Hypertension

Question 1

HTN Crisis Criteria

Answer 1

BP 180/120 or more

Evidence of target organ dysfunction (headache, dysuria, dyspnea, vision changes, etc.)

Question 2

HTN Risk Factors

Answer 2

Genetics
Obesity
Smoking
Metabolic Syndrome
High Fat Diet
High Sodium Diet
Inactivity
Sleep Apnea
Alcohol Intake
Stress

Question 3

Primary Hypertension

Answer 3

Genetic and Environmental factors
Generally idiopathic
Sodium and Potassium intake may play a role

Question 4

DASH Diet

Answer 4

The Dietary Approaches to Stop Hypertension (DASH) study showed a relationship between lower potassium intake and hypertension. In this study, it was found that blood pressure also decreased in response to a universally recommended diet that contains generous servings of fruits, vegetables, and low-fat dairy products with reduced sodium and saturated and total fat and increased potassium

Question 5

Secondary HTN

Answer 5

Assocaited with medical conditions such a renal arety stenosis, renal parenchymal disease, pheochromocytoma, hyperaldosteronism, coarctation of the aorta, acromegaly, Cushing syndrome, sleep apnea, and thyroid disease

Question 6

Renal Artery Stenosis

Answer 6

RAS results in hypertension when there is a 70% to 80% blockage of a renal artery, often activating the renin-angiotensin system

Question 7

Pheochromocytoma

Answer 7

Catecholamine producing tumor in adrenal gland causes HTN

Catecholamine levels elevated, usually have headache, hyperhidrosis, palpatation, hyperglycemia, hypermetabolic

Question 7

Pheochromocytoma

Answer 7

Catecholamine producing tumor in adrenal gland causes HTN

Catecholamine levels elevated, usually have headache, hyperhidrosis, palpatation, hyperglycemia, hypermetabolic

Question 8

Primary Hyperaldosteronism

Answer 8

Adrenal adenocarcinoma is often cause

Hypokalemia with HTN is suggestive

Question 9

Meds that may cause HTN

Answer 9

Corticosteroids
Anabolic Steroids
Contraceptives
NSAIDs
SSRI / SSNRI

Question 10

HTN Presentation

Answer 10

Often asymptomatic until very late, secondary HTN may be earlier to manifest symptoms

History / risk analysis and BP screenings essentials

Question 11

BP Screening Tips

Answer 11

Feet on floor, patient sitting for several minutes
Cuff bladder is at least 80% of arm circumference
Cuff 1 cm above the AC

Question 12

HTN Diagnosis

Answer 12

Generally
BP >120/80 is pre-hypertension
BP >140/90 is hypertension if less than 60 years old
BP >150/90 is hypertension if 60 or older

Must be at two different office visits, 2 weeks apart

Question 13

BP Goals

Answer 13

Less than 130/80 (generally) for patients with comorbids

Less than 120 systolic for primary HTN with no comorbids (generally)

Question 14

BP Treatment First Treatment

Answer 14

Lifestyle modifications is always the first step, and only treatment for prehypertension
Exercise (150 min/week with 2-3 days of resistance training)
Limit alcohol
Stop smoking
Lose weight
Reduce sodium intake, diet changes
Stress management

Question 15

BP Medications

Answer 15

Recommendations vary on age, ethnicity, comorbids

Typical - Thiazide diuertic is first
Non-black ethnicity may also get ACE-I, ARB, CCB, or combo
Black ethnicity - May get a CCB (amlodipine) and/or the Thiazide

Diabetics should usually get a ACE-I/ARB regardless of race

Most patients with BP of 160/100 need initial two-drug therapy

Question 16

BP medication follow up

Answer 16

Follow up in 1-4 weeks to assess effect, serum and renal panels
For renal patients, lab follow up in 5-7 days for GFR monitor
ACE-I/ARB should have a potassium and renal assessment

Question 17

HTN Crisis Management

Answer 17

Patients without end organ dysfunction may be treated with oral labetolol or hydralazine

Usual goal of serious crisis is lower BP slowly (25% in first hour), find source.

Question 18

Sodium intake recommendation

Answer 18

Limit to 2.3 grams per day or less. Check labels for added salt. Remember salt substitutes often have potassium!