Hypertension

Question 1

population of people with HTN in America and worldwide

Answer 1

60 million; 1 billion

Question 2

the relationship between BP and risk of CVD is

Answer 2

continuous, consistent, and independent of other risk factors

Question 3

the higher the BP

Answer 3

the greater the risk of MI, HF, CVA, and kidney disease

Question 4

antihypertensive therapy is associated with

Answer 4

35-40% reduction in stroke incidents
20-25% reduction in MI
>50% reduction in HF

Question 5

main organs damaged from HTN

Answer 5

Heart (LV hypertrophy), brain (CVA or TIA), chronic kidney disease, peripheral arterial disease

Question 6

HTN with no identifiable cause and percent of cases

Answer 6

primary essential HTN; 95%

Question 7

HTN with identifiable cause and percent of cases

Answer 7

secondary HTN; 5%

Question 8

causes of secondary HTN

Answer 8

sleep apnea, drug-induced, chronic kidney disease, chronic steroid therapy and cushing syndrome, coarctation of the aorta, pregnancy–preeclampsia and eclampsia, estrogen use, thyroid/parathyroid disease, white coat syndrome

Question 9

drugs that affect BP

Answer 9

cocaine, tricyclic antidepressant, NSAIDs, nicotine

Question 10

one of the most common causes of maternal and fetal morbidity and mortality

Answer 10

preeclampsia (HTN) and eclampsia (sever HTN causing seizures)

Question 11

people who would have secondary HTN

Answer 11

folks who exhibit HTN at an early age and have been reasonably well controlled and them become refractory to tx

Question 12

causes of primary HTN

Answer 12

unknown…COMPLEX INTERACTION B/W MULTIPLE GENETIC AND ENVIRONMENTAL FACTORS

Question 13

percentages of essential HTN in white and black adults and the onset of age

Answer 13

10-15% white adults
20-30% black adults
onset between ages 25-55

Question 14

risk factors associated with development of essential HTN

Answer 14

obesity, sleep apnea, excess alcohol, cigarette smoking, NSAIDS

Question 15

sx of essential HTN

Answer 15

asymptomatic

Question 16

PE findings

Answer 16

BP: elevation bilaterally
retinal changes: microaneurysms and exudates
Heart: hypertrophy to LV
Pulses: equal strength and time

Question 17

what is a major cause of morbidity and mortality in essential HTN

Answer 17

cardio complications

Question 18

HTN complication–heart

Answer 18

MI, Angina, HF, LV hypertrophy, ventricular arrhythmias

Question 19

does LVH regress with tx

Answer 19

yes; related to the degree of systolic pressure reduction

Question 20

HTN complication–brain

Answer 20

hemorrhagic and ischemic stroke

Question 21

what mental disease is HTN associated with

Answer 21

dementia of both vascular and Alzheimer types

Question 22

HTN complication–kidney

Answer 22

nephrosclerosis particularly in AA pts

Question 23

Labs tests

Answer 23

CBC with diff- RBC–Hgb/hematocrit
Urinalysis- microalbuminuria
BUN and Creatinine
Fasting Blood Glucose
Plasma Lipid- HDL, LDL, total
Electrolytes- Na+, K+

Question 24

Diagnostic tests

Answer 24

EKG- LVH–primary finding with sustained HTN
Echo- evaluate for cardiac disfunction and visualize septum size

Question 25

HTN targets (<60 >60, chronic kidney or diabetes any age)

Answer 25

<60- 140/90mmHg >60- 150/90mmHg chronic kidney/diabetes- 140/90mHg

Question 26

when dx HTN

Answer 26

two or more properly measured seated blood pressure readings, taken on two or more office visits verified in contralateral arm

Question 27

white coat syndrome

Answer 27

phenomenon where pt exhibits HTN in clinical setting but not at home d/t anxiety during clinic visit

Question 28

lifestyle modification

Answer 28

weight loss DASH diet (fruits, veggies, low dairy/fats) decrease salt intake increase physical activity alcohol moderation

Question 29

pharmacological medications

Answer 29

diuretics, beta blockers, ACE inhibitors

Question 30

diuretics

Answer 30

decrease plasma volume by increasing voiding adverse effect of voiding electrolytes lasix, hydrochlorothiazide

Question 31

beta blocker

Answer 31

decrease HR and cardiac output metoprolol, atenolol, lopressor

Question 32

ACE inhibitors

Answer 32

inhibition of renin-angiotensin-aldosterone system lotensin, accupril, ramipril

Question 33

ultimate public health goal of antihypertensive tx

Answer 33

reduction of cardiovascular and renal morbidity and mortality

Question 34

achieving BP goal may require

Answer 34

use of two or more hypertensive medication; second drug should be of a different class

Question 35

African Americans with HTN compared to whites/Hispanics

Answer 35

get HTN earlier in life more sever HTN more likely to be aware that they have HTN and should get tx less likely than whites to achieve target control levels higher rates of early death from HTN related problems

Question 36

gender prevalence of HTN

Answer 36

equal