CHAPTER 57 SYSTEMIC HYPERTENSION

Question 1

Categories of Blood pressure
-normal
-elevated
-Stage 1 HPN
-Stage 2 HPN

Answer 1

Normal: <120/<80
Elevated: 120-129/<80
Stage 1 HPN: SBP 130-139 or DBP 80-89
Stage 2: SBP >/= 140 or DBP >/=90

BP is based on an average of ≥2 careful readings obtained on ≥2 occasions

Question 2

Acute elevation of blood pressure, where the systolic blood pressure is >180 mm Hg and/or the diastolic blood pressure is >120 mm Hg

Answer 2

Hypertensive crisis

Question 3

Hypertensive crisis (systolic blood pressure >180 mm Hg and/or diastolic blood pressure >120 mm Hg) with concomitant end-organ damage

Answer 3

Hypertensive emergency

Targeted end organs:
brain, heart, aorta, kidneys, or eyes

Question 4

Marked and acutely elevated blood pressure without acute or worsening target organ dysfunction

Answer 4

Hypertensive urgency

Question 5

Chest pain, back pain Unequal blood pressures (>20 mm Hg difference) in upper extremities

Answer 5

Acute aortic dissection

Question 6

There is BOV with Retinal hemorrhages and cottonwool spots, hard exudates, and sausage-shaped veins

Answer 6

Hypertensive retinopathy

Question 7

Is a clinical diagnosis made after excluding focal ischemia or bleeding

Altered mental status, nausea, vomiting, headache

Answer 7

Hypertensive encephalopathy

Question 8

In this syndrome, acute end-organ dysfunction may not be measurable, but complications affecting the brain, heart, or kidneys may occur in the absence of acute treatment.

Anxiety, palpitations, tachycardia, diaphoresis

Answer 8

Sympathetic crisis

Question 9

Remarks

Answer 9

Measure blood pressure in both arms in a narrow time interval while the patient is quietly resting. Check blood pressure several times before starting antihypertensive therapy.

Question 10

Remarks

Answer 10

When an interarm blood pressure difference is detected, treat the higher blood pressure and ensure that subsequent measurements are made on the same arm

Question 11

Definition of preeclampsia

Answer 11

SBP >/= 140 or DBP >/= 90 on two occasions at least 4 hours apart in pregnant pxs beyond 20wks AOG

Question 12

Definition of eclampsia

Answer 12

Progression of preeclampsia to new-onset grand mal seizures in the absence of other neurologic conditions that could account for the seizure

Question 13

Treatment goals

Answer 13

1st hr: Reduce SBP NO MORE THAN 25%
2nd-6th hr: stable: reduce to 160/100
24-48 hrs: To normal BP

Question 14

Therapeutic goal in acute aortic dissection

Answer 14

SBP: 100 and 120 mm Hg
HR: ≤60 beats/min

ideally within the first hour of presentation

—-»>Reduce shear forces by ↓ BP and PR

Question 15

T/F: In managing aortic dissection, always use β-blocker prior to vasodilators; nitroprusside alone increases wall stress from reflex tachycardia; cyanide and thiocyanate toxicity in patients with reduced renal function or therapy >24–48 h

Answer 15

T

Question 16

T/F: Do not give nitrates in patients who have taken phosphodiesterase inhibitors for erectile dysfunction ≤24 h for sildenafil and 48 h for tadalafil

Answer 16

T

Question 17

first-line agents for cocaine-induced hypertension

Answer 17

Benzodizepines

—-decrease adrenergic stimulation

Question 18

first-line therapy for pheochromocytoma

Answer 18

Phentolamine

Question 19

Considered third-line agents in cocaine-induced hypertension after benzodiazepines and nitroglycerin

Answer 19

CCBs

Question 20

first-line agents in preeclampsia

Answer 20

Hydralazine, labetalol, and nifedipine

Question 21

contraindicated in hypertensive enceph –> it may worsen cerebral autoregulation

Answer 21

nitroglycerin

Question 22

In SAH, this is use to decrease mortality. BP control is not its primary goal, but some decrease in BP may be seen

Answer 22

nimodipine

—-lowers blood pressure and reduces v spasm and subsequent cerebral infarction rates, improving neurologic outcomes

Question 23

used with success in lieu of nimodipine and has similar hypotensive effects

Answer 23

Clazosentan

Question 24

Goal in ICH

Answer 24

SBP >220: consider aggressive management with IV infusion5

SBP 150-220: IV boluses of antihypertensive medications should be used to acutely lower SBP to 140 mm Hg

Question 25

Mainstay therapy in acute hypertensive pulmonary edema

Answer 25

nitrates

—reduce blood pressure, decrease myocardial oxygen consumption, and improve coronary blood flow.

Question 26

Fibrinolytic therapy is contraindicated in patients with ongoing blood pressure ________ mm Hg after antihypertensive therapy.

Answer 26

> 185/110

Question 27

Avoid in pregnancy and those with myocardial ischemia or bilateral renal artery stenosis

Answer 27

Enalaprilat

Question 28

contains approximately 0.2 gram of lipid per mL (2.0 kcal). Lipid restrictions may be necessary for patients with significant disorders of lipid metabolism.

Contraindicated in patients with severe aortic stenosis and egg or soy hypersensitivity

Answer 28

Clevidipine

Question 29

Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*

SBP 130-139 or DBP 80-89
and ASCVD risk <10%

Answer 29

Lifestyle modification and outpatient follow-up

Question 30

Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*

SBP 130-139 or DBP 80-89
and ASCVD risk >/= 10%

Answer 30

Lifestyle modification; initiate antihypertensive; follow-up in <1 month

Question 31

Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*

SBP 140-179 or DBP >90-109

Answer 31

Lifestyle modification; initiate antihypertensive therapy (ideally 2 agents); follow-up in <1 month

Question 32

Recommended Treatment Protocol for ED Patients With Increased Blood Pressure (BP)*

SBP >/= 180 or DBP >/=110

Answer 32

Evaluation for target organ damage; initiate lifestyle modification and antihypertensive therapy (ideally 2 agents); prompt outpatient follow-up (within a week)

Question 33

BP goal
-HF
-Post MI
-High CAD risk
-DM
-CKD

Answer 33

<130/80

Question 34

BP goal
-Recurrent Stroke Prevention

Answer 34

<140/80