Hypertension lecture

Question 1

what is defined as HTN?

Answer 1

equal or above 140/90

Question 2

What percentage of HTN is secondary? (i.e. because of renal, endocrine, congenital etiologies)

Answer 2

5%

Question 3

____% of cases of HTN are etiology unknown

Answer 3

95%

Question 4

• Environmental factors
• Sympathetic hyperactivity
• RAA axis

can all lead to…

Answer 4

Hypertension

Question 5

Obesity
Excess Na intake
Cigarette smoking
NSAIDs
Excess alcohol

Answer 5

Exacerbating factors of HTN

Question 6

Estrogen use 
Renal dz
Renal vascular HTN
Endocrine disorders
Coarctation of aorta (congenital)
HTN in pregnancy

Answer 6

All secondary causes of HTN

Question 7

Hypertension accelerates progression of..

Answer 7

Renal insufficiency

Question 8

Any form of chronic renal parenchymal disease can result in..

Answer 8

Hypertension

Question 9

Marked increase of renin
2 forms:
Fibromuscular hyperplasia
Atherosclerosis

Answer 9

Renal artery stenosis

Question 10

Fibomuscular hyperplasia (FMH) usually presents in who?

BP markedly elevated; renal function preserved; arteriography diagnostic; angioplasty/stent beneficial in treatment.

Answer 10

Young adults

Question 11

Athersclerosis renal artery stenosis presents in..

(BP elevated and unresponsive to meds; renal function often impaired; intervention may or may not help; long term med Rx necessary.)

Answer 11

Older adults

Question 12

Heart’s response to pressure overload

Answer 12

Hypertrophy

Question 13

Powerful predictor of prognosis, morbidity, mortality, and cardiac events once present.

Answer 13

LVH and hypertension

Question 14

HTN is major predisposing cause of stroke. What part of BP is most closely correlated with stroke?

Answer 14

Systolic is correlated more with strokes

Question 15

Retinal changes: 
Narrowing of arterioles (A/V over .50)
A-V nicking- (arteriosclerosis) 
Silver or copper wired appearance
Hemorrhages or exudates
Papilledema

Answer 15

signs of HTN

Question 16

Creatinine
BUN
Potassium levels

Answer 16

MUST CHECK IN HTN PATIENTS! (among other things)

Question 17

Why must you check potassium levels in HTN?

Answer 17

Bc will most likely put the pt on a diuretic, which can cause HYPOKALEMIA!*

Question 18

if LVH seen on EKG, what next tests can you run?

Answer 18

Cardiac/echo doppler

Question 19

DOC for diabetics with HTN

Answer 19

ACE inhibitor (or ARB) along with thiazide or CCB

Question 20

Focus primarily on ______ as this is the most important target for reducing morbidity and mortality.

Answer 20

Systolic BP

Question 21

Initial therapy for most HTN patients…

Answer 21

Thiazide diuretics

cost effective, lower systolic BP

Question 22

Diuretics are most potent in…

Answer 22

Blacks, elderly and obese

more effective in smokers

Question 23

is Chlorthalidone more or less potent than HCTZ?

Answer 23

MORE!

Question 24

Avoid diuretics with…

Answer 24

Hypokalemia

Gout

Question 25

Beta blockers are less effective in...

Answer 25

Black populations | Elderly

Question 26

New (2008) selective β-blocker with vasodilating properties. Nitric oxide mediated vasodilation Loses selectivity in high doses

Answer 26

Nebivolol

Question 27

What drug class is preferred for blacks and elderly?

Answer 27

calcium channel blockers

Question 28

Progressive renal insufficiency; more common in black populations, especially in the presence of DM.

Answer 28

Nephrosclerosis

Question 29

Usually asymptomatic. A.M. headaches may occur. Late findings include: -Symptoms related to LVH: Diastolic dysfunction (SOB, DOE). -Symptoms related to cerebral involvement- *TIA, stroke, hemorrhage. -Symptoms related to cardiac involvement- MI, angina, HF.

