1. Hypertension

Question 1

Most common type of HTN?

Answer 1

Primary (essential)

(HTN is most common chronic disease in US)

Question 2

Primary HTN risk factors

Answer 2

Black

Economically disadvantaged

Obesity

Family history

Lifestyle (diet, alcohol, smoking, sedentary)

Question 3

Primary HTN symptoms

Answer 3

Often none

If symptomatic, Headache most common

Question 4

Primary HTN diagnostics

Answer 4

High BP from two readings on two separate occasions

Question 5

Secondary HTN causes

Answer 5

MOST COMMON:
Renovascular

Question 6

Secondary HTN symptoms/signs

Answer 6

Age <20 or >50 at dx

High BP at dx (160/120)

Three trials of different BP meds not effective

Question 7

Secondary HTN diagnostics

Answer 7

GOLD STANDARD: Renal angiogram for renovascular cause

(Maybe check TSH)

Question 8

Hypertensive Crisis. Compare Emergency vs Urgency

Answer 8

Both BP 180/120

Emergency = End organ damage
Retinal exam, encephalopathy (confusion, syncope), oliguria/azotemia

Urgency = No end organ damage yet
Put them in a quiet room
Lower BP slowly (160/100 over hours)
Clonidine/Captopril

Question 9

Primary HTN first line treatments for all

Answer 9

Non-pharm!

Diet (lower sodium, increase potassium, DASH)

Decrease alcohol/tobacco

Exercise, weight loss

Question 10

Primary HTN, when to start meds?

Answer 10

Ambulatory BP above or equal to 135/85
Avg. Office BP above or equal to 140/90

BP goal 130/80 if comorbidities or age 65+

Question 11

Can you combine HTN drugs from the same groups?

Answer 11

No!

Question 12

Who do ACE/ARBs work best for with HTN?

Answer 12

Young white patients

Question 13

ACE/ARBs are drug of choice if HTN patient has this comorbidity…

Answer 13

Diabetes or CKD

Question 14

Side effects of ACE/ARB

Answer 14

Cough

Teratogenic

Angioedema

Hyperkalemia

Question 15

Which condition (not pregnancy) makes ACE/ARB contraindicated for HTN tx?

Answer 15

Bilateral renal artery stenosis

Question 16

Who do calcium channel blockers work best for in HTN treatment?

Answer 16

They work equally for all

But preferred in older blacks since ACE/ARBs less effective for them

Question 17

Calcium channel blocker side effects

Answer 17

Headache

Constipation

Peripheral edema

Bradycardia (dilt/ver)

Question 18

For treatment of HTN only, are thiazide or loop diuretics preferred?

Answer 18

Thiazides

Question 19

Best starter drug for mild/moderate HTN?

Answer 19

Thiazide diuretic

Question 20

Who do thiazide diuretics work best in?

Answer 20

Old, black, obese

Question 21

Thiazide diuretics side effects

Answer 21

Hypokalemia

Hyponatremia

Increased uric acid

GOOD side effect! Increased calcium in blood, so less osteoporosis

Question 22

Aldosterone blockers side effects

Answer 22

Gyno

Hyperkalemia

Question 23

The only time beta blockers should be first line for HTN is when …

Answer 23

CAD hx is present

Question 24

Alpha blockers side effects

Answer 24

Orthostasis (give at night!)

Question 25

Drug of choice for pregnant women with HTN?

Answer 25

Methyldopa