Hypertension

Question 1

Which ethnic groups have higher rates and poorer control of hypertension?

Answer 1

African American and Hispanic men (up to 60–65%).

Question 2

What hormones in the RAAS system drive hypertension?

Answer 2

Angiotensin II and aldosterone (vasoconstriction, sodium retention).

Question 3

What is nocturnal dipping and why is it important?

Answer 3

Normal 15% BP drop during sleep; non-dippers (<10%) have ↑ CVD/renal risk.

Question 4

What is chronotherapy in hypertension?

Answer 4

Evening dosing of ACEI, ARB, or CCB may restore normal dipping.

Question 5

How should clinic BP be measured?

Answer 5

Sit 5 min, back supported, cuff covers 80% of arm, deflate 2 mmHg/sec.

Question 6

What other marker may indicate HTN-related damage in men?

Answer 6

Erectile dysfunction.

Question 7

What history should be obtained in HTN?

Answer 7

Prior HTN, meds, risk factors (CVA, CAD, DM, CKD, OSA, PAD).

Question 8

What exams are important in HTN?

Answer 8

Heart (murmurs, LVH), renal bruits, neuro exam, fundoscopic exam.

Question 9

What labs are used in HTN workup?

Answer 9

BMP, creatinine, UA + microalbumin, lipids, CBC, glucose, uric acid, LFTs.

Question 10

What diet is recommended for HTN?

Answer 10

DASH diet: low Na (<1500 mg), high K, fruits/vegetables.

Question 11

How much exercise is recommended?

Answer 11

30 minutes most days.

Question 12

What is JNC 8 initial therapy?

Answer 12

Thiazide, ACEI, ARB, or CCB.

Question 13

Which meds are emphasized in African Americans?

Answer 13

Thiazide or CCB.

Question 14

What is the ADA BP goal for diabetics?

Answer 14

<140/80 mmHg; ACEI/ARB preferred.

Question 15

Which antihypertensive drugs are safe in pregnancy?

Answer 15

Methyldopa, labetalol, hydralazine (NO ACEI/ARB).

Question 16

What are ACEI side effects?

Answer 16

Cough, ↑K, angioedema.

Question 17

When are ARBs used?

Answer 17

If ACEI not tolerated; never combine with ACEI.

Question 18

What are side effects of dihydropyridine CCBs?

Answer 18

Edema, reflex tachycardia.

(Amlodipine, nifedipine, nicardipine)

Question 19

Why avoid non-dihydropyridines with beta blockers?

Answer 19

Risk of severe bradycardia/heart block.

(Verapamil, Diltiazem)

Question 20

When are beta blockers first-line?

Answer 20

Only if CAD, post-MI, or HF.

Question 21

What antihypertensive may help BPH?

Answer 21

Alpha-blockers.

Question 22

How soon to follow up in Stage 1 HTN?

Answer 22

1 month.

Question 23

How should Stage 2 HTN (>160/100) be managed initially?

Answer 23

Start with 2 drugs and more frequent follow-up.

Question 24

What is the step-up strategy if not at BP goal?

Answer 24

Increase dose → Add 2nd drug (synergistic) → Add 3rd drug.

Question 25

What defines resistant HTN?

Answer 25

On 3+ drugs (incl. diuretic) without control.

Question 26

What drug can be added for resistant HTN?

Answer 26

Spironolactone.

Question 27

What defines hypertensive urgency vs emergency?

Answer 27

Urgency: >180/120 w/o TOD → oral meds; Emergency: >180/120 + TOD → IV meds, hospitalize.

Question 28

How is adolescent HTN diagnosed?

Answer 28

After 3 visits; focus on lifestyle.

Question 29

What are important markers of targt organ damage?

Answer 29

Stroke, dementia, encephalopathy, hypertensive retinopathy, LVH, CAD, arrythmias, AAA, MI, CKD.