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HTN-Thumar Flashcards

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1
Q

What does the JNC8 focus on more than 7 did?

A

BP control rather than use of particular agents for compelling indications

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2
Q

What has specific initial treatment recommendations?

A

CKD and race

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3
Q

What is no longer used as first-line agents?

A

Beta blockers

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4
Q

Which drugs did the ALLHAT trial compare?

A

Chlorthalidone vs Amlodipine vs Lisinopril

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5
Q

What did the ALLHAT trial say about those 3 drugs?

A

There is no clear difference between single agents regarding fatal CAD and nonfatal MI

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6
Q

Which drug out of the 3 from ALLHAT trial MAY be preferable?

A

Chlorthalidone

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7
Q

What is recommended for CKD (+/- diabetes, regardless of race)

A

ACEI or ARB

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8
Q

What is recommended for the black population?

A

Thiazide or CCB

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9
Q

What is recommended for the general population?

A

Thiazide or CCB or ACEI or ARB

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10
Q

What is the definition of CKD?

A

Abnormalities of kidney structure or function, present for >3mos, with implications for health

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11
Q

What is CKD based on?

A

Cause, GFR category, and albuminuria category

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12
Q

What does Stage1-2 CKD consist of?

A

GFR >60ml/min for >3mos plus one or more markers of kidney damage (albuminuria)

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13
Q

What is an example of a marker for kidney damage?

A

Albuminuria

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14
Q

What does stages 3-5 of CKD consist of?

A

GFR<60ml/min for >3mos

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15
Q

What is the A1 category for albuminuria?

A

Normal to mildly increased

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16
Q

What is the range for A1 albuminuria?

A

<30mg/m

<3 mg/molecules

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17
Q

What is the A2 category for albuminuria?

A

Moderately increased

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18
Q

What is the range for A2 albuminuria?

A

30-300mg/m

3-30 mg/mmol

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19
Q

What is the category A3 for albuminuria?

A

Severely increased

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20
Q

What is the range for A3 albuminuria?

A

> 300mg/g

>30mg/mmol

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21
Q

G1 (GFR)

