, HTZ, and ACEi (or ARBs)

Question 3

If the patient has chronic kidney disease, prescribe ___________.

Answer 3

an ACEi or an ARB

Question 4

Those who are older than 75 or black should not be given _____________.

Answer 4

an ACEi

Question 5

Go through the JNC-7’s stages (dated, but still useful).

Answer 5

• Pre-hypertension: 130-139 / 80-89
• Stage I HTN: 140-159 / 90-99
• Stage II HTN: 160-189 / 100-109
• Urgency: above 180 / above 110
• Emergency: urgency level with symptoms

Notice that you add 20 systolic and 10 diastolic between most stages.

Question 6

For those with HTN and heart failure, use _____________.

Answer 6

beta-blockers and ACE inhibitors

Question 7

Those with hypertensive emergency need _____________.

Answer 7

IV antihypertensives

Question 8

What are the timeline criteria for lowering BP in a hypertensive emergency?

Answer 8

• 2-6 hours: lower by 25%
• 24-48 hours: return to normal levels

Faster than this can precipitate a stroke.

Question 9

CCBs are great at treating those with HTN and ______________.

Answer 9

angina

Question 10

Side effects of CCBs include _____________.

Answer 10

peripheral edema

Question 11

If the person develops ____________ on an ACEi, then you should switch them to ARBs.

Answer 11

persistent cough or facial edema

Question 12

List three antihypertensives that cause hyperkalemia.

Answer 12

• ACEi
• ARB
• Aldosterone receptor antagonists

Question 13

What are two contraindications to receiving ACEis?

Answer 13

• Being older than 75

* Being AA

Question 14

What is the big clinical association with clonidine and HTN?

Answer 14

Rebound HTN when stopped! Be careful. (This is especially relevant because clonidine is a TID medication and a single missed dose can cause hypertensive urgency.)

Question 15

How should hypertension be diagnosed?

Answer 15

• Two readings over 140/90, two weeks apart, at two separate visits
• Ambulatory monitoring is the best, but it’s rarely used

Question 16

How is secondary hypertension diagnosed?

Answer 16

• Any hypertension in a person younger than 35

* Hypertension refractory to 3 or more antihypertensives, with one being a diuretic

Question 17

Go through Dustyn’s mnemonic for secondary hypertension.

Answer 17

HHHARPCO
• Hypercalcemia
•Hyperthyroidism
• Hyperaldosteronism
• Aortic coarctation
•Renal vascular occlusion/stenosis
•Pheochromocytoma
•Cushing's syndrome
• OSA

Question 18

What are the recommendations from the SPRINT trial?

Answer 18

• If you are older than 60, target BP is less than 150/90.
• If you are younger than 50, target BP is less than 140/90.

No longer based on co-morbid conditions!