HTN guidelines/review

Question 1

What is the goal of treating HTN?

Answer 1

to reduce associated morbidity and mortality from CV events

Question 2

What does ACC/AHA recommend reguarding blood pressure guidelines?

Answer 2

high BP should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90

Question 3

What are ACC/AHA guidelines for HTN classification (nml vs elevated vs stage 1/2)

Answer 3

Normal= SBP <120 AND DBP <80

Elevated= 120-129 AND <80

HTN stage 1= 130-139 OR 80-89

HTN stage 2= >140 OR >90

Question 4

What is ACC/AHA recommendation for treatment/follow up of “elevated BP”

Answer 4

(elevated= SBP 120-129 and DBP <80)

Recommend healthy lifestyle changes and reassess in 3-6 months

Question 5

What is ACC/AHA recommendation for treatment/follow up of “normal BP”

Answer 5

(normal BP= SBP <120 and DBP <80)

Recommend:

• evaluating yearly
• encourage healthy lifestyle changes to maintain nml BP

Question 6

What is ACC/AHA recommendation for treatment/follow up of “HTN stage 1”

Answer 6

(Stage 1= SBP 130-139 OR DBP 80-89)

Recommend:

• assess 10-yr risk for heart dz and stroke using ASCVD risk calc
  
  • <10%: TLC, reasses in 3-6 months
  • >10% or pt has known CVD, DM or CKD:
    
    • TLC + antihypertensive (1 med)
    • reassess in 1 month

Question 7

According to ACC/AHA, what treatment/followup is recommended for a patient that has stage 1 HTN (SBP 130-139 or DBP 80-89) AND has an ASCVD risk of >10% or has known CVD/DM/CKD?

Answer 7

Recommend:

1. Start with lifestyle changes and BP-lowering med (1 med)
2. reassess in 1 month for med effectiveness
   
   • if goal met after 1 month- reassess in 3-6 months
   • if goal NOT met after 1 month- consider dif. med or titration
   • Continue monthly follow up until control is achieved

Question 8

According to ACC/AHA, what treatment/followup is recommended for a patient that has the following blood pressure: SBP >140 or DBP >90.

Answer 8

This is STAGE 2 HTN

Recommend

• healthy lifestyle changes and BP lowering med (2 meds or different classes)
• Reassess in 1 month for effectiveness:
  
  • If goal met after 1 month: Reassess in 3-6 months
  • If goal NOT met after 1 month: consider different meds or titration
  • Continue monthly follow up until control is achieved

Question 9

What is isolated systolic HTN defined as?

Answer 9

BP >130/<80

Question 10

What BP is considered diastolic HTN

Answer 10

<130/>80

Question 11

What is considered mixed systolic/diastolic HTN?

Answer 11

>130/>80

Question 13

Flow chart for ACC/AHA recommendations for BP treatment/follow up

Question 14

2017 ACC/AHA: What are new BP goals for patients with comorbidities?

Answer 14

updated guideline generally recommends prescribing BP-lowering medications in patients with clinical CVD and new stage 1 or stage 2 hypertension to target a BP of less than 130/80 mm Hg (this was previously less than 140/90 mm Hg).

Question 15

During a cardiac cycle, _____ of the time is spent in diastole and _____in systole.

Answer 15

2/3 in diastole, 1/3 in systole

Question 16

________ is calculated using the following equation:

(SBPx1/3) + (DBPx2/3)

Answer 16

Mean Arterial Pressure (MAP)

ex: the MAP of a BP that is 90/45= 30+30= 60

Question 17

What is the major determinent of SBP?

Answer 17

Cardiac Output

Question 18

What largely determines DBP?

Answer 18

Total peripheral resistance

Question 19

_____ is a function of SV, HR and venous capacitance

Answer 19

Cardiac output

so…

BP= HR x SV x TPR

Question 20

Elevated BP can result from increased ____ and/or increased _____

Answer 20

Cardiac output and/or increased total peripheral resistance

Question 21

What can cause increased Cardiac output and ultimately result in HTN?

Answer 21

1. Increased cardiac preload
   
   • from increased fluid vol. from excess sodium intake or renal sodium retention (from reduced # of nephrons or decreased glomerular filtration)
2. Venous Constriction:
   
   • ​​Excess stimulation of the RAAS system
   • SNS over activity

Question 22

The following are causes of increased _________, which can ultimately result in HTN

1. Functional Vascular constriciton
   
   • Excess stim. of RAAS
   • SNS over activity
   • Genetic alterations of cell membranes
   • Endothelial derived factors
2. Structural vascular hypertrophy
   
   • Excess stim. of RAAS
   • SNS over activity
   • Genetic alterations of cell membranes
   • Endothelial derived factors
   • Hyperinsulinemia resulting from the metabolic syndrome

Answer 22

Increased Peripheral resistance

Question 23

What is important to remember to include in your Ddx for HTN?

Answer 23

Current medications