5: Hypertension

Question 0

Essential HTN

Answer 0

*regardless of underlying predominant pathophysiology, pts without identified secondary causes are classified having essential HTN

Question 1

Hypertension- definition

Answer 1

systolic >140 or diastolic >90

on two or more occasions

Question 2

Drugs causing 2ary HTN

Answer 2

Chronic alcohol use in high doses
Cocaine
NSAIDs
Adrenergic meds
Decongestant containing ephedrine
Nicotine
Exogenous estrogens

Question 3

Pointers for BP measurement

Answer 3

• pt should not smoke or drink caffeine 30mins prior

- let the pt rest for 5mins in a quiet setting

Question 4

Cardiac damage

Answer 4

Left ventricular heave
S4
Pulmonary or peripheral edema

Question 5

Cerebrovascular damage

Answer 5

Carotid bruit

Neurologic deficits

Question 6

Peripheral vascular damage

Answer 6

Diminished pulses

Aneurysms

Question 7

Ocular damage

Answer 7

Arteriovenous nicking
Hemorrhages, exudates
Papilledema

Question 8

Renal damage

Answer 8

Peripheral edema

Renal bruits

Question 9

Hypertensive retinopathy- grades

Answer 9

0: no change
1: Barely detectable arteriolar narrowing
2: Obvious arteriolar narrowing with focal irregularities
3: 2+retinal hemorrhages or exudates
4: 3+papilledema

Question 10

Ocular damage by Arteriolar sclerosis- grades

Answer 10

0: normal
1: Barely detectable light reflex changes
2: Obvious increased light reflex changes
3: Copper wire arterioles
4: Silver wire arterioles

Question 11

Secondary HTN- suspect it when…

Answer 11

• abrupt onset of HTN
• BP>180/110mmHg at the time of diagnosis
• extreme age group on diagnosis: below 25 or above 65yrs
• episodes of hypertensive crisis- malignant HTN
• BP not responding to antihypertensive drugs
• sudden worsening of HTN in spite of good compliance

Question 12

Initial lab tests

Answer 12

• 12 LEAD EKG
• Urinalysis
• Hematocrit
• Fasting blood glucose or A1c
• serum Na, K, Creatinine, Ca
• lipid profile after a 9-12hr fast

Question 13

HTN- management

Answer 13

All ages

-CKD w/ or w/o diabetes: goal of 60: goal of 20 above the systolic goal-> initiation with 2 anti-HTN agents

Question 14

Ambulatory BP monitoring

Answer 14

in UK, HTN is confirmed with 24hr BP monitoring

mean 24hr BP of >130/80 is regarded as elevated BP

Question 15

Hypertensive urgency

Answer 15

HTN crisis (BP>180/120)

• no end organ damage
• BP can be brought down safely within a few hours

Question 16

Hypertensive emergency

Answer 16

HTN crisis

• target organ dysfunction and damage
• BP must be reduced immediately in an intensive care unit of a hospital
• > Immediate BP lowering by 25%-> gradually to 160/110 over next 2 to 6hrs
• rapid lowering of BP to near normal levels is avoided

Question 17

Metabolic syndrome X

Answer 17

dx by 3 out of 5
-Fasting glucose of >100mg/dL or drug for it
-BP >130/85mmHg or drug for it
-Triglyceride >150mg/dL or drug for it
-HDL 102cm (40in) in men, >88cm (35in) in women
if Asian American: >90cm (35in) in men, >80cm (32in) in women