Chapter 14 - Hypertension

Question 1

Strongest predictor in terms of BP measurement of cardiovascular risk stratified by age

Answer 1

Age < 50 = DBP Age 50-59 = SBP, DBP, PP Age > 60 = SBP

Question 2

Rate of renal artery disease in HTN

Answer 2

33% has disease 9.6% has > 60% RAS

Question 3

Stages of hypertension and SBP/DBP

Answer 3

TABLE 14.1

Question 4

Techniques to measure blood pressure

Answer 4

ROUTINE 1) 5 min rest 2) quiet room 3) arm level of heart 4) no caffeine/smk for 30 min 5) BP cuff 80% of arm 6) two measurements AMBULATORY BP monitoring

Question 5

Ambulatory blood pressure monitoring definition

Answer 5

HTN = 24hr average > 130/80 daytime average > 140/85

Question 6

Definition of white coat hypertension

Answer 6

1) elevated BP in physician office > 140/90 2) 24 hr BP < 130/80

Question 7

Secondary causes of hypertension and signs and symptoms

Answer 7

TABLE 14.2

Question 8

Generation of Ang II

Answer 8

Angiotensinogen from liver Renin converts it to angiotensin I ACE converts it to angiotensin II

Question 9

NO effects

Answer 9

1) vasodilation 2) increase inflammation 3) increase coagulation

Question 10

Lifestyle recommendations to reduce HTN

Answer 10

1) weight loss 2) limit Na intake 3) engage aerobic physical activity x 30 min/day

Question 11

Heart outcomes prevention evaluation

Answer 11

HOPE study ramipril reduced CV events in patients with HTN and PAD BP < 128/75 is beneficial

Question 12

SPRINT study

Answer 12

9361 patients with HTN and CV risk BP target < 120 is significant better than 140 for MI, ACS, CHF, death

Question 13

Thiazide diuretic key points

Answer 13

1) Chlorthalidone, HCT, indapamide, metolazone 2) indication: first line therapy, low renin, black, elderly 3) SE: hyperuricemia, hypokalemia, insulin resistance, erectile dysfunction 4) block sodium and chloride transport in distal convoluted tubule 5) ALLHAT trial shows benefit of thiazide compared to others 6) prevent kidney calcium stones 7) effect reduced by high Na intake and NSAID use

Question 14

Loop diuretic key points

Answer 14

1) Bumetanide, ethacrynic acid, durosemide, torsemide 2) Indicaton: CHF, impaired kidney function 3) SE: hypokalemia, volume depletion MOA: thick ascending limb of LoH block reabsorption of Na, Cl, K associated with SULFA allergic reaction

Question 15

Potassium-sparing diuretic and aldosterone antagonists

Answer 15

1) Amiloride, eplerenone, spironolactone, triamterene 2) indication: hypokalemia from other diuretic, primary aldosteronism, CHF, proteinuria 3) SE: hyperkalemia, GI side effects, gynecomastia

Question 16

Beta blocker key points

Answer 16

1) indicaton: CAD, afib, CHF 2) SE: hyperlipidemia, bradycardia, insulin resistance, depression

Question 17

ACE inhibitor key points

Answer 17

1) indication: CAD, CHF, LVH, proteinuria, younger patients 2) SE: angioedema, cough, hyperkalemia, AKI HOPE trial UKPDS trial = benefit of ACE i in HTN and diabetes improve death

Question 18

ARB hey points

Answer 18

1) indication: CAD, CHF, LVH, proteinuria 2) SE: angioedema, hyperkalemia, AKI LIFE trial = ARB help with lower CV morbidity/mortality

Question 19

Renin inhibitor key points

Answer 19

1) Aliskiren 2) HTN 3) SE: angioedema, hyperkalemia, GI side effects ALTITUDE study - higher risk of CV and renal events - rarely used drug

Question 20

Calcium channel blocker key points

Answer 20

Dihydropyridine: amlodipine, felodipine, isradipine, nicardipine, nimodipine, nifedipine Nondihydropyridine: diltiazem, verapamil indication: blacks, elderly SE: LE edema, constipation, bradycardia

Question 21

Alpha blocker key points

Answer 21

1) Doxazosin, terazosin 2) indication: HTN, BPH 3) SE: dizziness, fatigue increase risk of heart failure ALLHAT study

Question 22

Central alpha agonist

Answer 22

1) clonidine, methyldopa 2) indication: resistant hypertension, pregnancy 3) SE: rebound HTN, fatigue, dry mouth, ED

Question 23

Vasodilators key points

Answer 23

1) hydralazine, minoxidil 2) indication: resistant HTN with CHF or impaired renal fxn 3) SE: fluid retention, tachycardia

Question 24

ONTARGET study

Answer 24

Combination arb and acei increases AE without benefit

Question 25

Rheos device

Answer 25

pulse generator to bilateral carotid to generate carotid massage to reduce Htn

Question 26

symplicity DEVICE

Answer 26

decrease renal sympathetic afferent and efferent activity reduces BP