HTN Guidelines

Question 1

BP = […] x […]

Answer 1

BP = CO x TPR

Said in other words P = Q x R

From eqn. Q = P/R

Question 2

Stroke volume is determined by what 3 things?

Answer 2

Contractility

Preload

Afterload

Question 3

What organ systems are involved in the control of BP?

Answer 3

Heart

Vessels

Kidney

Endocrine hormones

Question 4

What is essential HTN?

Answer 4

Diagnosis is given when there is no clear, single origin of a person’s HTN

Polygenic disorder plus environment

Question 5

In theory, HTN should not exist b/c the kidney should be able to excrete the excess Na+ and water to reduce blood volume. So why does it exist?

Answer 5

Ability of kidney to do this is blunted in people with HTN, not clear why

Question 6

HTN is very common in what particular group of people?

Answer 6

Those with metabolic syndrome (obesity) and diabetes

Question 7

What trends in BP are seen with age?

Answer 7

Systolic increases over lifespan

Diastolic increases until age 50, then declines

Question 8

What drives the development of essential HTN in the eldery? In young people?

Answer 8

Elderly - increase in TPR
Young - increase in CO

Question 9

HTN is a major risk factor for […] and BP > […] systolic linearly increases the risk of CVD events

Answer 9

CVD and death

115

Question 10

Describe in general the pathogenesis of the consequences of HTN.

Answer 10

HTN leads to increased afterload, which can lead to concentric hypertrophy of left heart. It can also lead to arterial damage that results in accelerated atherosclerosis (increased lipid deposits, hypertrophy of smooth muscle cells, narrowing of small arterioles) which puts someone at risk for ischemia and weakened vessels which puts at risk for aneurysm.

Question 11

When do you diagnose HTN?

Answer 11

Average of 2 or more BP recordings per office visit at 3 visits each 2-4 weeks apart

Question 12

What is normal, elevated and stage 1 HTN as defined by the american college of cardiology?

Answer 12

Question 13

If you have a patient who is presenting with new mild HTN, what’s the recommended first line treatment?

Answer 13

Diuretics - ALLHAT trial showed they’re as good as Ca channel blockers, ACE inhibitors, and alpha blockers for treating mild HTN and they’re generally tolerated better. Not possible for people who can’t take diuretics or who have more complicated HTN that requires multiple drugs