Hypertension

Question 1

HTN is defined as sustained SBP ______ and/or DBP ______

Answer 1

SBP >130 mmHg

DBP >80 mmHg

Question 2

HTN affects ____% of Black people, ___% of whites, ____% of Asians & ____% of Hispanics.

Answer 2

Black = 40%

White = 30%

Asian = 29%

Hispanics = 27%

Question 3

The lifetime risk of getting HTN is ___%

Answer 3

90%

(The longer you live the more likely you are to develop HTN)

Question 4

Category: Normal BP

Answer 4

SBP: <120

DBP: <80

Question 5

Category: Evelated BP

Answer 5

SBP: 120 - 129

DBP: <80

Question 6

Category: Stage 1 HTN

Answer 6

SBP: 130 - 139

DBP: 80 - 89

Question 7

Category: Stage 2 HTN

Answer 7

SBP: ≥140

DBP: ≥ 90

Question 8

Chronic HTN can lead to ______ (5)

Answer 8

-IDH
-Stroke
-RF
-Retinopathy
-PVD

Overall increased mortality

Question 9

With HTN, what increases morbidity/mortality during perioperative period?

Answer 9

If its unDx/unTx

Question 10

Define: Isolated systolic HTN

Answer 10

SBP: >130

DBP: normal

Question 11

Define Isolated diastolic HTN

Answer 11

SBP: <130

DBP: >80

Question 12

_______ is the most common type of chronic HTN. How is it defined?

Answer 12

Combined SBP & DBP HTN

SBP: >130
DBP: >80

Question 13

_________ is a risk factor fo cardiovascular morbidity. It correlated with ______________.

Answer 13

Widened pulse pressure

Vascular remodeling/stiffness

Question 14

What causes HTN? (2)

Answer 14

Increased CO
Vascular resistance

Question 15

Whats the difference between primary & secondary HTN?

Answer 15

Primary: Genetic & lifestyle based
-Potential causes: SNS hyperactivity, dysregulation of RAAS, deficiency of endogenous vasodilatory
-Obesity, alcoholism, tobacco

Secondary: Rare & potentially correctable
-Causes: Hyperaldosteronism, thyroid dysfunction, OSA, Cushings, Pheochrmocytoma

Question 16

HTN in children is generally ________ HTN dt ________ (2)

Answer 16

secondary

Renal disease
Coarctation of aorta

Question 17

What are drugs that increase BP?

Answer 17

-Ketoconazole (antiinfective)

-Cyclooxygenase inhibitors/NSAIDs

-Growth hormone inhibitors

-Ephedra, ginseng, ma huang (herbal)

-Amphetamines, cocaine (illicit)

-cyclosporine, sirolimus, tacrolimus (immunosuppressant)

-Buspirone, Carbamazepine, Clozapine, lithium, MAOIs, SSRIs, tricyclics (psych)

-PO contraceptives, androgens (sex hormones)

• methylprednisolone, prednisone (steroids)

-Decongestants, diet pills (sympathomimetic)

Question 18

Chronic HTN leads to ________ (3)

Answer 18

-Remodeling of small & large arteries

-endothelial dysfunction

-irreversible end-organ damage

Question 19

Disseminated vasculopathy plays a major role in _______ (7)

Answer 19

-IHD
-LVH
-CHF
-CVA
PAD
AA
-Nephropathy

Question 20

How can you detect vasculopathy?

Answer 20

Ultrasound:

Measure common carotid intimal-to-medial thickness

Arterial pulse-wave velocity

Question 21

_______ trends can track the progression of LVH

Answer 21

EKG
Echo

Question 22

_______ tracks microvascular changes associated with ___________

Answer 22

MRI

cerebrovascular
damage

Question 23

What is the therapeutic goal for HTN?

Answer 23

< 130 / < 80

Question 24

T/F: 29 million ppl treated for HTN are above their BP goal

Answer 24

T

Question 25

Define Resistant HTN

Answer 25

above BP goal despite being on 3 or more antiHTN drugs @ max dose Drugs include: CCB, ACE-I/ARB, Diuretic (Includes drugs that hit different target)

Question 26

Define Controlled resistant HTN

Answer 26

controlled BP requiring 4+ medications

Question 27

Define Refractory HTN

Answer 27

uncontrolled BP on 5+ drugs Rare -- 0.5% of pts

Question 28

Define Pseudo-resistant HTN

Answer 28

-appears resistant to drug therapy which results in BP inaccuracies Causes: white coat syndrome (dt anxiety) -medication noncompliance

Question 29

What are lifestyle changes to help lower BP?

Answer 29

weight loss -↓ETOH -exercise -smoking cessation -Salt restriction -inrease potassium and calcium intake

Question 30

There is a continuous relationship btw _______ and HTN

Answer 30

↑ BMI

Question 31

When overweight, for every 1 kg of weight loss, there is a ______ reduction in BP

Answer 31

1 mmHg

Question 32

T/F: Excessive alcohol use is assoc w/ HTN & antihypertensive resistance

Answer 32

T

Question 33

Which supplements can help decrease BP & cerebrovascular disease?

Answer 33

potassium and calcium

Question 34

What are the 8 ACC/AHA guidelines for BP management?

Answer 34

1. OOO/At home BP are recommended to dx/tritrate BP meds 2. Tx pts w/ IHD, CVD, CKD, ASD w BP meds if SBP >130 3. If BP elevated & no Cerebro/Cardio disease --> Tx w/ meds not lifestyle changes 4. Same goals for ppl w or w/o DM or CKD 5. ACE-I, ARB, CCB, or thiazide diuretics effective in **nonblack HTN pts** 6. **black adult HTN pts** w/o heart failure or CKD, support initial therapy w CCB or thiazide diuretics 7. Antihypertensive therapy w ACE-I or ARB w CKD improves kidney outcomes 8. Nonpharmacologic interventions are important for BP

Question 35

When should you use a BB with HTN?

Answer 35

Pt has CAD or tachydysrhythmias Resistant HTN

Question 36

Treatment of secondary HTN is often includes ________. What Dx require this?

Answer 36

surgical correction renal artery stenosis adrenal adenoma pheochromocytoma

Question 37

___________(3) are not recommended in bilateral renal artery stenosis. Why?

Answer 37

ACE-I’s ARBs Direct renin inhibitors Can accelerate renal failure

Question 38

Primary hyperaldosteronism can be treated w/ ____________

Answer 38

spironolactone (aldosterone antagonist)