Hypertension

Question 1

What is the BP criteria for diagnosing HTN in individuals <60 years old?

Answer 1

> 140/90

Question 2

What is the BP criteria for diagnosing HTN in individuals >60 years old?

Answer 2

> 150/90

Question 3

Which cause of secondary HTN should be suspected in patients with hypokalemia?

Answer 3

Primary hyperaldosteronism

Question 4

Name 5 causes of secondary HTN

Answer 4

Renal artery stenosis, pheochromocytoma, coarctation of aorta, Cushing’s syndrome, OSA

Question 5

When symptoms of HTN are present, this indicates

Answer 5

Organ damage has occurred

Question 6

What are exogenous differential diagnoses of HTN?

Answer 6

Alcohol, pregnancy, medications, drugs

Question 7

What are endocrine differential diagnoses of HTN?

Answer 7

Primary aldosteronism, Cushing’s syndrome, hypothyroidism, hypercalcemia (secondary to parathyroidism), pheochromocytoma, acromegaly

Question 8

What imaging should be done with HTN?

Answer 8

Renal angiography, echo

Question 9

An EKG should be used to assess for ischemia or LVH which manifests as

Answer 9

Large S wave in V1 and large R wave in V5

Question 10

What labs should be ordered when managing HTN?

Answer 10

Urinalysis, CBC, CMP (potassium, calcium), BUN/Cr, fasting blood glucose, lipoproteins, uric acid

Question 11

Dietary sodium should be reduced to

Answer 11

<2300 mg/day

Question 12

What are 1st line choices to treat HTN in non-AAs and AAs?

Answer 12

Non-AA with or without DM: thiazide-like diuretics, CCBs, ACEIs, ARBs

AA: thiazide-like diuretics or CCB

Question 13

Beta-blockers are not 1st line treatment for HTN, but can be an adjunct for patients with

Answer 13

CAD or HF

Question 14

Which non-dihydropyridines are contraindicated in patients with HFrEF?

Answer 14

Diltiazem and Verapamil

Question 15

What labs should be monitored if patient is on diuretics, ACEIs, or ARBs?

Answer 15

Potassium and renal function

Question 15

If HTN therapy is initiated or adjusted during a visit, when should the patient follow up?

Answer 15

1-4 weeks

Question 16

Which 9 parenteral medications can be used in severe HTN?

Answer 16

Nitroprusside, Nitroglycerin, Labetalol, Esmolol, Nicardipine, Furosemide, Hydralazine, Fenoldopam, Clonidine

Question 17

Labetalol and Esmolol should be avoided if possible or used with caution in patients with

Answer 17

HF or asthma

Question 18

What can Nicardipine prevent and cause?

Answer 18

Prevent cerebral vasospasm
Cause ischemia

Question 19

Nitroprusside is a vasodilator that has a quick duration of 1-10 mins and requires what kind of monitoring?

Answer 19

Monitor ICP and arterial monitoring is critical

Question 20

What medication takes effect in minutes and is used for patients with HF or CAD?

Answer 20

Nitroglycerin

Question 21

Which medication can be used in eclampsia?

Answer 21

Hydralazine

Question 22

Which medication should be avoided in CAD and likely with dissection?

Answer 22

Hydralazine

Question 23

Which drug takes effect in 15 mins, should be used with caution due to risk of reflex tachycardia, and is contraindicated in glaucoma?

Answer 23

Fenoldopam (vasodilator and diuretic)

Question 24

Which medication takes effect in 5-15 mins and should be avoided in patients allergic to eggs or soy?

Answer 24

Clonidine

Question 25

BP and HR should be measured:

Answer 25

In each arm twice

Question 26

If Cushing's syndrome is suspected when managing HTN, which lab test should be ordered?

Answer 26

24-hr urine cortisol

Question 27

If pheochromocytoma is suspected when managing HTN, which lab tests should be ordered?

Answer 27

24-hr creatinine, catecholamines, and metanephrines

Question 28

What classifies HTN as resistant to therapy, requiring a referral to an MD?

Answer 28

Failure of 3 full-dose, or maximally tolerated antihypertensive drugs, including a diuretic

Question 29

Asian patients should be treated for HTN with

Answer 29

CCBs or ARBs

Question 30

All patients with DM should be started with what HTN drug?

Answer 30

ACEIs regardless of race

Question 31

All patients should be started on what HTN drug unless contraindicated?

Answer 31

Thiazide diuretic

Question 32

For non-orthostatic patients whose blood pressure are >/= 160 systolic or 100 diastolic, what is the initial pharmacologic treatment?

Answer 32

2 drug therapy

Question 33

What HTN drug should be considered for underlying cardiac disease or anxiety?

Answer 33

BBs

Question 34

Which diuretic should be avoided in patients with renal dysfunction?

Answer 34

Thiazides

Question 35

Which diuretic should be used for patients with CHF and/or renal dysfunction?

Answer 35

Loop

Question 36

Which HTN drug is preferred for patients with renal impairment?

Answer 36

ACEIs