Hypertension

Question 1

What does the first Korotkoff sound indicate?

Answer 1

Systolic Blood Pressure

Question 2

What is indicated by the end of Korotkoff sounds?

Answer 2

Diastolic Blood Pressure

Question 3

Hypertension is more common in men until which age group?

Answer 3

HTN is more common in women after 55-64

Question 4

The percentage of the population with HTN corresponds directly to which condition?

Answer 4

CVD

Question 5

What are some (8) risk factors for Atherosclerosis?

Answer 5

1. High LDL
2. Low HDL
3. Sex Hormones
4. HTN
5. Renal Failure
6. Diabetes
7. Smoking
8. Sedentary Life Style

Question 6

What is the leading cause of death in the US?

Answer 6

CVD (+ Stroke)

Question 7

People with HTN are more likely to develop which 3 conditions (and risk)?

Answer 7

1. Coronary Artery Disease (x3)
2. Congestive Heart Failure (x6)
3. Stroke (x7)

Question 8

What is the tightest disease link with elevated BP?

Answer 8

Stroke

Question 9

What is considered “normal” BP by JNC 7 and what are the recommendations for lifestyle modifications and drugs?

Answer 9

120/80

• Encourage LSM
• No Drugs

Question 10

What is considered “Pre-HTN” by JNC 7 and what are the recommendations for lifestyle modifications and drugs?

Answer 10

120-139/80-89

• Yes LSM
• No Drugs

Question 11

What is considered “Stage 1 HTN” by JNC 7 and what are the recommendations for lifestyle modifications and drugs?

Answer 11

140-159/90-99

• Yes LSM
• Mono or Combo Therapy

Question 12

What is considered “Stage 2 HTN” by JNC 7 and what are the recommendations for lifestyle modifications and drugs?

Answer 12

160+/100+

• Yes LSM
• Combo Drug Therapy

Question 13

What is Kaplan’s definition of HTN?

Answer 13

“HTN is that level of blood pressure at which the benefits of therapy outweigh the risks”

Question 14

Lowing BP decreases the risk of which three conditions?

Answer 14

1. Stroke**
2. MI
3. CHF
   * *Lowering BP prevents Strokes better than it prevents MI

Question 15

What are compelling indications for HTN?

Answer 15

1. Heart Failure
2. Diabetes with Proteinuria
3. CAD (prior MI increases risk)
4. Chronic Renal Insufficiency
5. CVA

Question 16

What formula allows estimation of BP?

Answer 16

MAP - CVP = CO x TPR

**You can ignore CVP since it is so low

Question 17

How would an increase in BP effect CO and TPR?

Answer 17

Either CO or TPR (or both) would increase

Question 18

How are cardiovascular reflexes elicited?

Answer 18

Through signals from baroreceptors (Carotid Sinus and Aortic Arch) and Chemoreceptors (Peripheral, Aortic and Carotid Body) that trigger responses (sympathetic, parasympathetic or hormonal)

Question 19

Blood Pressure can be thought of as caused by which organ system?

Answer 19

The kidney and sodium excretion

Question 20

What is the priority in responding to hemorrhage, and what hormones are involved?

Answer 20

Goal- Maintain MAP

Hormones- RAAS, Sympathetics and Endothelin

Question 21

What is the priority in responding to salt excess, and what hormones are involved?

Answer 21

Goal- Excrete Salt

Hormones- ANP, Cardiotonic Steroids, NO

Question 22

What is the key feature of Guyton’s Concept of Hypertension?

Answer 22

A renal set point for sodium homeostasis

Question 23

Guyton’s model of HTN showed what? What is the consequence?

Answer 23

That increases in TPR or CO –> Increased BP, but only transiently before returning to normal.
**This means an altered renal “set point” is necessary to maintain HTN

Question 24

What is used to diagnose renovascular hypertension? What is an alternative?

Answer 24

1. Arteriogram

2. Captopril Renogram may be used as a screening test

Question 25

What is the consequence of decreased perfusion to one kidney?

Answer 25

The effected kidney will secrete Renin --> AII --> Aldo --> causes the normal kidney to decrease Na excretion --> HTN

Question 26

What is indicated by non-stimulatable Renin levels and non-supressable Aldosterone levels with low serum Potassium?

Answer 26

Hyperaldosteronism

Question 27

What is a Pheochromocytoma?

Answer 27

A tumor causing autonomous production of NE and E (vasoconstrictors) leading to an increase in TPR and elevated serum catecholamines

Question 28

How does chronic renal failure result in HTN?

Answer 28

Impaired natriuresis --> volume expansion --> increased CO and increased PR --> Increased BP

Question 29

What are causes of essential HTN?

Answer 29

1. Genetics 2. Dietary Na 3. Alcohol 4. Stress 5. Sedentary Lifestyle 6. Smoking 7. Dietary K and Ca

Question 30

What are causes of secondary HTN?

Answer 30

1. Chronic Renal Failure 2. Renovascular 3. Aldosteronism 4. Pheochromocytoma 5. Sleep Apnea 6. Hypothyroidism 7. Coarction of the Aorta

Question 31

What is Malignant HTN?

Answer 31

A medical emergency where there is evidence for acute vascular injury (usually seen through the retinal exam) **BP may not be that "high"

Question 32

Who should be evaluated for secondary HTN?

Answer 32

1. HTN presenting early -30 2. HTN without a family history 3. Severe or difficult to control HTN

Question 33

What is the gold standard evaluation method for renovascular HTN?

Answer 33

Arteriogram

Question 34

What are the 3 types of Hyperaldosteronism?

Answer 34

1. Adrenal Tumor (Conn's) 2. Adrenal Hyperplasia 3. Pseudohyperaldosteronism (Licorice/tobacco/Liddle's Syndrome)

Question 35

Hypokalemia in the face of an ACE inhibitor is a red flag for what condition?

Answer 35

Hyperaldosteronism

Question 36

How does one stimulate Renin and suppress Aldosterone in the diagnosis of Hyperaldosteronism?

Answer 36

1. Stimulate Renin with DIURETIC | 2. Suppress Aldo with VOLUME EXPANSION

Question 37

What are the Grades for Fundoscpoic Changes?

Answer 37

I- Arterial narrowing II- AV Nicking III- Hemorrhage/Exudate IV- Papilledema

Question 38

What are risk factors for Atherosclerosis?

Answer 38

1. Smoking 2. Dyslipidemia (High LDL or Low HDL) 3. Age > 60 4. Male or postmenopausal female 5. Family History

Question 39

What is the drug recommendation for uncomplicated HTN?

Answer 39

Diuretics and Beta Blockers

Question 40

What is the drug recommendation for diabetes and HTN?

Answer 40

ACE Inhibitors or ARB

Question 41

What is the drug recommendation for MI?

Answer 41

Beta Blocker

Question 42

What is the drug recommendation for Systolic Heart Failure?

Answer 42

ACE Inhibitors or ARB

Question 43

In JNC 8, why are Beta Blockers no longer first line for HTN?

Answer 43

Less stroke protection