Therapeutics of HTN pt. 1

Question 1

what is essential htn

Answer 1

elevated arterial blood pressure with an unknown etiology

Question 2

what is secondary htn

Answer 2

elevated arterial blood pressure due to concurrent medical conditions or medications

Question 3

what is isolated systolic htn

Answer 3

systolic BP values are elevated and diastolic BP values are not

Question 4

what is resistant htn

Answer 4

failure to attain BP goal while adherent to a regimen that includes at least 3 agents at max dose (including a diuretic) or when 4 or more agents are needed

Question 5

what is orthostatic hypotension

Answer 5

a systolic BP decrease of >20 mmHg, a diastolic BP decrease of >10 mmHg within three minutes of positional change, and/or increase in HR >20 bpm

Question 6

what are essential htn pathophysiology

Answer 6

humoral abnormalities
neuronal mechanisms
vascular endothelial mechanisms
peripheral autoregulation defects
electrolyte disturbances

Question 7

what are the modifiable htn risk factors

Answer 7

high sodium intake
obesity
low potassium intake
excess alcohol intake

Question 8

what are the non-modifiable htn risk factors

Answer 8

age
ethnicity
genetic predisposition
gender

Question 9

what can cause secondary htn

Answer 9

CKD
renovascular disease
primary aldosteronism
OSA
drug-induced
food/substances
pheochromocytoma
cushing’s syndrome/chronic steroid use
thyroid or parathyroid disease
aortic coarctation

Question 10

what substances can increase BP

Answer 10

illicit drugs
caffeine
nicotine
decongestants
amphetamines
antidepressants
atypical antipsychotics
immunosuppressants
OCs
NSAIDs
systemic steroids
oncology agents

Question 11

what is the in office BP measurement

Answer 11

two readings, 5 minutes apart, and sitting in a chair. take measurement in opposite arm to confirm reading

Question 12

what is ambulatory BP monitoring indicated for

Answer 12

indicated for white coat, masked htn, nighttime BP dipping

Question 13

what is home BP monitoring indicated for

Answer 13

indicated for evaluation of white coat, masked htn, and response to therapy

Question 14

what is normotensive BP pattern

Answer 14

no htn in healthcare setting
no htn in home/AMB setting

Question 15

what is sustained htn BP pattern

Answer 15

htn in healthcare setting
htn in home/AMB setting

Question 16

what is masked htn pattern

Answer 16

no htn in healthcare setting
htn in home/AMB setting

Question 17

what is white coat htn pattern

Answer 17

htn in healthcare setting
no htn in home/AMB setting

Question 18

what are the pros of HBPM and ABPM

Answer 18

confirm diagnosis
aide in med titration
identify white coat and masked htn
better predictor of long term cv outcomes

Question 19

what are the cons of HBPM and ABPM considerations

Answer 19

user error
equipment cost
will insurance cover?

Question 20

what is normal BP

Answer 20

<120 AND <80

Question 21

what is elevated BP

Answer 21

120-129 AND <80

Question 22

what is htn stage 1

Answer 22

130-139 OR 80-89

Question 23

what is htn stage 2

Answer 23

> =140 OR >=90

Question 24

what is the ACC/AHA recommendation for normal BP

Answer 24

healthy lifestyle changes
reassess in 1 year

Question 25

what is the ACC/AHA recommendation for elevated BP

Answer 25

non-pharm tx reassess in 3-6 months

Question 26

what is the ACC/AHA recommendation for htn stage 1

Answer 26

Question 27

what is the ACC/AHA recommendation for htn stage 2

Answer 27

Question 28

how often should pts at BP goal follow up

Answer 28

q3-6 months

Question 29

what is the BP threshold for tx initiation for clinical CVD or 10yr ASCVD risk >= 10%

Answer 29

>= 130/80

Question 30

what is the BP threshold for tx initiation for no clinical CVD or 10yr ASCVD risk <10%

Answer 30

>=140/90

Question 31

what is the BP threshold for tx initiation for older persons (>=65yo)

Answer 31

systolic BP >=130

Question 32

what is the BP threshold for tx initiation for pt with stable ischemic heart disease

Answer 32

>= 130/80

Question 33

what is the BP threshold for tx initiation for pt with secondary stroke prevention

Answer 33

>=140/90

Question 34

what are the goals of htn tx

Answer 34

decrease morbidity/mortality by: reaching BP targets select agent with proven CV benefit

Question 35

what is the ACC/AHA and ADA BP goal

Answer 35

<130/80

Question 36

what is the ACC/AHA BP goal for elderly

Answer 36

<140/90

Question 37

what is the KDIGO BP goal

Answer 37

SBP <120 for adults with elevated BP and CKD, if tolerated

Question 38

what is SPRINT trial's subject population

Answer 38

pts without diabetes or prior stroke

Question 39

what is SPRINT trial's outcome

Answer 39

reduced death in intensive group average of 2.8 meds needed to achieve systolic <120 increased risk of hypotension, electrolyte imbalances, AKI

Question 40

what is ACCORD trial's subject population

Answer 40

pts with T2DM, age 40-79, CVD or multiple CVD risk factors

Question 41

what is ACCORD trial's outcome

Answer 41

reduced risk of stroke by 41% increased risk of AEs

Question 42

what is weight loss impact on SBP

Answer 42

-5 mmHg

Question 43

what is DASH diet impact on SBP

Answer 43

-11 mmHg

Question 44

what is decreased sodium intake impact on SBP

Answer 44

-5 to 6 mmHg

Question 45

what is enhanced potassium intake impact on SBP

Answer 45

-4 to 5 mmHg

Question 46

what is physical activity impact on SBP

Answer 46

-4 to 8 mmHg

Question 47

what is moderate alcohol intake impact on SBP

Answer 47

-4 mmHg

Question 48

what does the DASH diet recommend

Answer 48

veggies and fruits whole grains fat free or low fat dairy products fish, poultry, beans nuts, vegetable oil foods rich in K, Ca, Mg, fiber, protein, low Na

Question 49

what foods do DASH diet restrict

Answer 49

foods high in sat fats sweets sugar sweetened beverages

Question 50

what are htn pharm tx

Answer 50

ACEi ARBs CCB direct renin inhibitors Beta blockers diuretics alpha 1 blockers central alpha 2 agonists vasodilators