HTN

Question 1

Flowchart- mng HTN

Question 2

When to start medication for hypertension

Answer 2

High or established ASCVD risk (MI, angina, CA stenosis)
Consider: intermediate risk

Question 3

MCC of secondayr HTN

Answer 3

Primary aldosteronism

Question 4

Target for those on antihypertensives

Answer 4

<140/90

Question 5

What lifestyle recommednations for HTN

Answer 5

Regular aeorbic exercise
Reduce soidum intake
DASH diet
Reduce ETOH
Reduce weight

Question 6

Recommended regimes for starting antihypertensives

Answer 6

Single drug at low or moderate dose
2 drugs at low dose

Question 7

Recommended antihypertensive combinatiions and for whom

Answer 7

ACE/ARB + CCB -> DM, lipid abnormalities
ACEi/ARB + thiazide -> HF, post stroke
ACEi/ARB + Bb -> Post MI, HF
Bb + dihydropyridine CCB -> heart disease

Question 8

ACE/ARB + CCB: good/bad combination and why/whynot

Answer 8

Good - DM and lipid abnormalities

Question 9

ACEI/ARB + thiazide: good/bad combination and why/whynot

Answer 9

Good- HF, post stroke

Question 10

ACEi/ARB + Bb: good/bad combination and why/whynot

Answer 10

Good - post MI, HF

Question 11

Bb + dihydropyridine CCB: good/bad combination and why/whynot

Answer 11

Good - heart disease

Question 12

Which antihypertensive combinations should be avoided and why

Answer 12

ACE/ARB + K sparing diuretic -> Hyperkalemia
Bb + verapamil/diltiazem -> heart block
ACE + ARB -> increased hypotension risk, syncope, renal dysfunction
Thiazide + Bb -> not for pt w/ glucose intolerance, metabolic syndrome, established DM
ACEi/ ARB + diuretic + NSAID –> AKI

Question 13

ACE/ARB + K sparing diuretic: good/bad combination and why/whynot

Answer 13

bad: hyperkalemia

Question 14

Bb + verapamil/ diltiazem: good/bad combination and why/whynot

Answer 14

bad- heart block

Question 15

ACE + ARB: good/bad combination and why/whynot

Answer 15

Bad- increased hypotension risk, syncope, renal dysfunction

Question 16

Thiazide + Bb: good/bad combination and why/whynot

Answer 16

Bad - Not for pt w/ glucose intolerance, metabolic syndrome, established DM

Question 17

ACEi/ ARB + diuretic + NSAID: good/bad combination and why/whynot

Answer 17

Bad + AKI

Question 18

In which hypertensive patients are ACEi indicated

Answer 18

HFrEF, CKD, post MI

Question 19

What to monitor when starting/ changing ACEI dose

Answer 19

BP, kidney impairment, hyperkalemia

Question 20

Contraindications to ACEi

Answer 20

High dose diuertics, hyponatermia, renovascular HTN, hx of angioedema

Question 21

In which hypertensive patients are dihydropyridine CCB

Answer 21

Stable angina

Question 22

What to monitor when starting ARB

Answer 22

Peripheral edema - do not tx with diuertics

Question 23

In which hypertensive patients are ARBs indicated

Answer 23

Cardio + renoprotective

Question 24

What to monitor when taking ARBS

Answer 24

Hypotension, hyperkalemia, kidney impairment

Question 25

Contraindications to ARB

Answer 25

bilateral renal artery stenoisis, high dose dieuretics, hyponatremia, renovascular HTN, elderly, angioedema with ACEi

Question 26

In which hypertensive patients are thiazide diuretics indiated

Answer 26

second line or first line for >65yo with uncomplicated HTN

Question 27

Contraindications to thiazide diuertics

Answer 27

GOut Younger patients - rirsk of diabetes

Question 28

When to prescribe beta blockers in hypertensive patient

Answer 28

HTN, Stable angina, post MI - seocnd line