Pharm 5 Cardio pt1

Question 1

Why hypertension is bad in younger ppl:

Answer 1

: its effects last a long time. Avoiding sequelae (such as CHF) is a big goal of treating hypertension

Question 2

How does hypertension prevalence compare by gender and age?

Answer 2

A higher percentage of men than women have high BP until age 45.
From ages 45 to 54, the proportions of men and women with high BP are similar.
In the older age groups, more women than men have high BP, with prevalences reaching about 84% among women aged 75 or older and 70% in men in the same age category.

Question 3

The JNC guidelines were developed in response to:

Answer 3

the implementation of the National High Blood Pressure Educational Program in 1972 to raise awareness of the prevalence of and need for treatment standards for patients with hypertension.

Question 4

JNC7 has >__ drugs for Hypertension

Answer 4

125

Question 5

Hypertension-related Comorbidities (3)

Answer 5

Of people with BP >140/90 mm Hg:
69% with first MI
77% with first stroke
74% with heart failure
Precedes heart failure in 91% of cases
Associated with a 2- to 3-times higher risk for heart failure

Question 6

The Prospective Studies Collaboration
found that the risk for vascular death for each decade of age was the same down to a usual systolic BP of at least __ mm Hg and a usual diastolic BP of at least __ mm Hg.
Below those levels there was little evidence of an association.

Answer 6

Systolic: 115
Diastolic: 75

Question 7

Meta-analysis of 17 trials revealed that a reduction of __mm Hg in DBP reduced:
stroke mortality 40%
coronary heart disease mortality 16%

Answer 7

5-6 mm Hg

Even minimal reductions in BP have dramatic improvements overall.

Question 8

Rationale of hypertension prevention

Answer 8

Primary prevention stops the costly cycle of managing hypertension and its complications

Question 9

What defines *Resistant Hypertension?

Answer 9

someone who is on triple drug therapy at optimal doses, 1 of those 3 drugs is a diuretic, and their bp is still not controlled.

Question 10

3 types of hypertension control therapies

Answer 10

Monotherapy 50 - 60% of patients
Two-drug therapy 80 - 85%
Triple-drug therapy 90 - 95% (older patients)

Question 11

Major Classes of Antihypertensive Agents (7)

Answer 11

Diuretics (make you pee)
Beta-adrenergic receptor blockers (-blocker)
Alpha-adrenergic receptor blockers (-blocker
Calcium channel blockers (calcium antagonists or CCBs)

Angiotensin-converting enzyme inhibitors (ACE-inhibitor)
Angiotensin II receptors blockers (ARBs)
DRIs (a direct renin inhibitors, one drug in this class)

Question 12

Many antihypertensive agents can be combined, name 3 classes that usually are NOT combined.

Answer 12

ACE, ARB, DRIs usually are not combined.

Question 13

Definition of Hypertension.

Can be caused by (5)

Answer 13

Elevation of arterial blood pressure above 140/90 mm Hg
Can be caused by:
An underlying disease process (secondary hypertension): Exogenous substances (caffeine, cocaine, etc.), Renal artery stenosis, Hyperaldosteronism, Pheochromocytoma.
Idiopathic process (primary or essential hypertension)

Question 14

Stages of Hypertension

Answer 14

High-Normal: 130-139/85-89
Stage 1: 140-159/90-99
Stage 2: 160-179/100-109
Stage 3: >179/>109

Question 15

Are stats on Hypertension surrogate data or outcomes data? What does that mean?

Answer 15

these patients are outcomes data. You can’t tell if a specific patient with BP 200/100 will have problems, just that the population with that BP has had problems.
Surrogate data is something physical we can measure.

Question 16

3 most important risk factors that increase mortality associated with htn.

What’s the next most important after that?

Answer 16

Age > 60 
Gender: men, postmenopausal women 
Family history 
(things you can't change)
Nest most important: smoking

Question 17

3 ways of lowering blood pressure

Answer 17

Reduce cardiac output (ß-blockers, Ca2+ channel blockers)
Reduce plasma volume (diuretics)
Reduce peripheral vascular resistance (vasodilators)

Question 18

What Provides revised guidelines for management of hypertension?

Answer 18

JNC 7

Question 19

JNC VII Recommendations (3), depending on BP

Answer 19

Anyone 120/80: lifestyle modifications, get a htnsive drug with a COMPELLING INDICATION (comorbidities that are treated with antihypertensive drugs: Diabetes, Renal Disease, CAD, Angina, CHF)
>140/90: Lifestyle modifications, drugs even without a compelling indication

Question 20

**What is a ‘compelling indication’ to put someone on a hypertensive drug? And what drugs would you do (4)

Answer 20

Diabetes mellitus: ACE-inhibitor, ARB if intolerant of ACE-I
Heart failure: ACE-inhibitor, diuretics
Isolated systolic hypertension (elderly): Long-acting dihydropyridine calcium channel antagonists (CCBs)
Myocardial infarctions: beta-blockers, ACE-inhibitor

Question 21

Systolic htn

Answer 21

only the systolic # is raised, diastolic is still normal.

Question 22

Monotherapy for Hypertension (5 types)

Answer 22

Diuretics
ß-adrenoceptor blockers
 a1-adrenoceptor blockers
Ca2+ channel blockers
ACE inhibitors, ATII antagonists and DRIs

Question 23

What’s the problem with alpha-blockers?

Answer 23

**Putting them on alpha blockers can make ppl very dizzy, and have syncopal episodes for first few days on the drug. They’ll get out of bed at 3am, have a syncopal episode and break their hip.
Tell them how to carefully get up to prevent this from happening.

Question 24

The only drug for pregnant women with Hypertension

Answer 24

Methyldopa