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Cardiology: Exam > Hypertension > Flashcards

Hypertension Flashcards

(92 cards)

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1
Q

What are the two major exceptions when a single elevated blood pressure reading is sufficient to diagnose hypertension?

A
  • Obvious evidence of end-organ damage (HTN Emergency)
  • BP > 220/125
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2
Q

A 3 month delay in treatment of hypertension in high-risk patients is associated with how much of an increase in cardiovascular morbidity and mortality?

A

Twofold (2x)

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3
Q

What is considered a Normal blood pressure?

A

< 120/80

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4
Q

What is considered an Elevated blood pressure?

A

120 - 129/ < 80

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5
Q

What is considered Stage 1 HTN?

A

130-139/80-89

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6
Q

What is considered Stage 2 HTN?

A

≥ 140/90

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7
Q

Type of hypertension that results from multiple genetic and environmental factors with NO IDENTIFIABLE CAUSE.

A

Primary Essential Hypertension
(95% of patients)

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8
Q

When does Primary Essential Hypertension usually present in life?

A

25 - 50 years old

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9
Q

Type of hypertension that results from an identifiable specific cause.

A

Secondary Hypertension
(5% of patients)

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10
Q

What two types of patients should you suspect Secondary Hypertension in?

A
  • HTN develops at Young Age or > 50
  • Previously controlled HTN becomes refractory to treatment
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11
Q

Syndrome that is defined by:
- Upper Body Obesity
- Insulin Resistance
- Hypertriglyceridemia

A

Metabolic Syndrome

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12
Q

How many medications is Secondary Hypertension usually resistant to?

A

3 Meds
(at max doses)

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13
Q

What is the most common cause of Secondary Hypertension?

A

Renal Parenchymal Disease

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14
Q

What is the Screening Test for Renal Vascular Hypertension?

A

None

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15
Q

What is the definitive diagnostic test for Renal Vascular Hypertension?

A

Renal Arteriography

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16
Q

Is Renal Arteriography recommended as routine to adjunct to coronary studies?

A

No

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17
Q

Secondary Hypertension occurs in about 80% of patients with what syndrome?

A

Cushing Syndrome
(excess Glucocorticoid)

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18
Q

Evidence of Radial-Femoral delay should be sough in all younger patients with hypertension out of concern for what pathology?

A

Coarctation of the Aorta

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19
Q

What can be a cause of Secondary Hypertension in women?

A

Estrogen Use

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20
Q

When should you refer someone with Hypertension?

A

Severe
Resistant
Early Onset (Before 20)
Late Onset (After 50)

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21
Q

What are some complications of Untreated Hypertension?

A

Structural and Functional Changes
Thrombosis

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22
Q

When does morbidity and mortality related to HTN double in rate?

A

Every 6 mmHg increase in Diastolic BP

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23
Q

What is the most frequent symptoms of Mild to Moderate Primary Hypertension?

A

Headache

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24
Q

How long can Mild to Moderate Primary Hypertension be asymptomatic for?

