HTN

Question 1

Most common disease-related reason for visits to primary care providers

Answer 1

HTN

Question 2

Numerical definition for HTN (Stage 1) (new standards)

Answer 2

Systolic: >130 mmHg
Diastolic: >80 mmHg

Question 3

How should you measure a BP

Answer 3

Pt seated for >5 min., feet on floor, arm at heart level

No caffeine, exercise or smoking for >30 min

Question 4

At least ____ measurements should be made over multiple visits and averaged to diagnose and treat HTN

Answer 4

2

Question 5

Alternatives to office BP measurement

Answer 5

Home BP monitoring

Ambulatory BP monitoring

Question 6

How should patients monitor BP at home?

Answer 6

Made after 5 min. of rest
2-3 made in morning and again in evening
7 days of consecutive measurements prior to office visits

Question 7

BP measured repeatedly over 24 hours with an automated device; acquired at set intervals; average daytime, nighttime and 24-hr BPs are calculated

Answer 7

Ambulatory BP monitoring

Question 8

(Systolic/Diastolic) blood pressure increases steadily with age

Answer 8

Systolic

Question 9

(Systolic/Diastolic) blood pressure increases steadily until ~50 years old, then begins to decline

Answer 9

Diastolic

Question 10

__________ have the highest prevalence of HTN

Answer 10

African Americans

Question 11

Younger patients (<40yo) have a higher incidence of isolated (systolic/diastolic) hypertension

Answer 11

Diastolic

Question 12

Older patients (>50yo) have a higher incidence of isolated (systolic/diastolic) hypertension

Answer 12

Systolic

Question 13

African Americans have a _______ fold greater risk for HTN related renal disease and a _____% higher heart disease mortality

Answer 13

5-fold; 50% higher

Question 14

It is suggested that in order to reduce coronary heart disease rates, physicians should focus on not only decreasing high BP but also…

Answer 14

address other risk factors (Cholesterol, DM, smoking, LVH)

Question 15

Neurologic regulation of BP

Answer 15

a1 and b2 receptors

Question 16

With increasing age, cardiac output tends to (inc./dec.) and peripheral resistance tends to (inc./dec.)

Answer 16

CO: decrease
PR: increase

Question 17

_________ contributes to isolated systolic HTN in the elderly

Answer 17

Vascular stiffness

Question 18

% of hypertension diagnosis that are considered essential/primary

Answer 18

90

Question 19

Top three causes of secondary hypertension

Answer 19

Chronic Kidney Disease
Primary Aldosteronism
Renovascular

Question 20

The pathogenesis of major consequences of HTN can be divided into what two categories

Answer 20

Inc. Afterload

Arterial Damage

Question 21

HTN affects most vascular structures except…

Answer 21

veins

Question 22

Organs at most risk to damage via HTN

Answer 22

Heart
Arteries
Brain
Kidney

Question 23

Inc. afterload can result in what heart pathology

Answer 23

Hypertrophy

Question 24

Why does the heart compensate for inc. afterload by hypertrophy and not hyperplasia?

Answer 24

Because these cells have very limited capacity to undergo mitosis

Question 25

What causes the enlarged nuclei in ventricular hypertrophy?

Answer 25

increased ploidy (normal is 2N; these nuclei can be 4N, 8N or 16N)

Question 26

Increased mass in the left ventricle (LVH) is manifest as what on an EKG

Answer 26

Greater positive voltage (taller R waves) in leftward leads (1, aVL and V6) Greater negative voltage (deeper S waves) in rightward leads (V1-3) Downsloping ST depressions/T wave inversions in lateral leads

Question 27

Effects of chronic HTN on microvasculature

Answer 27

Thickened vessel wall (inc. elastin and collagen) for strength Can progress to stenotic lumen

Question 28

Most commonly used EKG criterion for LVH

Answer 28

S in V1 + R in V5/V6 >35mm

Question 29

pathogenesis of chronic HTN on microvasculature; results in thickened walls with elastin and collagen; small arteries

Answer 29

Benign arteriosclerosis

Question 30

pathogenesis of chronic HTN on microvasculature; results in thickened walls with collagen and plasma proteins; arterioles

Answer 30

Benign/Hyaline arteriolosclerosis

Question 31

common cause of renal failure; benign nephrosclerosis

Answer 31

Chronic HTN causing stenotic lumen resulting in ischemia

Question 32

Stenosis of occipital microvasculature (does/doesn't) affect vision

Answer 32

Doesn't (is useful for viewing affected vessels)

Question 33

pathogenesis of severe/malignant HTN on microvasculature; results in either thickened walls with more smooth muscle cells or fibrinoid necrosis

Answer 33

Malignant arteriosclerosis | Malignant ateriolosclerosis

Question 34

characterized by an abrupt and severe elevation in blood pressure that results in acute end-organ damage

Answer 34

Malignant hypertension

Question 35

"onion skinning" in cases of severe HTN

Answer 35

Thickened wall with increased layers of smooth muscle cells

Question 36

Why do you treat 140/90 mmHg in general population, but 130/80 mmHg in high-risk individuals?

Answer 36

Need more aggressive/proactive treatment to prevent future complications

Question 37

Treatment goal for hypertensive patients (what numerical value)

Answer 37

<130/80 mmHg

Question 38

Lifestyle interventions for those with HTN

Answer 38

``` Weight reduction DASH diet (fruits, veg., low fat milk) Reduce sodium More physical activity Moderation of alcohol ```

Question 39

What two situations are characterized by severe elevations in BP >180/120 mmHg

Answer 39

1. Hypertensive Emergency | 2. Hypertensive Urgency

Question 40

What is the evidence that it is a hypertensive emergency?

Answer 40

Evidence of new or worsening target organ damage * requires immediate reduction of BP with IV drugs in ICU

Question 41

What is the evidence that it is a hypertensive urgency?

Answer 41

No acute target organ damage * requires drug therapy to reduce BP w/o hospitalization

Question 42

What are the goals of HTN drug therapy?

Answer 42

1. Reduction of CV and renal morbidity/mortality | 2. BP <130/80 mmHg

Question 43

What is the most important benefit of lowering BP?

Answer 43

treatment of htn with meds decreases CV risk such as stroke, MI, and HF

Question 44

At each level of risk of CVD (11%, 15%, 21%), there was

Answer 44

similar relative risk reduction

Question 45

In high risk patients, there was

Answer 45

greater ABSOLUTE reduction

Question 46

What is the threshold for drug treatment in patients with uncomplicated HTN

Answer 46

BP > or = 140/90 mmHg

Question 47

What is the threshold for drug treatment in HTN patients with complications or other medical conditions (CVD, Chronic kidney disease, diabetes, 10-year ASCVD risk >10%)

Answer 47

BP > or = 130/80 mmHg

Question 48

Age, sex, race, BP, cholesterol, diabetes, tobacco use are risk factors that are counted to determine

Answer 48

a patient's 10-year risk of CVD

Question 49

What are the first line of treatment of hypertension?

Answer 49

1. Thiazide diuretics 2. Calcium channel blockers 3. ACE inhibitors 4. Angiotensin receptor blockers (ARB)

Question 50

What two drugs are NOT recommended to be used in combinations?

Answer 50

ACE inhibitors & ARBs