Primary Hypertension I

Question 1

BP to categorize as hypertension (in healthy and in diabetes)

Answer 1

healthy; 140/90

DM; 130/80

Question 2

criteria for diabetes

Answer 2

1. hypertensive urgency or emergency
2. hypertension with end-organ damage or DM (VISIT 2)
3. diagnosis based on repeat clinic visits, ambulatory blood pressure monitor, or self/home prsesure monitoring (3+ VISITS)

Question 3

Question 4

endogenous regulation/factors of blood pressure

Answer 4

autoregulation/feedback through symptathetic nervous system (SVR)

• renin-angiotensin-aldosterone system (SVR)
• plasma volume (CO)

Question 5

general causes of a high blood pressure

Answer 5

1. genetic
2. poor diet
3. lack of exercise
4. stress
5. alcohol
6. certain medications

Question 6

How do you ensure BP accuracy?

Answer 6

• discrard first reading if auscultationg
• use average of subsequent 2+ readings

Question 7

___ ____ is the preferred method of performing in-office BP measurement

Answer 7

automated blood pressure

Question 8

what type of BP measurement is the preferred way of diagnosing hypertension

Answer 8

out of office BP measurements (ambulatory BP measurement, or home BP measurement)

Question 9

Question 10

masked hypertension and white coat hypertension

Answer 10

skewed hypertensive states that is not true hypertension

masked; normotensive in office, below 140, but above that at home.

white coat; super high blood pressure in the office, but low at home

Question 11

note

Question 12

central nervous system symptoms of end organ damage

Answer 12

CNS; agitation/confusion, seizures (hypertensive encephalopathy)

Question 13

ENT symptoms of End organ damage

Answer 13

hypertensive retinopathy

Question 14

outline some systemic symptoms of end organ damage head to toe

Answer 14

Central Nervous System
• Stroke; ischemic and hemorrhagic
• Dementia

Eyes/Ears/Nose/Throat
• Hypertensive Retinopathy

Cardiac and Peripheral Vascular Disease
• CAD, LVH, PVD
• CHFrEF (systolic dysfunction) and CHFpEF (diastolic dysfunction)

Renal
• Chronic kidney disease (low GFR or proteinuria)
• End-stage renal disease

Question 15

usually you have to do an AOBP >135/80 or OBPM >140/90 and measure the BP multiple times. when can you diagnose hypertension on the first visit?

Answer 15

when BP>180/110 on first visit

Question 16

outline the hypertension diagnostic algorithm

Answer 16

Question 18

physical findings on eye exam that is indicative of hypertensive retinopathy

Answer 18

cotton wool spots, AV nicking, retinal hemorrahes, optic disc swelling, hard exudates

Question 19

general rule of thumb when it comes to hypertension as a risk for CVD

Answer 19

for every 20mmhg SBP and 10mmHG DBP above 115/75 the risk of death from heart disease or stroke doubles

Question 20

Initial Evaluation of the Hypertensive Patient

Answer 20

1. determine presence of end-organ damage (history/[hysical)
2. assess overall CV risk (to inform treatments)
3. consider ruling out secondary causes

Question 21

standard labs for hypertension

Answer 21

CBC- polycythemia, thrombocytosis

serum electrolytes

diabetes screening; fasting/random glucose, Hb A1c

serum creatinine, urinalysis, and random urine albumin: creatinine ratio

lipid profile

12 lead EKG

Question 22

CHEP global cardiovascular risk assessment; someone is high risk if they are diabetic, or if they are over 50 and have:

Answer 22

`1.clinical or sub-clinical cardiovascular disease

OR

2, chronic kidney disease (proteinuria <1g/d, eGFR <60ml/min)

3. estimated 10-year global cardiovascular risk >15% (framingham calculator)

OR

4. Age >75 years

Question 23