8. Elevated Blood Pressure

Question 1

95 - 98% of the hypertension in the United States is essential hypertension

Answer 1

chronically higher blood pressure readings than normal with no underlying identifiable cause.

Question 2

Identifiable causes of hypertension are far less common and are known as

Answer 2

secondary hypertension

Question 3

Causes of secondary hypertension

Answer 3

sleep apnea, chronic renal disease, renovascular causes, drug-induced causes, pheochromocytoma, primary aldosteronism, chronic steroid use, Cushing’s syndrome, thyroid and parathyroid disease, and coarctation of the aorta.

Question 4

In order to accurately diagnose a patient with hypertension

Answer 4

at least two elevated measurements - five minutes apart, one in each arm, should be made on two or more visits.

(A patient cannot be diagnosed with hypertension if the patient is acutely ill or in acute pain.)

Question 5

Important Elements of the Physical Exam in Patients with Hypertension

Answer 5

BMI
Funduscopic 
Auscultate for carotid, abdominal, and femoral bruits
Palpate thyroid
Lung
Heart 
Abdominal
lower extremity
neuro

Question 6

Target Blood Pressure Goal

Answer 6

Age 60 years old General population

Question 7

Thiazides

Answer 7

most cost-effective antihypertensive drug
may affect electrolyte levels
should be avoided in patients with a history of gout
may cause elderly patients to become incontinent of urine

Question 8

Lifestyle Changes to Decrease Blood Pressure

Answer 8

Lifestyle modification avg systolic BP reduction

1. Weight Reduction 5-20 mmHg/10 kg weight loss
2. DASH eating plan 8-14 mmHg
3. Dietary Sodium Reduction 2-8 mmHg
4. Physical Activity 4-9 mmHg
5. Moderation of Alcohol Consumption 2-4 mmHg

Question 9

The USPSTF recommends initiating aspirin therapy in men age 45 to 79 years to reduce the risk of myocardial infarction. In women age 55 to 79, the USPSTF advises taking aspirin to reduce the risk of ischemic stroke.

Answer 9

at 45 to decrease risk for MI (man)

at 55 to decrease risk of ischemic stroke (women)

Question 10

When to refer to a Specialist

Answer 10

Generally, failure to achieve blood pressure goal in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic