HTN

Question 1

How is HTN linked to functional decline

Answer 1

End organ damage such as renal function and vascular dementia. #1 cause of strokes, possible like to Alzheimers

Question 2

Is there benifit to tx in people over 80yrs old

Answer 2

Yes, trial showl large reduction of death rate from stroke (39%), CVD (23%), HF (64%), other causes (21%).

Question 3

Which vessels are resistant in systolic HTN

Answer 3

Large vessels

Question 4

Which vessels are resistant in dystolic HTN

Answer 4

small vessels with HTN leading to increased resistance and even closure of small vessels

Question 5

Lifestyle factors associated with HTN

Answer 5

Smoling, excessive ETOH, obesity

Question 6

Definition of HTN (stage 1)

Answer 6

BP 140/90 x 3 readings

Question 7

Definition of essential HTN

Answer 7

HTN without known cause eg environmental and genetic combination

Question 8

Defefnition of secondary HTN

Answer 8

eg renal disease, hyperthyroid disease

Question 9

pseudoHTN

Answer 9

brachial stiffness so that cuff cannot compress and get a correct reading

Question 10

HTN hypterensive urgency

Answer 10

Systolic of 179 or diastolic 109 - no symptoms of end organ damange. Emergency if symptomatic IE: SOB, chestpain, headahce, visual changes, acute renal failure, altered mental status

Question 11

What is appropriate cuff size

Answer 11

80% of upper arm circumference

Question 12

Should people <90 be treated for HTN

Answer 12

Evidence does not support at this time

Question 13

What systolic BP should be treated in <80 yrs old

Answer 13

< 150mmHg to target 140 - 145mmHg

Question 14

Non-pharm tx

Answer 14

weightloss, activity, DASH diet, d/c smoking, reduce etoh

Question 15

Definition of HTN (stage 2)

Answer 15

SBP - 160, DBP - 100

Question 16

1st line pharma for stage 1 HTN

Answer 16

diuretics cornerstone in elderly. CCB, ACEI or ARB - or combo

Question 17

1st line pharma for stage 2 HTN

Answer 17

at least 2 medication is BP is >20mmHg

Question 18

1st line chronic kidney disease

Answer 18

ACEI or ARB

Question 19

1st line angina

Answer 19

BB, CCB

Question 20

Who is DASH diet contraindicated in

Answer 20

stage 3-4 kidney disease due to K+

Question 21

COnsiderations for use of diruetics

Answer 21

monitor lytes, particularly K+, can increase uric acide

Question 22

Why are ACEI and ARBS potenially less effective in elderly

Answer 22

Elderly have reudced renin-angiotension system than younger adults

Question 23

Do elderly typically need more than one medication to control HTN

Answer 23

Yes

Question 24

why are BB not 1st line in .60 yrs

Answer 24

unless compelling indications, increases risk of stroke

Question 25

1st line medication for isolated systolic HTN

Answer 25

Diuretic chlorthalidone if SBP 160mmHg and disloic <90mmhg

Question 26

How to tx widening pulse pressure

Answer 26

strong indicated for risk of stroke, HF or CVD weather pre por post tx. thiazine diuretics most effective in reducing

Question 27

What does CAD do to BP

Answer 27

Increases systolic, decreased siasloic

Question 28

Whats the link between low diastolic and MI

Answer 28

Low pressure impairs cornoary blood flow (should not be lower than 70mmHg). Same risk as those with DBP >90mmHg

Question 29

FIrst line TX for elderly with htn, stable angina and/or prior MI

Answer 29

BB - hear tremoddling, consider adding long acting DPH CCB. ACE is good for left ventricular function compromise

Question 30

TX goal for CHF

Answer 30

Reduce preload and afterload.

Question 31

Which TX is preferered for CHF

Answer 31

Diuretics, ACE and BB

Question 32

What tx for diastolic sidfunction

Answer 32

Reduce rate with BB or CCB to improve filling

Question 33

Current guidlines for chronic renal disease

Answer 33

Typically ACE or ARB - medications can cause decline in GFR though

Question 34

tx of BPH and HTN

Answer 34

ALLHAT trial showed alpha blocker dozazosin worked well