A

Years

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25
What are two urgent presentations of HTN?
Uncontrolled HTN Hypertensive Emergencies
26
Symptoms of HTN Encephalopathy.
Headache Somnolence Vomiting
27
Symptoms of Posterior Reversible Encephalopathy Syndrome.
Headache Seizures Altered Consciousness Disturbance of Vision
28
Focal neurologic deficits would indicate what?
Stroke
29
Symptoms of Left Ventricular After-load.
Angina Dyspnea
30
Symptoms of Aortic Dissection or Rupture.
Severe Chest or Abdominal Pain
31
Hypertensive Retinopathy findings
Copper Wiring AV Nicking Cotton Wool Spots Papilledma
32
Falsely elevated BP seen in older patients.
Osler Sign
33
Weight Loss with a target BMI of 18.5 - 24.9 can reduce blood pressure by how much?
5 - 20 mmHg per 10kg loss
34
DASH Diet can reduce blood pressure by how much?
8 - 14 mmHg
35
Sodium intake < 100 mmol/day can decrease blood pressure by how much?
2 - 8 mmHg
36
Limiting alcohol intake to: ≤ 2 for Men ≤ 1 for Women can reduce blood pressure by how much?
4 mmHg
37
Exercise can reduce blood pressure by how much?
5 - 10 mmHg
38
Mindfulness can reduce blood pressure by how much?
5 mmHg
39
Who should be treated with Anti-Hypertension medications?
- All patients that will have a reduced Cardiovascular Risk from treatment - or - SBP > 140 DBP > 90
40
What are the Major Risk Factors of Cardiovascular Disease based on the AHA guidelines?
Hypertension Smoking Obesity Inactivity Dyslipidemia Diabetes Microalbuminuria or eGFR < 60 Age (Male 55+ or Female 65+) Family History of premature CV Disease
41
What two medications are used to reduce Cardiovascular Events from occurring?
Rosuvastatin Aspirin
42
What are the classes of Anti-Hypertensive medications?
ACE Inhibitors Angiotensin (II) Receptor Blockers Calcium Channel Blockers Diuretics Beta Blockers
43
Class of medications that are commonly used as the initial medication for mild to moderate HTN. Both cardio- and renoprotective.
ACE Inhibitors
44
Name two ACE Inhibitors
Lisinopril Enalapril
45
What are the indications for ACE Inhibitors?
HTN in Diabetes Nephropathy CHF Post-MI
46
Before starting a patient on ACE Inhibitors, what must you establish?
K⁺ and Creatinine Serum Levels (repeat in 1-2 weeks after initiation)
47
What is a contraindication for giving ACE Inhibitors?
Pregnancy
48
What are some side effects of ACE Inhibitors?
First-Dose Hypotension Hyperkalemia Cough Skin Rashes Angioedema
49
Name two Angiotensin (II) Receptor Blockers.
Losartan Valsartan
50
Patients that cannot tolerate which two medications should receive ARBs?
Beta-Blockers ACE-Inhibitors (don't use in combo with ACE-I)
51
What are some side effects of ARBs?
Hyperkalemia Hypotension Renal Insufficiency
52
What is a contraindication for giving ARBs?
Pregnancy
53
Class of medications that causes vasodilation.
Calcium Channel Blockers
54
What are the two classes of Calcium Channel Blockers?
Dihydropyridines Non-Dihydropyridines
55
Class of Calcium Channel Blockers that have little to no effect on cardiac contractility.
Dihydropyridines - Amlodipine - Nifedipine - Nicardipine
56
Class of Calcium Channel Blockers that affect cardiac contractility and conduction.
Non-Dihydropyridines - Diltiazem - Verapamil
57
What are the contraindications of Calcium Channel Blockers?
CHF 2ⁿᵈ + 3ʳᵈ AV Blocks
58
What is the only Calcium Channel Blockers with established safety in patients with severe Heart Failure?
Amlodipine
59
Diuretics that increase sodium and water excretion by preventing the reabsorption of Na⁺ and water at the distal diluting tubule.
Thiazide Diuretics
60
What is an example of a Thiazide Diuretics?
Hydrochlorothiazide
61
Diuretics that inhibit water transport across the Loop of Henle.
Loop Diuretics
62
What electrolytes do Loop Diuretics affect?
Excretion of: Water Na Cl K
63
What are some examples of Loop Diuretics?
Furosemide Bumetanide
64
What are some side effects of Loop Diuretics?
Ototoxicity Do not use with Sulfa Allergy
65
Diuretics that inhibit aldosterone mediate Na⁺ & Water absorption.
Potassium-Sparing Diuretics (Mineralocorticoid Receptor Blockers)
66
What is an example of a Potassium-Sparing Diuretic?
Spirinolactone
67
Which diuretics are first-line for uncomplicated HTN?
Thiazide Diuretics
68
Which diuretics are the strongest?
Loop Diuretics
69
Which diuretics are the weakest?
Potassium-Sparing Diuretics
70
What are some side effects of Potassium-Sparing Diuretics?
Hyperkalemia Gynecomastia (do not use in renal failure or hyponatremia)
71
Which diuretics should be used with caution in Gout and Diabetes?
Thiazide Diuretics
72
What are some side effects of Thiazide Diuretics?
Hyponatremia Hypokalemia Hypercalcemia Hyperglycemia
73
Cardioselective Beta Blockers.
Atenolol Metoprolol Esmolol
74
Nonselective Beta Blockers.
Propranolol
75
Alpha + Beta Blockers
Labetalol Carvedilol
76
What class of Beta Blockers are a good choice for people with lung issues?
Cardioselective
77
What do Beta Blockers do?
Decrease Renin Release ↓Heart Rate + CO
78
What can Beta Blockers be used to treat?
HTN Angina HF MI Migraines Essentail Tremor
79
Name some Alpha Blockers.
Prazosin Terazosin Doxazosin
80
What are the First-Line hypertension medications for either: Black Persons Persons Age 55+
Calcium Channel Blockers - or - Thiazide Diuretics
81
What are the First-Line hypertension medications for: Persons Under 55
ACE-Inhibitor ARB Calcium Channel Blocker Thiazide Diuretic
82
What is the Second-Line hypertension medication for: Persons Under 55
Vasodilating Beta-Blocker
83
What are the Second-Line hypertension medications for: Black Persons Persons Age 55+
ARB ACE-I Vasodilating Beta Blockers
84
What medications are used for all patients with Resistant HTN?
Aldosterone Receptor Blocker (Spironolactone)
85
What are some additional options for patients needing hypertension medication?
Central Alpha Agonist Peripheral Alpha Antagonist
86
What type of follow-up is recommended for Hypertensive patients?
Blood Lipids (Yearly) EKG (Every 2 - 4 years)
87
Failure to reach blood pressure control in patients who are adherent to full doses of an appropriate three-drug regimen (including a diuretic)
Resistant Hypertension
88
Hypertension above what values is considered a Hypertensive Emergency?
> 180/120
89
If you suspect End-Organ Injury due to Hypertension, what tests should you perform?
Blood Screening: - Thrombotic Microangiopathy - AKI - Myocardial Damage Urine Exam: - Blood or Protein - Substances of Abuse (Cocaine)
90
What is the goal reduction rate when treating a Hypertensive Emergency?
No more than 25% in first hour 5-15% over the next 23 hours
91
What are the two exceptions to treating Hypertensive Emergencies?
Stroke - often falls spontaneously - don't treat unless BP exceeds 180-200 - Reduce by 10-15% Aortic Dissection - Keep under 120SBP and under 60HR all within 30 minutes
92
In most situations, which medications can be used to best control blood pressure?
Calcium Channel Blockers + Beta Blockers (Nicardipine + Labetalol or Esmolol)

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