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Hypertension Flashcards

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1
Q

Hypertension is defined as sustained systolic BP >_ mmHg

A

130

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2
Q

Hypertension is defined as sustained diastolic BP >_ mmHg

A

80

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3
Q

Isolated systolic HTN is defined as systolic BP greater than _ and diastolic BP less than _

A

130
80

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4
Q

Isolated diastolic HTN is defined as systolic BP less than _ and diastolic BP greater than _

A

130
80

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5
Q

What is the difference between Stage I and Stage II HTN

A

Stage I:
SBP 130-139
DBP 80-89

Stage II
SBP >140
DBP >90

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6
Q

What is defined as normal blood pressure?

A

SBP < 120
DBP < 80

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7
Q

What is defined as elevated blood pressure?

A

SBP 120-129
DBP < 80

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8
Q

Which population is most affected by HTN?

A

African Americans (40%)

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9
Q

HTN is a risk factor for what three conditions?

A

Cardiovascular disease
Stroke
Renal disease

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10
Q

What causes Primary (Essential) HTN?

A

Etiology is unclear

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11
Q

What contributes to Primary (Essential) HTN?

A

SNS activity
Dysregulation of RAAS
Deficiency in endogenous vasodilators

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12
Q

What genetic and lifestyle risk factors contribute to HTN?

A

Obesity
ETOH
Tobacco

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13
Q

What five conditions contribute to Secondary HTN in middle-aged adults?

A

Hyperaldosteronism
Thyroid dysfunction
OSA
Cushing’s disease
Pheochromocytoma

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14
Q

What are some causes of Secondary HTN in children?

A

Renal parenchymal disease
Coarctation of the aorta

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15
Q

What age group has the highest percentage of HTN?

A

Children (70-85%)

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16
Q

Describe Resistant HTN

A

BP above goal despite 3+ anti-HTN drugs at max dose
(CCB, ACI-I or ARB + diuretic)

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17
Q

Describe Controlled Resistant HTN

A

Controlled BP requiring 4+ medications

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18
Q

Described Refractory HTN

A

Uncontrolled BP on 5+ drugs

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19
Q

What is Pseudo-resistant HTN?

A

Intolerance to medications
Resulting in BP inaccuracies or med noncompliance
(White coat syndrome)

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20
Q

For every _ kg of weight loss we can expect a _ mmHg drop in blood pressure

A

1
1

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21
Q

What consequences come with Chronic HTN?

A

Remodeling of small & large arteries
Endothelial dysfunction
Irreversible end-organ damage

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22
Q

What 4 drug classes are effective in treating HTN in Non-black patients?

A

ACE-I’s
ARBs
CCBs
Thiazide diuretics

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23
Q

What drug classes are effective in black patients w/o HF or CKD initially?

A

CCBs
Thiazide diuretics

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24
Q

What two drug classes are effective in patients with CKD?

A

ACE-I’s
ARBs

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25
Beta-blockers are reserved for patients with ___
CAD or tachydysrhythmias
26
Treatment for Secondary HTN is usually __
Interventional (Surgical)
27
What three conditions attribute to Secondary HTN?
Renal artery stenosis Adrenal adenoma Pheochromocytoma
28
ACE-I, ARBs, and Direct Renin inhibitors are contraindicated with what condition?
Bilateral renal artery stenosis
29
Primary aldosteronism is usually treated with what drug?
Spironolactone
30
What medications should be held the night before or on the day of surgery?
ACE-I's ARBs Diuretics
31
Stopping Beta-blockers or Clonidine can have what effect before surgery?
Rebound effect
32
Stopping CCBs can have what effect before surgery?
Increased perioperative cardiovascular events
33
What anti-HTNisve should be avoided in pregnant patients?
ACE-I's ARBs
34
At what blood pressure measurements is immediate intervention warranted for pregnancy-induced hypertension?
SBP >160 mmHg DBP >110 mmHg
35
What drug is first line for peripartum HTN?
Labetalol
36
What drug is the gold standard for rapid arterial dilation?
Sodium Nitroprusside
37
What new 3rd gen CCB has begun being used more often for its short DOA?
Clevidipine
38
What other CCB is used in BP management during surgery?
Nicardipine
39
Pulmonary HTN is defined as a mPAP of __ mmHg
>20 mmHg
40
What two signs are noted with Pulmonary HTN?
Accentuated S2 & S4 sounds (gallop) LE swelling
41
Precapillary PH is defined as a PVR of __ without an __ in LAP or PAWP
>3.0 WU increase
42
Isolated Postcapillary PH is defined as a PAWP __ with a __ PVR
>15 mmHg normal
43
Combined Pre and Postcapillary PH is defined as a PAWP __ and a PVR __
>15 mmHg >3.0 WU
44
High flow PH occurs without a __ in PAWP or PVR
elevation (caused by pulmonary shunt or high CO)
45
What diagnostic procedure is required to diagnose Pulmonary HTN and PAH?
Right Heart Cath
46
What is the formula for PVR?
(mPAP-PAWP)/CO
47
Mild PH is defined as
mPAP 20-30 mmHg
48
Moderate PH is defined as
mPAP 31-40 mmHg
49
Severe PH is defined as
mPAP >40 mmHg
50
What risk factors are there for idiopathic PAH?
Trick question. It has none
51
PAH leads to sustained __ and the remodeling process leads to __ of small __
vasoconstriction pathologic distortion pulmonary arteries
52
What drug class is used as initial treatment for PAH?
CCBs
53
What three classes of pulmonary vasodilators are used for PAH?
Prostanoids Endothelin receptor antagonists Nitric oxide/guanylyl cyclase pathway meds
54
Prostanoids mimic __ to produce vasodilation while __ platelet aggregation
Prostacyclin Inhibiting
55
What medications are classified as prostanoids?
Epoprostenol (IV) Iloprost (inhaled) Treprostinil (SQ, IV, INH, PO) Beraprost (PO)
56
What is the only prostanoid that has been shown to reduce mortality?
Epoprostenol
57
What other class of medications can be used for PAH and Pulmonary HTN?
PDE 5 inhibitors
58
What initial signs are present with PAH?
Nonspecific fatigue Dyspnea Cough
59
What signs are present with advanced PAH?
Angina or syncope during exercise
60
What six signs can be present on physical exam for PAH?
Parasternal lift Accentuated S2, S3, and or S4 JVD Peripheral edema Hepatomegaly Ascites
61
Interventions that affect what three factors must be considered prior to surgery for PAH patients?
RV preload Afterload Oxygen supply/demand
62
What five factors can affect RV afterload?
PEEP Hypoventilation Hypercarbia Acidosis Atelectasis

Physical Assessment (3 decks)

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