Hypertension

Question 1

Hypertension definition

Answer 1

Elevation of systemic BP above a value deemed to carry excessively high risk of hypertension complications

Question 2

BP =

Answer 2

CO x PRV

pressure of blood in an artery
influenced by genetic and environmental factors

Question 3

Treating HTN lowers the risk for

Answer 3

stroke
MI
CHF

Question 4

Detrimental issues leading to HTN

Answer 4

Obesity
Sedentary lifestyle
Sodium in diet
Excessive water
Alcohol
Caffeine

Cigarettes
NSAIDS
Recreational drugs
Decongestants
Herbal supplements

Question 5

Goals of HTN Therapy

Answer 5

Get BP <150

Question 6

Resistant HTN

Answer 6

> /= 140/90 despite 3 drugs

30% of pts need 3 or more drugs
< 30% of pts achieve goal with 1 drug

Question 7

Pathology of systemic HTN

Complications

Answer 7

Intimal arterial thickening and atherosclerosis

Many findings on exam of pt related to complications

• LV enlargement
• Hypertensive nephrosclerosis
• Intracranial bleeding
• Thromboembolic episodes
• Disease of the retina

Question 8

Normal HTN

Answer 8

< 120/80

Question 9

Prehypertension

Answer 9

120-139 / 80-89

Question 10

Stage 1 HTN

Answer 10

140-159 / 90-99

Question 11

Stage 2 HTN

Answer 11

> 160 / or > 100

Question 12

Malignant HTN

Answer 12

over 200/130 in presence of retinal abnormalities and often acute vascular damage

Question 13

First diagnoses of HTN

Answer 13

s

Question 14

Presentation of pts with HTN

-what is the most common complaint?

Answer 14

Most common: no complaints

Can have

• morning headaches
• less often changes in vision
• palpitations or chest discomfort
• fatigue or shortness of breath with exertion

Question 15

What is the most common secondary cause of HTN?

What are some others?

Answer 15

CKD (chronic kidney disease)
-renal parenchyma disease leading to sodium and volume retention

others

• hyperaldosteronism
• renal artery stenosis
• pheochromocytoma
• coarctation of the aorta
• hyperthyroidism
• hyperparathyroidism
• Cushing’s syndrome

Question 16

What are some clues of secondary HTN in P/E

Answer 16

• Prolonged abdominal bruit - renal artery stenosis
• Decreased or diminished femoral pulses - coarctation
• Renal calculi - hyperparathyroidism
• Hyperthyroidism symptoms
• Abdominal striae - Cushing’s
• Paroxismal H/A, pallor, palpitation - pheochromocytoma

Question 17

Role of the kidney in primary HTN

Answer 17

normally: kidney secretes renin –> ATII –> inc BP

Most pts with HTN do not have high renin levels
Renin levels are often inappropriately normal (not suppressed)

Note: HTN follows the kidney if transplanted

Question 18

BP = CO x PVR

which value is elevated in primary HTN?

Answer 18

CO normal
PVR elevated

Renin normal

Question 19

Basic lab tests in HTNive patients

Answer 19

U/A
Electrolytes
BUN/creatinine
FBS
Lipids
ECG

Question 20

Special lab tests in HTNive patients

Answer 20

Aldosterone levels
TSH
Renin
Renal artery doppler/CT or MRI
Dexamethasone suppression test
24-hr catecholamines in pheo suspected

Question 21

What is the most effect non-pharmacologic therapy for HTN?

Answer 21

weight loss

Question 22

DASH diet

Answer 22

Dietary Approaches to Stop HTN

Rich in fruits and vegetables
Low in fats
Low sodium
Reduce alcohol
Exercise 30 minutes most days of the week

Question 23

What drugs are preferred for pts with diabetes and mild to moderate kidney disease?

Answer 23

ACE inhibitors

Question 24

What drugs are used in CHF?

Answer 24

ACE inhibitors and diuretics

Question 25

Beta blockers should be avoided in?

Answer 25

pts with bronchospastic disease blacks (do better with CCBs and diuretics) younger pts diabetics on insulin

Question 26

Short acting CCBs have increased risk of ..

Answer 26

hypotension and MI

Question 27

What type of drugs should be tried first with HTN?

Answer 27

diuretics