HTN Special Pops

Question 1

Primary hypertension

Answer 1

– no identifiable cause

Question 2

Secondary hypertension

Answer 2

– an underlying cause is identified

Question 3

Goals: 1.

Answer 3

Determine if its primary or secondary.

Question 4

Goal 2

Answer 4

If secondary, identify underlying cause

Question 5

Goal 3

Answer 5

. Identify other co-morbid factors for CVD, or diseases associated with an increased risk for CVD

Question 6

Normal BP under 13

Answer 6

<90th precentile

Question 7

Elevated BP under 13

Answer 7

<90th precentitile to <95th precenitle, or 120/80 whichever is lower

Question 8

Stage 1 under 13

Answer 8

Systolic BP >95th precentile to <95th precntile + 12 mm Hg, or 130/80 to 139/89 mmHg, (whichever is lower)

Question 9

Stage 2 under 13

Answer 9

Systolic and diastolic BP >95th precentile +12 mmHg or >140/90 mmHg (whichever is lower)

Question 10

Normal BP over 13

Answer 10

<120 and <80

Question 11

Elevated BP over 13

Answer 11

120 to 129

<80

Question 12

Stage 1 over 13

Answer 12

130/80 to 139/89

Question 13

Stage 2 Over 13

Answer 13

> 140/90

Question 14

Peds Initiate treatment in following examples

Answer 14

Symptomatic HTN
Stage 2 HTN
Stage 1 HTN without evidence of end-organ damage, that persists despite 6 months of non-pharm therapy
Hypertensive end-organ damage
Any stage of HTN or high BP with CKD
Any stage of HTN with DM

Question 15

Drugs in children’s and adolecents

Answer 15

Ace inhibitors
Angiotensin-receptor blockers (ARBs)
Thiazide diuretics
Calcium channel blockers
Beta blockers

Question 16

Choice of drug for peds

Answer 16

data comparing antihypertensive drugs in children are lacking and hence it is not possible to make an evidence-based choice
Recommendations based upon the underlying cause of HTN, concurrent disorders, and the preference and experience of the responsible provider

Question 17

Four major hypertensive disorders that occur in pregnant women:

Answer 17

preeclampsia-eclampsia
chronic hypertension
preeclampsia-eclampsia superimposed upon chronic hypertension
gestational hypertension

Question 18

Preeclampsia-eclampsi

Answer 18

syndrome of new onset of hypertension and proteinuria or new onset of hypertension and end-organ dysfunction with or without proteinuria, most often after 20 weeks of gestation in a previously normotensive woman.

Question 19

Chronic (preexisting) hypertension

Answer 19

hypertension that antedates pregnancy, is present before the 20thweek of pregnancy, or persists longer than 12 weeks postpartum

Question 20

Preeclampsia-eclampsia superimposed upon chronic hypertension

Answer 20

diagnosed when a woman with chronic hypertension develops worsening hypertension with new onset proteinuria or other featur

Question 21

Gestational hypertension

Answer 21

elevated blood pressure first detected after 20 weeks of gestation in the absence of proteinuria or other diagnostic features of preeclampsia.

Question 22

Treatment of severe hypertension (defined as systolic BP ≥160 mmHgand/ordiastolic BP ≥110 mmHg) persisting for

Answer 22

Treatment of severe hypertension (defined as systolic BP ≥160 mmHgand/ordiastolic BP ≥110 mmHg) persisting for

Question 23

Mild (systolic 140 to 150mmHg, diastolic 80 to 100mmHg) – consider

Answer 23

symptoms and co-morbidities

Question 24

All anti-HTN cross the

Answer 24

placenta

Question 25

Methyldopa – wildly used in

Answer 25

in pregnancy women/long-term safety for fetus has been demonstrated

Question 26

Other options for HTN in pregnancy

Answer 26

Beta-blockers, calcium channel blockers, hydralazine, thiazide diuretics, clonidine.

Question 27

Drugs to avoid in pregnancy

Answer 27

ACE inhibitors, ARBs, direct renin inhibitors  Mineralocorticoid receptor antagonists  Nitroprusside

Question 28

Breastfeeding what beta blockers can be used

Answer 28

Propranolol, metoprolol, labetalol

Question 29

Breastfeedign what CCB can be used

Answer 29

Diltiazem, nifedipine, nicardipine, and verapamil | Appear to be safe during lactation

Question 30

Breast feeding what ACE can be used

Answer 30

Transferred into milk at very low levels.  Newborns may be more susceptible to the hemodynamic effects of these drugs (hypotension, oliguria and seizures) Captopril, enalapril

Question 31

Breastfeeding what Diruetics can be used

Answer 31

HCT < 50mg/day

Question 32

Breastfeeding diuretics may reduce

Answer 32

may reduce milk volume. | HCT <150 mg/day

Question 33

Methyldop and hydralazine apear to be ___ in breastfeding

Answer 33

safe

Question 34

Geriatrics general principles

Answer 34

Lower dose to minimize SE Lower BP over a period of weeks to up to 6 months as long as no HTN emergency or urgency Systolic Pressure Intervention Trial (SPRINT) Consider orthostatic hypotension

Question 35

Lower dose to minimize SE Lower BP over a period of weeks to up to 6 months as long as no HTN emergency or urgency Systolic Pressure Intervention Trial (SPRINT) Consider orthostatic hypotension

Answer 35

Low-to-moderate-dose thiazide diuretics (e.g., 12.5 to 25 mg/day of chlorthalidone) Long-acting calcium channel blockers (most often dihydropyridines) ACE inhibitors or ARBs. A long-acting dihydropyridine or a thiazide diuretic is generally preferred in older adult patients because of increased efficacy in blood pressure lowering 

Question 36

JNC-8 – initial therapy – older adults

Answer 36

Co-morbid conditions with compelling indications (e.g., HF, MI, CKD: ACE-1 or ARB)

Question 37

Co-morbid conditions for older adults

Answer 37

Co-morbid conditions with compelling indications (e.g., HF, MI, CKD: ACE-1 or ARB)

Question 38

Addition for a second line drug for older adults

Answer 38

Addition of a second-drug ACCOMPLISH trial - significant improvement in outcomes at the same attained blood pressure with benazepril plus amlodipine compared with benazepril plus hydrochlorothiazide. Long-acting ACE inhibitor/ARB

Question 39

Resistant HTN

Answer 39

BP remains above goal despite concurrent use of three anti-hypertensive agents of three different classes.

Question 40

Resistant HTN one agent should be a

Answer 40

should be a diuretic, and all agents should be prescribed at maximum recommend dose (or maximally tolerated)

Question 41

Resistant HTN if BP controlled with

Answer 41

If BP controlled with 4 or more medications