A

Normal or high

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22
Q

G1 range

A

> 90

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23
Q

G2

A

Mildly decreased

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24
Q

G2 range

A

60-89

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25
G3a
Mildly to moderately decreased
26
G3a range
45-59
27
G3b
Moderately to severely decreased
28
G3b range
30-44
29
G4
Severely decreased
30
G4 range
15-29
31
G5
Kidney failure
32
G5 range
<15
33
What is a common lab to order for albuminuria?
Albumin-creatintine ratio “ACR” or microalbumin/urine creatinine ratio
34
What is a normal ACR?
<30mg/g
35
What is “albuminuria”
>30mg/g
36
Moderately increased ACR is what
30-300
37
Severely increased ACR is what
>300mg/g
38
Who has high-volume HTN?
Black population
39
Low plasma renin activity and increased sodium/fluid loading
Black population-HTN
40
The black population with HTN is particularly responsive to what?
Sodium restriction and dieresis
41
Thiazide diuretics and CCBs have better efficacy for the black population as what?
Monotherapy
42
What is most effective in improving cerebrovascular, heat failure, and combined CV outcomes?
Thiazide diuretics and CCBs in black population
43
You can consider starting with dual therapy is the BP is how much over goal?
>20/10mmHg above goal at diagnosis
44
What are the options if the BP goal is not reached within one month of initiating treatment?
Increase/maximize dose or initial drug OR | Add second agent from different class
45
What combination therapies should be considered first?
ACEI+CCB over ACEI+thiazide
46
Which two classes should NOT be used in combo?
ACEI and ARB
47
If goal cant be reached using third drug:
Ensure dose optimization and proper BP measurement, consider aldosterone-antagonist, BB, alpha-blocker, etc, refer to specialist
48
If the goal cant be reached with 3 drugs, what type of HTN could it be?
Secondary or resistant
49
What is one of the biggest barriers to HTN management?
Compliance
50
What is favorable treatment for the elderly?
Low-dose thiazide diuretics
51
What should be considered when treating the elderly for HTN?
Fall risk, hypoperfusion if BP is too low
52
What is the age cutoff for HTN treatment?
60-80
53
What is the HYVET trial?
Assessed BP treatment in >80YO
54
What drugs were associated with a trend towards reduced rates of fatal/nonfatal stroke for the elderly?
Diuretic+/- ACEI
55
What is the take home point from the HYVET trial?
Its better to treat than to not treat elevated BP in the elderly
56
What is first line HTN treatment for pregnancy?
Methyldopa, Labetalol
57
What is second line treatment for HTN in pregnancy?
Nifedipine, Verapamil
58
What is the BP goal for pregnancy?
<160/100
59
How can we improve pts adherence to HTN meds?
Use charts or pill boxes, link med use with daily activities, provide support, simplify medication regimens
60
Chronotherapeutics is what?
Considering to administer one BP med at night
61
What are some pros to chronotherapy?
better 24 hour control, possibly less dizziness, nighttime elevated BP correlates more with CV risk than daytime
62
What is the exception to administering HTN meds at night?
Diuretics-dont prescribe at night
63
How much can weight reduction lower BP?
5-20mmHg/10kg
64
How much can adopting the DASH eating plan lower BP?
8-14mmHg
65
How much can lowering dietary sodium decrease BP?
2-8mmHg
66
How much can physical activity decrease BP?
4-9mmHg
67
How much can lowering alcohol consumption decrease BP?
2-4mmHg
68
“Blood pressure that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes”
Resistant HTN
69
What is the classic triad of meds for resistant HTN?
Diuretics, ACEI or ARB, CCB
70
What are some risks for resistant HTN?
Incresing age, high baseline BP, excessive dietary salt, CKD, diabetes, LVH, African-American, female, residence in southeast US
71
What is a common secondary cause of resistant HTN?
Pseudoresistance
72
Pseudoresistance can be due to several situations:
Faulty BP monitoring, white coat HTN, NON-ADHERENCE (most common cause)
73
What % of pts stop their BP meds within the first year of treatment
40%
74
What are common secondary causes of HTN?
Obstructive sleep apnea, primary aldoesteronism, advanced CKD, renal artery stenosis, volume overload, excess alcohol, obesity meds
75
What are some uncommon causes of secondary HTN?
Pheochromocytoma, Cushing’s, hyperparathyroidism, intracranial tumor
76
What types of drugs can cause secondary HTN?
NSAIDs, COX-2inhibitors, stimulants, cocaine, sympathomimetics (decongestants, diet pills), OCPs, cyclosporine, tacrolimus, steroids, erythropoietin, natural licorice, herbals
77
What are the medication options for resistance HTN?
Based on expert consensus and/or clinical experience
78
What should be considered when treating resistant HTN?
Utilizing different drug mechanisms; optimizing management of co-morbidities; proper 24hr BP control
79
Which potassium-sparing diuretics can be used for resistant HTN?
Spironolactone
80
What are some pros to use Spironolactone for resistant HTN?
Can decreased SBP 5-20, DBP 5-10, improves LV size with addition to a 3 drug regimen
81
What is the dosing for potassium-sparing diuretics for resistant HTN?
Spironolactone 12.5-50mg daily Eplerenone 50mg BID Amiloride 2.5-10mg daily
82
BB should already be part of the resistant HTN regiment for pts that also have what?
CHF or CVD (angina, prior MI_
83
When should BBs be considered for resistant HTN treatment?
If resting HR is >80bpm | Consider Carvedilol, Labetalol
84
Alpha-blockers can be considered for resistant HTN when pts have
Low HR and or BPH
85
Which other drugs can be used (but often are not due to adverse effects)
Clonidine, Hydralazine

Clinical Therapeutics (8 decks)

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