Hypertension Flashcards
(98 cards)
1
Q
acceptable increase in creatinine within first 2 months of aceinhibitor therapy
A
30%
2
Q
First line therapy: Acei
A
Htn with hf and systolic dysfunction
type 1 dm and proteinuria
mi or cad
new af
left ventricular dysfunction
hd
3
Q
selectively antagonize Ang Ii at the AT1 receptor
A
ARB
4
Q
B1 selective
A
Atenolol, Metoprolol, Bisoprolol, Acebutolol
5
Q
Nonselective + A blockade or other mechanism
A
Labetalol Carvedilol Nebivolol
6
Q
coexisting heart failure and htn
A
B blocker
7
Q
inhibit entry of calcium or its mobilization from intracellular stores, lower peripheral resistance
A
Calcium channel blockers
8
Q
Most potent vasodilator among ccb
A
dihydropyridines - amlodipine, nifedipine
9
Q
augment atrial natriuretic peptide release
A
ccb
10
Q
important tx option for renal transplant recipients - reduces initial graft nonfunction by attenuating ischemic and reperfusion injury, preserves long term renal function by protecting against cyclosporine nephrotoxicity
A
CCBs
11
Q
cause of edema in dihydropyridines
A
uncompensated precapillary vasodilation
12
Q
crosses the blood brain barrier and have a direct agonist effect in a2 adrenergic receptors in the midbrain and brainstem
A
central adrenergic agonist
13
Q
most common adverse effect of a agonist
A
dry mouth
14
Q
decrease peripheral vascular resistance, act directly on vascular smooth muscle
A
direct acting vasodilators
15
Q
direct vasodilator reserved for severe or intractable hypertension
A
minoxidil
16
Q
common adverse effect of minoxidil
A
hypertrichosis
17
Q
associated with development of sle (direct vasodilator)
A
hydralazine
18
Q
derivative of spironolactone that is approx 24x less potent in blocking mr than spironolactone
A
eplerenone
19
Q
Bp target < 60
A
< 140/90
20
Q
Bp target > 60 yo
A
< 150/90
21
Q
Ideal therapy for older patients
A
vasodilators - ace/arb + hctz, ccb
22
Q
optimal therapy in pregnant
A
a-methyldopa, hydralazine or bblocker
23
Q
angina tx
A
Bblocker, nitrates, ccb
reduce hr and induce vasodilation
24
Q
Lvh htn tx
A
hctz acei ccb arb
avoid vasodilators
reduce sbp
25
systolic dysfunction htn tx pharma consideration
reduce afterload and preload
acei, arb, hctz, bblocker, aldactone
26
diastolic dysfunction
improve myocardial compliance
bb, ccb, acei arb
avoid loop diuretics
27
MI
reduce heart rate, bb, acei
28
inability to reach desired bp goal despite the use of 3 optimally dosed drugs, one of which is a diuretic or need for four or more medications yo reach desired goal
Resistant htn
29
most common cause of resistant htn
non adherence
30
most potent parenteral vasodilator - dilates arteriolar resistance and venous capacitance vessels
sodium nitroprusside
31
degree of pressure gradient between aorta and poststenotic renal artery before measurable release of renin develops
10-20mmhg
32
critical lesions require how much of luminal obstruction before hemodynamic effects are detected
70-80%
33
Effects of angiotensin II
vasoconstriction
renal Na retention
aldosterone secretion
Vascular effects
Sns
myocardial effects
34
affects the intima or fibrous layers of the vessel wall, F, smoking, classically away from renal artery, string of bead appearance
fibromuscular disease, medial fibroplasia
35
most common cause of renovascular disease, at origin of artery
atherosclerosis
36
appear in the midportion of the vessel, strong predilection for the R renal artery
medial fibroplasia
37
syndromes associated with renovascular hypertension
1. Early or late onset htn
2. acceleration of treated essential htn
3. Deterioration of renal function in treater essential htn
4. Acute renal failure during treatment of hypertension
5. Flash pulmonary edema
6. Progressive renal failure
7. Refractory congestive cardiac failure
38
lateralizafion is defined as a ratio of more than ___ between the renin activity of the stenotic kidnet and the nonstenotic kidney
1.5
39
used to monitor after renal revascularizarion to monitor restenosis and target vessel patency
Doppler studies
40
gold standard for definition of vascular anatomy and stenotic lesions in kidney
Intra arterial angiography
41
resistive index that reflects intrinsic parenchymao and small vessel disease in the kidney that does not improve after revascularizarion
> 80
42
Most frequently reported complication after ptra and stenting
Minor - groin hematoma and puncture site trauma
43
Creatinine and size of kidneys which will unlikely benefit from surgical or endovascilar procedures
Crea > 3 cm, Small kidneys < 8 cm
44
Indications for revascularizarion
circulatory congestion
deteriorating kidney function
bilateral high grade ras
solitary functioning kidney
uncontrolled hypertension
45
Screening in primary hyperaldosteronism
Plasma aldosterone concentration to renin activity: ARR of 30
46
False positives Arr
K and Na loading, bb, nsaid, ckd
47
False negative primary hyperaldosteronism
HypoK, diuretics, acei, arb, ccb
