Hypertension

Question 1

Risk factors for primary hypertension

Answer 1

Age, Obesity, Family History, Race
Excess Na, OH
Inactivity, Diabetes, Personality Traits
Reduced Nephron Number, Low Vit D

Question 2

Important roles of the kidney in primary HTN

Answer 2

Secretion of Vasoactive Factors

Sodium retention increasing circulating volume

Question 3

Explain the vasoactive factors from the kidney’s role in HTn

Answer 3

Renin –> ATII

Most patiets don’t have elevated, but have inappropriately normal levels

Question 4

How does the Na retention play out in HTN

Answer 4

Patient develop increased peripheral resistane that helps excrete retained Na without volume overload

Question 5

Aside from the abnormal renin and Na effects, other important components of primary HTN physiology

Answer 5

Elevated adrenergic activity
Hyperinsulinemia
Blockage of Na/K ATP-ase

Question 6

Renal causes of 2dary HTN

Answer 6

Renal Parenchymal Disease

Renovascular HTN

Question 7

Elaborate the role of renal parenchymal disease in 2ndary HTN

Answer 7

CKD, Acute GN, AKI

Sodium retention, increased Renin Release, and increased sympathetic activity

Question 8

Elaborate the role of renovascular disease in 2ndary HTN

Answer 8

Atherosclerosis, fibromuscular dysplasia
Treat w/ ACE Inhibitor and follow renal Fxn
Renal artery stent/angio in select patients (fibromuscular)

Question 9

Endocrine causes of secondary HTN

Answer 9

Hyperaldosteronism
Pheochromocytoma
Hyper/hypothyroidism
Hyperparathyroidism
Cushing's

Question 10

Suspect hyperaldosteronism in patients with triad of…

Answer 10

HTN, Unexplained hypokalemia, and metabolic alkalosis

Question 11

Non renal and Non endocrine causes of 2ndary HTN

Answer 11

Coarction of the Aorta
Drug Induced
Obstructive Sleep Apnea

Question 12

Drugs that can cause 2ndary HTN

Answer 12

Oral Contraceptives
NSAIDs
Antidepressants/Alcohol
Decongestants/Stimulants

Question 13

Levels of Normal BP

Answer 13

Under 120, 80

Question 14

Levels of Prehypertension

Answer 14

120-139, 80-89

Question 15

Levels of Stage 1 HTN

Answer 15

140-159, 90-99

Question 16

Levels of Stage 2 HTN

Answer 16

Over 160, 100

Question 17

Explain Moderate to Severe Hypertensive Retinopathy

Answer 17

DBP over 120
Retinal hemorrhages, papilledema, exhudates
assoc. w/ encephalopathy, acute HTN nephrosclerosis

Question 18

Explain “Hypertensive Emergency”

Answer 18

DBP over 120 with evidence of acute end organ damage.

Parenteral Treatment

Question 19

Explain “Hypertensive Urgency”

Answer 19

DBP over 120 in asymptomatic patients

No evidence of benefit of parenteral treatment

Question 20

Important rules to diagnosing HTN

Answer 20

Can’t diagnose if already medicated, acutely ill

Required 2+ visits showing HTN on certified equipment

Question 21

Preferred method of diagnosing HTN?

Answer 21

ambulatory

Question 22

Physical exam findings that indicate risk for HTN probs

Answer 22

Obesity, Fundoscopic Exam, Thyroid Exam, Heart/CV and Lung Exam, Aneyursm, Bruits

EKG

Question 23

Lab tests that may indicate probs with HTN

Answer 23

Urinalysis, Fasting blood glucose, fasting lipid profile, serum electrolytes and creatinine

Question 24

What do you see on the EKG of a HTN patient

Answer 24

Dropped ST

Inverted Q

Question 25

Why do an echo on a HTN patient

Answer 25

Assess L ventricular mass, which corellates w/ negative outcomes

Question 26

Target of therapy for low risk patients over 60? Who are low risk patients?

Answer 26

under 150/90 | No diabetes, CKD, or target organ damage

Question 27

How does the treatment goal change for low risk HTN patients under 60

Answer 27

140/90 goal

Question 28

Target of HTN therapy for high risk patients

Answer 28

Below 130/80

Question 29

Important lifestyle modifications to suggest for HTN patients

Answer 29

Lose weight if overweight + Exercise DASH diet Dietary Na Reduction Moderate OH Activity

Question 30

Important rules of DASH diet

Answer 30

Fruits and Vegetables (4-5 servings/day) Low fat Dairy Products (2-3) Low total+saturated fats

Question 31

First line drugs for Stage 1 HTN

Answer 31

Thiazides | ACE-i of CCB also fair game

Question 32

WHy use a diuretic for HTN?

Answer 32

Correct Na excretion defect | Lower peripheral resistance

Question 33

If treating diabetic or black patients, first line antihypertensives include...

Answer 33

Thiazide | CCB

Question 34

First line treatment of HTN in patient with CKD + HTN

Answer 34

ACEi or ARB