Answer 29

Nephrosclerosis

Question 30

DOC for HTN and angina?

Answer 30

beta blocker or CCB

Question 31

DOC for HTN and HF?

Answer 31

ACE inhibitor

Question 32

DOC for HTN and diabetes? or for HTN and renal dz?

Answer 32

ACE inhibitor/ARB

Question 33

Goals of treating HTN?

Answer 33

decrease endpoints! | endopoints= MI, Stroke, LVH, PAD, all cause/cardiac mortality, HF and renal failure

Question 34

MI, Stroke, LVH, PAD, all cause/cardiac mortality, HF and renal failure.

Answer 34

Endpoints (what you are trying to avoid when treating HTN)

Question 35

Focus primarily on _____ BP as this is the most important target for reducing morbidity and mortality.

Answer 35

systolic

Question 36

#1 DOC for HTN

Answer 36

Thiazide diuretics

Question 37

- Initial effects via decreased plasma volume | - chronic effects via decreased SVR.

Answer 37

Diuretics

Question 38

Avoid in patients with hyponatremia and gout

Answer 38

Diuretics

Question 39

More potent in blacks, elderly and obese. More effective in smokers.

Answer 39

Diuretics

Question 40

Decrease BP by decreasing CO (-inotropic effect and ↓HR). SVR increases, renin levels decrease. Less effective in black populations and in elderly.

Answer 40

Beta blockers

Question 41

Very useful in patients with HTN and other co-morbid conditions: angina pectoris, post MI→↓mortality, HF→↓mortality, essential tremor, migraine headaches, arrhythmias/sudden death (class II anti-arrhythmic)

Answer 41

Beta blockers

Question 42

selective β-blocker with vasodilating properties. Nitric oxide mediated vasodilation Loses selectivity in high doses

Answer 42

Nebivolol (Bystolic)

Question 43

Mortality and other “end-point” benefits (post MI, HF) applicable primarily to....

Answer 43

lipid soluble beta blockers

Question 44

Are beta blockers as successful in LVH regression compared to other treatments?

Answer 44

NO

Question 45

May worsen acute HF; but clearly beneficial for patients with chronic compensated & stable HF and low ejection fraction- ↓mortality. May worsen advanced PAD and rest pain. Mask signs of hypoglycemia in Type I diabetics. CNS: Fatigue, nightmares, depression, sexual dysfunction-

Answer 45

Beta blockers

Question 46

Inhibit renin-angiotensin-aldosterone system and: Inhibit Bradykinin degradation Stimulate vasodilating prostaglandin synthesis. Useful as initial Rx or when added to other drugs for HTN.

Answer 46

ACE inhibitors

Question 47

ACE inhibitors Anti-hypertensive efficacy significantly improved when combined with...

Answer 47

diuretic | synergistic effects

Question 48

May be useful for heart failure in patients who cannot take ACEI; do not inhibit bradykinin breakdown. Renoprotective in diabetics. Few side effects, and no cough.

Answer 48

ARBs

Question 49

Act by peripheral vasodilation Effective in all demographic groups, and are preferable in blacks and the elderly. Additional protection against stroke

Answer 49

Ca channel blockers

Question 50

In addition to vasodilation these drugs have negative inotropic, chronotropic and dromotropic (slow A-V conduction) effects. Can exacerbate heart failure and cause SA and AV nodal dysfunction. Also used as anti-anginals and in Rx of arrhythmias.

Answer 50

Nondihydro CCBs

Question 51

Significant vasodilation, reduction in SVR. Fluid retention and reflex tachycardia occur (role of ß-blockers and diuretics). Unlikely to cause heart failure and conduction problems (in vivo). Must use long acting preparations. 2nd or 3rd line agents in diabetics.

Answer 51

Dihydro CCBs

Question 52

SE= headaches, periph edema

Answer 52

CCBs