HPN

Question 1

Deaths in hypertensive patients have been shown
to be due to 
1
2
3
4

Answer 1

stroke 45%, heart failure 35%,

kidney failure 3% and others 17%.

Question 2

Factors increasing chances of dying in hypertensive
patients are: 
1
2
3
4

Answer 2

male patient, young patient, family

history, increasing diastolic pressur

Question 3

For adults aged 18 years

and older hypertension is:

Answer 3

• diastolic pressure >90 mmHg and/or

* systolic pressure >140 mmHg

Question 4

•__________ is that of
≥ 140 mmHg in the presence of a diastolic
pressure <90 mmHg

Answer 4

Isolated systolic hypertension

Question 5

__________ is the presence of
sustained hypertension in the absence of
underlying, potentially correctable kidney,
adrenal or other factors

Answer 5

Essential hypertension

Question 6

____________is that with a diastolic
pressure >120 mmHg and exudative vasculopathy
in the retinal and kidney circulations

Answer 6

Malignant hypertension

Question 7

_________ is a BP >140/90 mmHg
despite maximum dosage of tw o drugs for 3–4
months

Answer 7

Refractory hypertension

Question 8

90% of HPN are ________

Answer 8

essential

Question 9

What kind of HPN?

It is also more likely in patients
whose BP is responding poorly to drug therapy,
patients with well-controlled hypertension whose BP
begins to increase, and patients with accelerated or
malignant hypertension

Answer 9

Secondary hypertension

Question 10

PE for secondary HPN

Abdominal systolic bruit

Answer 10

Kidney artery stenosis

Question 11

PE for secondary HPN

Proteinuria, haematuria, casts

Answer 11

Glomerulonephritis

Question 12

PE for secondary HPN

Bilateral kidney masses with or without haematuria

Answer 12

Polycystic disease

Question 13

PE for secondary HPN

History of claudication and delayed femoral pulse

Answer 13

Coarctation of the aorta

Question 14

PE for secondary HPN

Progressive nocturia, weakness

Answer 14

Primary aldosteronism (check serum potassium)

Question 15

PE for secondary HPN

Paroxysmal hypertension with headache, pallor,
sweating, palpitations

Answer 15

Phaeochromocytoma

Question 16

Renal Artery Stenosis

_______ kidney artery stenosis accounts for
the majority of cases, while ______
remains an important cause

Answer 16

Atherosclerotic

fibromuscular dysplasia

Question 17

How record HPN?

Answer 17

On each occasion when the BP is taken, two or more
readings should be averaged. Wait at least 30 seconds
before repeating the procedure.

Question 18

When to repeat BP readings?

Answer 18

If the first two readings differ by more than 6 mmHg systolic or 4 mmHg diastolic, more readings should be taken

Question 19

Whom to measure sitting and standing BP?

Answer 19

Measure sitting and standing BP in elderly

and diabetic patients

Question 20

If the initial reading is high (DBP >90 mmHg, SBP

>140 mmHg) repeat the measures after______

Answer 20

10 minutes of quiet rest.

Question 21

The________ influence in the medical
practitioner’s office may cause higher readings so
measurement in other settings such as the home or
the workplace should be managed whenever possible.

Answer 21

‘white coat’

Question 22

Initial diastolic BP readings of 115 mmHg or more,
particularly for patients with __________
may need immediate drug therapy

Answer 22

target organ damage,

Question 23

If mild hypertension is found, observation with
repeated measurement over________months should be
followed before beginning therapy

Answer 23

3–6

Question 24

This is required for the diagnosis and follow-up
of patients with fluctuating levels, borderline
hypertension or refractory hypertension (especially
where the ‘white coat’ effect may be significant

Answer 24

Ambulatory 24-hour monitoring

Question 25

``` Guidelines for ambulatory BP measurement: 1 2 3 4 5 ```

Answer 25

* unusual variability of office BP * marked discrepancy between office and house BP * resistance to drug treatment * suspected sleep apnoea * when two BP readings >140/90

Question 26

These people have a type of conditioned response to the clinic or office setting and their home BP and ambulatory BP profiles are normal.

Answer 26

‘White coat’ hypertension

Question 27

T or F Pts with ‘White coat’ hypertension They appear to be at low risk of cardiovascular disease but may progress to sustained hypertension

Answer 27

T

Question 28

If the average diastolic BP at the initial visit is 90–100 mmHg, and there is no evidence of end organ damage, _____ is indicated

Answer 28

non-pharmacological therapy is indicated for a | 3-month period

Question 29

Hovell has estimated that for every | 1 kg of weight lost, BP dropped________

Answer 29

by 2.5 mmHg | systolic and 1.5 mmHg diastolic

Question 30

Drinking more than _______of alcohol a day raises BP and makes treatment of established hypertension more difficult.

Answer 30

20 g

Question 31

Reduction or withdrawal of regular alcohol intake | reduces BP by ______

Answer 31

5–10 mmHg

Question 32

Reduction of sodium intake to less than ______ | sodium per day is advised

Answer 32

100 mmol

Question 33

_____ and_______ exercise helps to | reduce BP

Answer 33

Regular aerobic or isotonic

Question 34

There is evidence that _______ and _______ supplementation can reduce BP

Answer 34

lacto–vegetarian diets and | magnesium

Question 35

HPN Tx A period of _______weeks is needed for the effect to become fully apparent

Answer 35

4–6

Question 36

Relatively ineffective combinations of anit HPN

Answer 36

* Diuretic and calcium-channel blocker | * β -blockers and ACE inhibitors

Question 37

