PRIMARY (ESSENTIAL) HYPERTENSION

Question 1

Pathogenesis of Primary HTN

Answer 1

Increased sympathetic activity and responsiveness

Increased angiotensin II (AII) activity and mineralocorticoid excess

Question 2

Management of Primary HTN

Answer 2

Drug selection depends on underlying conditions, “compelling indications” (e.g., ACEI/ARB for heart failure, post-myocardial infarction, α-blockers for benign prostate hypertrophy, β-blockers for essential tremors, hyperthyroidism, migraine, atrial fibrillation/flutter with rapid ventricular rates, potassium-sparing diuretics for hyperaldosteronism, thiazide diuretics for osteoporosis).

Question 3

Note specific drug contraindications

Answer 3

ACEI in angioedema, β-blockers with poorly controlled bronchospasm, reserpine in depression, methyldopa in liver disease, ACEI/ARB/or renin inhibitors in pregnancy or pregnancy planning, β-blockers and non-dihydropyridine CCB in second- or third-degree heart blocks