48
confirmatory tests for Pa
Saline loading
oral Na loading
fludricortisone
Captopril challenge
49
+ saline loading test
plasma aldosterone > 10 ng/ml (2L in 4h)
50
+ oral sodium loading test
urinary aldosterone > 12-14 mcg/day (6g/day for 3-5 days)
51
+ fludrocortisone suppression test after 0.1 mg of fludrocortisone every 6 hrs for 4 days
+ if upright plasma aldo > 6 ng/dL and renin/cortisol low
52
+ captopril challenge test after 20-25 mg
+ plasma aldosterone elevated and unchanged after 1 amd 2h
53
initial study in subtype testing of pa
adrenal ct
54
small hypodense nodule (2 cm in diameter)
Aldosterone producing adenoma
55
normal adrenals or nodular changes
Idiopathic hyperaldosteronism
56
> 4 cm, heterogenous, indistinct margins, hemorrhage and necrosis
Aldosterone producing adrenal ca
57
medical management for GRA
low dose dexa/pred
58
11B-hydroxysteroid dehydrogenase deficiency
licorice
59
htn hypoK inappropriate kaliuresis with low aldosterone and renin
liddle syndrome
60
headache, sweating, hypertension in paroxysms
Pheochromocytoma
61
tx of pheochromocytoma
alpha blocker - phentolaminr or phenoxybenzamine
62
screening for acromegaly
Insulin like growth factors
63
tx for aortic dissection
bblocker plus nitroprusside
120 mmhg in 20 mins
64
phenomenon where a mild increase in blood pressure results in a concomitant increase in Na excretion
Pressure natriuresis
65
factor produced by adipocytes found to impair nitric oxide synthesis and enhances endothelin 1 production favoring the devt ko htn in obesity
resistin
66
when decreased causes insulin resistance, decreased induction of enos, increased sympathetic activity
adiponectin
67
When increased heightens sns
leptin
68
causes Na retention causing increased bp
angiotensinogen
69
isolated office htn, high bp in the office and normal bp in the out of office environment
White coat htn
70
normal bp in the office, increased outside
masked htn
71
difficult to control bp with 3 optimally dose drugs one of which is a diuretic, need for 4 or more medications
resistant htn
72
orthostatic hypotension is defined as a drop of more than how many mmhg in BP after 3 mins of standing
20/10
73
labile htn and hypotensive symptoms
home bp monitoring
74
gold standard when patients have home bp values that are borderline
abpm
75
monitor orthosatic htn
home bp
76
supine htn and average levels of bp
abpm
77
autosomal dominant disorder with htn, met alk, low aldo and low renin, increased bp with aldactone intake
hypertension brachydactyly syndrome
78
hypokalemia, met acid with normal renal fxn, htn
gordon syndrome
79
hypok, met alk, low plasma aldosterone and renin, enac mutation
liddle syndrome
80
hypok met alk low plasma and aldosterone, mutation in 11B hydroxysteroid dehydrogenase type 2
Apparent mineralocorticoid excess
81
Mutation in MR, hypok and met alk, low aldosterone and renin, increased bp due to pregnancy or aldactone intake
Geller syndrome
82
mutationnof hypertension brachydactily syndrome
phosphodiasterasr E3a
83
short fingers, stature; brainstem compression from
vascular tortuosity in the posterior fossa
htn brachydactyly syndrome
84
patients who lack normal BP dip of 20% during sleep
sleep bp that falls by less than 10% compared with awake levels
nondippers
85
cut off of high renin
6.5 ng/mL/hr
86
medication of choice high levels of renin
acei, arbs, renin inhibitors, bblockers
87
Low levels of renin tx of choice
diuretics, aldosterone antagonists, ccbs or a blockers
88
when to work up for secondary htn
htn younger than 30 with no family hx of htn
> 55 yo with new onset htn, worsening of bp control, recurrent flash pulmo edema, abdominal bruit, inc of more than 30% after raas blocker
89
treatment of primary hyperaldosteronism
verapamil, hydralazine, peripheral a adrenoreceptor antagonists
90
cut off size to consider adrenal adenocarcinoma
> 4 cm
91
diffuse hyperplasia of aldosterone producing cells within adrenal cortex
idiopathic hyperaldosteronism
92
enlarged limbs of one or both adrenal glands > 10 mm thick
Unilateral adrenal hyperplasia
93
Management for acute aortic dissection
sbp < 120 within 20 mins
Bblocker and vasodilator
94
bp target for htn with hemorrhage
10-15% reduction over 1-2 hrs
95
bp target for major hematuria or kidney injury
0-25% reduction in map over 1-12 h
96
Bp target for hypertensive enceph
25% over 2-3 h
97
bp target for acute head injury
0-35% reduction over 2-3h with nitroprusside
98
LIDDLE
Autosomal dominant, gain of function mutation do ENaC in the collecting tubules
HTN due to increased Na+ retention, hyporenin/hypoaldosteronism due to volume expansion, but hypokalemia and metabolic alkalosis due to facilitated renal K+ and H+ secretion in the collecting tubules via the favorable electrochemical gradient generated by the enhanced Na+ reabsorption through ENaC.
Treatment: low-sodium diet and direct ENaC inhibitors such as amiloride and triamterene.
