Hypertension

Question 1

Screening (USPSTF)

Answer 1

Start at 18 years of age

Question 2

Hypertension in a 60 year old

Answer 2

> 150 or > 90

Question 3

Organ systems impacted by hight blood pressure

Answer 3

Heart
Brain
Kidney
Blood vessels
Eyes

Question 4

How quickly can end organ damage begin

Answer 4

Within 10 years

Question 5

Family Hx: Death from CAD

Answer 5

Men

Question 6

Moderate EtOH

Answer 6

1. 0 oz men (2 drinks)

0. 5 oz women ( 1 drink)

Question 7

Kidney markers that indicate higher risk of hypertnesion

Answer 7

Micoalbuminuria

GFR 60 or lower

Question 8

Secondary HTN

Answer 8

Sleep apnea
CKD
Endocrine: Aldosterone, Thyroid, Cortisol, Epi/Norepi, Parathyroid
Coarctation of the aorta
Medications/Supplements/Drugs

Question 9

Percent of HTN that is essential

Answer 9

95 to 98

Question 10

How many times should BP be taken at a single visit if elevated

Answer 10

Twice

• 5 minutes apart
• Once in each arm

Question 11

How many visits does it take to dx HTN

Answer 11

At least two

Question 12

Length requirements for BP cuff

Answer 12

80% of arm circumference

Question 13

Width requirement for BP cuff

Answer 13

40% of arm circumference

Question 14

What should you conduct a neurological exam with new onset HTN

Answer 14

Get a baseline

Question 15

Explanatory model of illness

Answer 15

How a patient explains the cause of their illness, how they think they can manage it, and how they can stay healthy

Question 16

Labs for new dx of HTN

Answer 16

ECG: Baseline
UA: End organ damage
Blood glucose: Risk factor
Hematocrit: Anemia
K+: Medication
Cr or GFR: End organ damage
Ca+: May indicate HTN 2/2 renal dysfunction
Lipids: Risk factor
Albumin or Albumin/Cr ratio: End organ damage

Question 17

When should an ACEI be used for HTN in the general black population?

Answer 17

Age 60+
Chronic Kidney Disease
- Required 
Diabetes
- This is no longer a required medication

Question 18

Which treatment population can have a goal of

Answer 18

Age 60+

- Unless they are diabetic or have CKD

Question 19

Most cost effective medication for HTN

Answer 19

HCTZ

Question 20

Side effects of HCTZ

Answer 20

Low Na+
Precipitate gout flare
Incontinent

Question 21

Recommended dosages of HCTZ

Answer 21

25 mg is the optimal dose and be started in health adults

Pts 60+ should be started at lower doses and titrated up

Question 22

Effect of weight reduction

Answer 22

5 to 20 per 10 kgs lost

Question 23

Effect of DASH on HTN

Answer 23

8 to 14

Question 24

Effect of Na restriction on HTN

- 100 mmol/day (2.4 g Na or 6 g NaCl

Answer 24

2 to 8

Question 25

Effect of physical activity on HTN

Answer 25

4 to 9

Question 26

Effect of moderate EtOH on HTN

Answer 26

2 to 4

Question 27

ASA use in HTN

Answer 27

Men: 45 to 79 for MI reduction Women: 55 to 79 for stroke reduction

Question 28

Options for adjusting medication if not meeting goal | - All of the following are options

Answer 28

1. Maximize doses 2. Add second agent without changing the first 3. Do a fixed combo drug

Question 29

If BP is resistant to two medications

Answer 29

Add a third

Question 30

Should alpha-blockers ever be used as first line management?

Answer 30

No - No reduction in morbidity and mortality - Not even if patient has BPH

Question 31

Ethnic groups with worst BP control

Answer 31

Mexican and Native Americans

Question 32

Which medications are renal protective, regardless of BP control?

Answer 32

BB ACEI ARB

Question 33

One not so well known benefit of thiazides

Answer 33

Slows demineralization in osteoporosis

Question 34

Good for tachyarrhythmias/fibrillation, migraines, essential tremors, and perioperative HTN

Answer 34

Beta blockers

Question 35

Can BB mask hypoglycemia?

Answer 35

In theory

Question 36

What patients should avoid BB

Answer 36

Asthma patients

Question 37

Acceptable rise Cr after starting ACEI

Answer 37

35%

Question 38

Preg C category drugs

Answer 38

ACEI | ARBS

Question 39

Benefit of ARBS of ACEI

Answer 39

Less bradykinin production

Question 40

Useful in raynaud's and some arrhythmias

Answer 40

CCB

Question 41

Contraindicated for use in essential HTN and HTN urgencies or emergencies

Answer 41

Short acting CCB

Question 42

Cut off for starting a K sparing diuretic

Answer 42

K of 5+

Question 43

Risk of using high dose aldosterone in CHF

Answer 43

increase risk of sudden death

Question 44

When to refer to specialsit

Answer 44

Full adherence to appropriate 3 drug regimen - One drug must be a diuretic Maximize TLC

Question 45

Often overlooked medication that worsens HTN

Answer 45

NSAIDs