Hypertension Chat

Question 1

Definition of Hypertension (2017 ACC/AHA)

Answer 1

Sustained SBP >130 mmHg and/or DBP >80 mmHg

Question 2

Prevalence of HTN in US

Answer 2

Affects over 100 million people; nearly ½ of adults

Question 3

Ethnic Disparities in HTN

Answer 3

40% of African Americans, 30% Whites, 29% Asians, 27% Hispanics

Question 4

Primary HTN Causes

Answer 4

Unclear; associated with SNS activity, RAAS dysregulation, low vasodilators

Question 5

Secondary HTN Common Causes

Answer 5

Hyperaldosteronism, thyroid dysfunction, OSA, Cushing’s, pheochromocytoma

Question 6

HTN Organ Damage

Answer 6

Can lead to ischemic heart disease, stroke, renal failure, retinopathy, and more

Question 7

Isolated Systolic HTN

Answer 7

SBP >130 mmHg & DBP <80 mmHg

Question 8

Isolated Diastolic HTN

Answer 8

SBP <130 mmHg & DBP >80 mmHg

Question 9

Combined HTN

Answer 9

SBP >130 mmHg & DBP >80 mmHg

Question 10

Pulse Pressure Significance

Answer 10

Widened pulse pressure = vascular stiffness and CV risk

Question 11

HTN Treatment Goal

Answer 11

BP <130/<80 mmHg

Question 12

Resistant HTN

Answer 12

BP above goal on 3+ meds at max dose

Question 13

Refractory HTN

Answer 13

Uncontrolled BP on 5+ drugs

Question 14

Pseudo-resistant HTN

Answer 14

Due to white coat syndrome or poor compliance

Question 15

Weight Loss & HTN

Answer 15

1 mmHg BP drop per 1 kg weight loss

Question 16

Dietary Factors

Answer 16

Low salt, high K+ and Ca2+ reduce BP

Question 17

Alcohol & Exercise Effects

Answer 17

ETOH increases HTN; exercise reduces it

Question 18

First-line Drugs (Nonblack)

Answer 18

ACE-I, ARB, CCB, Thiazide

Question 19

First-line Drugs (Black pts)

Answer 19

CCB or Thiazide

Question 20

HTN & Diabetes/CKD Goal

Answer 20

Same as general HTN: <130/<80 mmHg

Question 21

Beta Blockers Role

Answer 21

Not first-line unless CAD or tachyarrhythmia present

Question 22

Preop HTN Considerations

Answer 22

BP trends more important than one-time reading

Question 23

When to Delay Surgery

Answer 23

Only for SBP >180 or DBP >110 with symptoms

Question 24

Intraoperative Risk

Answer 24

HTN increases risk of MI, CVA, blood loss

Question 25

HTN and Induction

Answer 25

At risk for hypotension from drugs and HTN from intubation

Question 26

Hypertensive Crisis

Answer 26

SBP >160 or DBP >110 with end-organ damage

Question 27

Fast-acting Antihypertensives

Answer 27

Clevidipine (1-min half-life), SNP for arterial dilation

Question 28

HTN Vascular Changes

Answer 28

Remodeling, endothelial dysfunction, irreversible damage

Question 29

Diseases Linked to Vasculopathy

Answer 29

Ischemic heart disease, LVH, CVA, PAD, nephropathy

Question 30

Diagnostic Tools for Vasculopathy

Answer 30

Carotid ultrasound, EKG, echocardiogram, MRI

Question 31

Drugs that Increase BP

Answer 31

Include NSAIDs, steroids, decongestants, etc.

Question 32

Common Secondary HTN in Kids

Answer 32

Renal parenchymal disease or aortic coarctation

Question 33

Secondary HTN Treatments

Answer 33

Includes surgical correction, aldosterone antagonists

Question 34

White Coat HTN

Answer 34

Transient HTN due to anxiety in clinical settings

Question 35

Preop Medication Management

Answer 35

Pause ACE-I & diuretics; continue BBs, CCBs

Question 36

Symptoms Suggesting Secondary HTN

Answer 36

Flushing/sweating (pheo), bruit (RAS), low K+ (hyperaldo)

Question 37

Risks of Stopping BBs or Clonidine

Answer 37

Can cause rebound HTN

Question 38

HTN Effects During Induction

Answer 38

Vulnerable to hypotension from meds, HTN from DL

Question 39

Volume Status in HTN

Answer 39

Often volume-depleted due to diuretics

Question 40

Considerations for A-line & Induction

Answer 40

Consider pre-induction A-line and Esmolol

Question 41

Hypertensive Urgency vs Emergency

Answer 41

Emergency = end-organ damage; urgency = no damage

Question 42

Drugs for Hypertensive Emergency

Answer 42

Labetalol, Clevidipine, Nicardipine, SNP

Question 43

Titration Goal in HTN Crisis

Answer 43

Slowly reduce BP to avoid hypoperfusion

Question 44

Definition of PH

Answer 44

Mean PAP >20 mmHg

Question 45

Symptoms of PH

Answer 45

Accentuated S2, LE swelling, dyspnea, syncope

Question 46

PH Hemodynamic Profiles

Answer 46

Precapillary, Postcapillary, Combined

Question 47

Precapillary PH Criteria

Answer 47

PVR ≥3.0 WU, PAWP <15 mmHg

Question 48

Postcapillary PH Criteria

Answer 48

PAWP >15 mmHg, normal PVR

Question 49

Combined PH Criteria

Answer 49

PAWP >15 mmHg, PVR >3.0 WU

Question 50

PAH Diagnostic Test

Answer 50

Right heart catheterization

Question 51

PAH Mortality & Prevalence

Answer 51

Rare; 15 per million; 1-year mortality ~15%

Question 52

PAH Risk Factors

Answer 52

Idiopathic, genetic (BMPR2), drugs/toxins

Question 53

Classes of PAH Drugs

Answer 53

Prostanoids, ERAs, NO/cGMP modulators

Question 54

Prostanoids in PAH

Answer 54

Epoprostenol (IV) lowers mortality; others improve function

Question 55

Nitric Oxide in PAH

Answer 55

Inhaled NO → vasodilation via cGMP; short-lived

Question 56

ERAs in PAH

Answer 56

Block endothelin to improve hemodynamics

Question 57

Surgical Risks in PAH

Answer 57

Venous embolism, hypoxia, airway pressure, RV stress

Question 58

Symptoms of Advanced PAH

Answer 58

Angina, syncope, ascites, peripheral edema

Question 59

PAH Preop Workup

Answer 59

Right heart cath for mod-severe cases; vasoreactivity testing

Question 60

Responsive PAH to CCB

Answer 60

Only 10–15% respond to inhaled NO and CCBs

Question 61

PAH: Intraop Goal

Answer 61

Maintain RV-pulmonary circulation coupling

Question 62

RV Afterload in PAH

Answer 62

Increased, dynamic interaction with vascular stiffness

Question 63

Myocardial Supply-Demand in PAH

Answer 63

RV ischemia from high wall stress, low perfusion

Question 64

Ortho Surgery Risk in PH

Answer 64

Increased morbidity/mortality in hip/knee surgery

Question 65

Laparoscopy Risk in PAH

Answer 65

CO2, head-down, and increased pressure affect RV

Question 66

Thoracic Surgery Risk in PAH

Answer 66

Lung collapse causes hypoxia and ↑RV afterload

Question 67

Conversion to Inhaled Vasodilators

Answer 67

Done for PAH pts during lung collapse or surgery