Hypertension

Question 1

As BP increases so does the risk of: 5 things

Answer 1

i. MI
ii. Heart failure
iii. Stroke
iv. Renal disease
v. Retinopathy

Question 2

All ethnicities: Three factors for decreased prevalence

Answer 2

Born outside US
Doesn’t speak English
Limited time living in US

Question 3

African Americans has (3 things)

Answer 3

Highest prevalence
More resistant HTN
More nocturnal non dipping BP

Question 4

African Americans are less responsive to

Answer 4

renin inhibiting meds

Better control with: calcium channel blockers & diuretics

Question 5

African Americans are at an increased risk of

Answer 5

Angioedema (allergy deep in skin) with ACE inhibitors

Question 6

Men & HTN

Answer 6

more common before middle age

Question 7

Women & HTN

Answer 7

increased 2-3x with oral contraceptives
Preeclampsia
More common after menopause
Harder to control for women

Question 8

Normal BP

Answer 8

Systolic <120

Dystolic <80

Question 9

Elevated (pre-hypertension) BP

Answer 9

SBP 120-129

DBP <80

Question 10

Hypertension stage 1

Answer 10

SBP 130-139

DBP 80-89

Question 11

Hypertension Stage 2

Answer 11

SBP 140 or higher

DBP 90 or higher

Question 12

Hypertension Crisis

Answer 12

SBP higher than 180

DBP higher than 120

Question 13

Two types of hypertension

Answer 13

Primary & secondary hypertension

Question 14

Primary hypertension

Answer 14

also called essential/idiopathic HTN
Elevated BP of unknown cause
90-95%

Question 15

Contributing factors to primary hypertension (8 things)

Answer 15

Altered endothelial function increased SNS activity
increased Na+ intake
overproduction of Na+ retaining hormones
overweight
diabetes
tobacco
excess alcohol

Question 16

Secondary hypertension

Answer 16

elevated BP with specific cause; sudden development

5-10%

Question 17

Clinical findings relate to underlying cause (secondary hypertension)

Answer 17

Cirrhosis;
aortic problems;
drug-related;
endocrine, neurologic, or renal problems; pregnancy-induced, or sleep apnea

Question 18

Secondary hypertension treatment is

Answer 18

aimed at removing or treating cause

Question 19

Increased BP=

Answer 19

Increased CO or SVR

Persistently increased SVR

Question 20

Risk Factors for Primary Hypertension

Answer 20

a. Age
b. Alcohol use
c. Tobacco use
d. Diabetes
e. Elevated serum lipids
f. Excess dietary sodium
g. Gender
h. Family history
i. Obesity
j. Ethnicity
k. Sedentary lifestyle
l. Socioeconomic status
m. Stress

Question 21

Different sets of genes regulate

Answer 21

BP at different times

Question 22

Research of primary hypertension genetic link

Answer 22

endothelial dysfunction

Question 23

Hypertension Clinical Manifestations (S&S)

Answer 23

“Silent Killer” asymptomatic until severe & target organ disease occurs

Question 24

Symptoms of severe hypertension (6 things)

Answer 24

Fatigue
Dizziness
Palpitations
Angina
Dyspnea
Nocturia

Question 25

Target organ diseases occur most frequently in:

Answer 25

♡ , brain, peripheral vascular disease, kidney, eyes

Question 26

What occurs in the ♡ from HTN?

Answer 26

1. Coronary artery disease; atherosclerosis 2. Left ventricular hypertrophy a. Large & thickening 3. Heart failure

Question 27

What occurs in the brain from HTN?

Answer 27

Cerebrovascular disease TIA/Stroke; atherosclerosis Hypertensive encephalopathy

Question 28

What occurs in peripheral vascular disease?

Answer 28

i. Atherosclerosis leads to PVD, aortic aneurysm, aortic dissection ii. Intermittent claudication

Question 29

Kidney

Answer 29

Nephrosclerosis leads to chronic kidney disease (CKD)

Question 30

Eyes-retinal damage

Answer 30

Blurry or loss of vision; retinal hemorrhage

Question 31

Damaged retinal vessels indicate concurrent damage to

Answer 31

in heart, brain, and kidneys

Question 32

Labs are done for hypertension too:

Answer 32

1. Identify or rule out secondary HTN 2. Evaluate target organ disease 3. Determine CV risk 4. Establish baselines before starting therapy

Question 33

Hypertension lab names:

Answer 33

Renal function, U/A, BMP, CBC, serum lipid profile, uric acid, ECG, ophthalmic exam

Question 34

Ambulatory blood pressure monitoring (ABPM); avoids

Answer 34

"white coat" HTN

Question 35

Noninvasive, fully automated system that measures BP at preset intervals over 12 to 24-hour period

Answer 35

Ambulatory BP monitoring

Question 36

Teaching for ABPM

Answer 36

Teach patient to hold arm still while device reads BP and keep diary of activities

Question 37

Other applications for use of ABPM

Answer 37

1. Antihypertensive drug resistance 2. Hypotensive symptoms with antihypertensive therapy 3. SNS dysfunction 4. Episodic HTN (spiking during different times of the day) 5. Diurnal variability; nondippers; reverse dippers

Question 38

Lifestyle modifications, AHA life's simple 7

Answer 38

2. Manage BP 3. Control cholesterol 4. Reduce blood sugar 5. Get active 6. Eat better 7. Lose weight 8. Stop smoking

Question 39

Overall goals of HTN care

Answer 39

i. Achieve and maintain goal BP | ii. Reduce CV risk factors and target organ disease

Question 40

Lifestyle modifications

Answer 40

Weight reduction i. Weight loss of 1 kg (2.2lbs) will decrease SBP by 1 mm Hg ii. Calorie restriction and physical activity

Question 41

DASH eating plan

Answer 41

i. Fruits, vegetables, fat-free or low-fat milk/milk products, whole grains, fish, poultry, beans, seeds, and nuts ii. Calcium & Magnesium

Question 42

Sodium for healthy adults

Answer 42

less than 2300 mg/day

Question 43

Sodium for blacks, middle-aged and older, those with hypertension, diabetes, or chronic kidney disease

Answer 43

less than 1500 mg/day

Question 44

Salty Six (AHA)

Answer 44

bread/rolls, lunch and cured meats, sandwiches, pizza, soup, poultry

Question 45

Moderation of Alcohol Intake

Answer 45

Men: 2 drinks/day; women: 1 drink/day

Question 46

Physical Activity

Answer 46

Moderate-intensity aerobic activity, at least 30 minutes, most (at least 5) days of the week for goal of 150 minutes/week

Question 47

Nicotine causes

Answer 47

vasoconstriction and elevated BP

Question 48

Smoking cessation reduces risk factors

Answer 48

within 1 year

Question 49

Two primary actions of hypertension

Answer 49

i. Decrease circulating blood volume | ii. Reduce SVR

Question 50

Patient teaching

Answer 50

i. If a drug is not tolerated, then another classification will be used ii. Monthly follow-up visits until at goal BP; then 3 to 6 months

Question 51

Patients should:

Answer 51

report all side effects & different meds may be tried if severe

Question 52

Common side effects of drug therapy

Answer 52

Orthostatic hypotension sexual problems dry mouth frequent voiding

Question 53

Failure to reach goal BP with appropriate therapy and drug

Answer 53

Resistant Hypertension

Question 54

Resistant hypertension increases the risk for

Answer 54

stroke of MI

Question 55

Causes of resistant hypertension

Answer 55

1. Improper BP measurement 2. Volume overload 3. Drug-induced or other causes 4. Associated conditions 5. Secondary HTN

Question 56

Primary prevention of HTN

Answer 56

1. Lifestyle modification—DASH, decreased Na+ | 2. Education regarding dangers of HTN

Question 57

Individual patient evaluation and education (4 things)

Answer 57

i. Screening programs ii. Identify risk factors for HTN and CAD iii. BP measurement; health assessment iv. Drugs and/or previous treatment

Question 58

Assess for orthostatic hypotension

Answer 58

i. BP and HR after supine for 5 minutes ii. Assist to standing iii. Measure BP and HR at 1 minute and 3 minutes of position change

Question 59

Normal orthostatic hypotension

Answer 59

``` SBP decreased (less than 10 mm Hg) DBP and HR increased slightly ```

Question 60

Abnormal orthostatic hypotension

Answer 60

SBP decreased 20 mm Hg or more 1. DBP decreased 10 mm Hg or more 2. HR increased 20 beats/min or more

Question 61

Most patients start with

Answer 61

diuretic