``` Undesirable combinations • More than one drug from a particular pharmacological group: — ___________(heart block, heart failure) — __________ (hyperkalaemia) ```

Answer 37

β -blockers and verapamil potassium-sparing diuretics and ACE inhibitors or ARB

Question 38

_________ are good first-line therapy for | hypertension

Answer 38

Thiazides

Question 39

___________ are less potent as antihypertensive agents but are indicated where there is concomitant cardiac or kidney failure and in resistant hypertension

Answer 39

Loop diuretics

Question 40

________ are less effective where there is kidney | impairment

Answer 40

Thiazides

Question 41

_______ may antagonise the antihypertensive | and natriuretic effectiveness of diuretics

Answer 41

NSAIDs

Question 42

A diet high in potassium and magnesium should accompany _______ therapy (e.g. lentils, nuts, high fibre

Answer 42

diuretic

Question 43

_______ has different properties to the thiazide | and loop diuretics and has less effect on serum lipids

Answer 43

Indapamide

Question 44

NSAIDs may interfere with the hypotensive | effect of ________

Answer 44

β -blockers.

Question 45

___________plus a β -blocker may unmask | conduction abnormalities causing heart block

Answer 45

Verapamil

Question 46

• These drugs reduce BP by vasodilatation. • The properties of individual drugs vary, especially their effects on cardiac function

Answer 46

CCB

Question 47

The ________ compounds (nifedipine and felodipine) tend to produce more vasodilatation and thus related side effects

Answer 47

dihydropyridine

Question 48

Unlike verapamil or diltiazem (which slow the heart), ___________ drugs can be used safely with a β -blocker

Answer 48

dihydropyridine

Question 49

_________ is contraindicated in second and third | degree heart block

Answer 49

Verapamil

Question 50

______ and _______ should be used with | caution in patients with heart failure

Answer 50

Verapamil and diltiazem

Question 51

Angiotensin-converting enzyme is responsible for 1 2 3

Answer 51

``` 1. converting angiotensin I to angiotensin II (a potent vasoconstrictor and 2. stimulator of aldosterone secretion) and 3. for the breakdown of bradykinin (a vasodilator). ```

Question 52

Cough, which occurs in about _______of patients, may disappear with time or a reduction in dose but it often persists and requires a change in drug in some patients.

Answer 52

15%

Question 53

_______ a potentially life-threatening condition, | may occur in 0.1–0.2% of subjects.

Answer 53

Angioedema,

Question 54

These agents competitively block the binding of angiotensin II to type I angiotensin receptors and block the effects of angiotensin more selectively than the ACE inhibitors

Answer 54

Angiotensin II receptor | antagonists (sartans

Question 55

They are useful alternatives for hypertensive patients who discontinue an ACE inhibitor because of cough and may be used in combination with thiazide diuretics.

Answer 55

Angiotensin II receptor | antagonists (sartans

Question 56

A specific problem of this alpha blocker is the ‘firstdose phenomenon’; this involves acute syncope about 90 minutes after the first dose, hence treatment is best initiated at bedtime

Answer 56

Prazosin

Question 57

Prazosin potentiates_______ and works best if used with them

Answer 57

β -blockers

Question 58

Other than calcium-channel blockers these include hydralazine, minoxidil and diazoxide, which are not used for first-line therapy but for refractory hypertensive states and hypertensive emergencies

Answer 58

Vascular smooth muscle relaxants

Question 59

example of such a central acting agent is______ which apparently stimulates the imidazoline receptors in the brain to inhibit sympathetic outflow in the body

Answer 59

moxonidine,

Question 60

Typical presentations of hypertensive emergencies (which are rare) include

Answer 60

hypertensive encephalopathy, acute stroke, heart failure, dissecting aortic aneurysm and eclampsia.

Question 61

BP goals in HPN Emergencies

Answer 61

Aim to reduce the BP by no more than 25% within the first 2 hours then towards 160/100 mmHg within 2 to 6 hours.

Question 62

Isolated systolic hypertension is most frequently seen | in __________

Answer 62

elderly people

Question 63

T or F

Answer 63

Patients with isolated systolic hypertension should be treated in the same way as those with classic systolic/diastolic hypertension

Question 64

________exists where control has not been achieved despite reasonable treatment for 3–4 months

Answer 64

Refractory hypertension

Question 65

_____ and_____ are preferable in the young hypertensive, with______ a second agent.

Answer 65

ACE inhibitors or calcium-channel blocking agents diuretics

Question 66

Older patients may respond to ______

Answer 66

nonpharmacological | treatment.

Question 67

Reducing dietary sodium is more beneficial than | with _______

Answer 67

younger patients.

Question 68

Add only one agent at a time and wait about_______ | weeks between dosage adjustments

Answer 68

4

Question 69

Older patients may respond better to 1 2 3

Answer 69

diuretics, | calcium-channel blockers and ACE inhibitors.

Question 70

Younger patients may respond better to 1 2

Answer 70

β -blockers | or ACE inhibitors