8- HTN

Question 1

pre-HTN criteria

Answer 1

120-139/80-89

Question 2

HTN if <60 y/o

Answer 2

> 140/90

Question 3

HTN is >60 yo

Answer 3

> 150/90 (unless has CKD or diabetes –> then 140/90)

Question 4

to make HTN diagnosis, what do you need to do

Answer 4

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

patient cant be sick

Question 5

recommended HTN med for black people

Answer 5

Calcium channel blocker or thiazide diuretic

Question 6

recommended HTN med for people with chronic kidney disease

Answer 6

ACEI or ARB

Question 7

recommended HTN med for people with diabetes

Answer 7

ACE Inhibitor, ARB, calcium channel blocker, or thiazide diuretic

Question 8

recommended HTN med for non-black people

Answer 8

ACE Inhibitor, ARB, calcium channel blocker, or thiazide diuretic

Question 9

what is the most cost-effective antihypertensive drug.

Answer 9

thiazides

Question 10

Thiazide diuretics should be avoided in patients with a history of

Answer 10

gout

Question 11

thiazide side effects

Answer 11

hyponatremia

elderly–>incontinent

Question 12

Initial Laboratory Testing for New Diagnosis of Essential Hypertension

Answer 12

EKG
UA
blood glucose- undiagnosed DM
hematocrit- anemia?
serum potassium
serum Ca
BUN, Cr, GFR
serum cholesterol
urinary albumin excretion

Question 13

why do we measure serum Ca?

Answer 13

One-third of patients with hyperparathyroidism and hypertension may have illness attributable to renal parenchymal damage due to nephrolithiasis.

Increased calcium levels can also have a direct vasoconstrictive effect. I

Question 14

Which lifestyle change will decrease blood pressure the most?

Answer 14

lose weight

Question 15

When to Initiate Aspirin in Hypertensive Patients

Answer 15

in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.

Question 16

If the blood pressure is still not at goal, JNC 8 next recommends selecting a drug treatment titration strategy:

Answer 16

Maximize first medication before adding second or

Add second medication before reaching maximum dose of first medication or

Start with two medication classes separately or as fixed-dose combination.

Question 17

when are alpha blockers used in HTN?

Answer 17

They are only utilized as an adjunct in hard-to-control blood pressure.

often prescribed in prostatism but should not be used as a first line anti-hypertensive in patients with benign prostatic hypertrophy (BPH).

Question 18

do alpha blockers decrease mortality?

Answer 18

no

Question 19

side effects of thiazides

Answer 19

May exacerbate urine incontinence.
Monitor chemistry levels, especially sodium and potassium.
Avoid in patients with gout.
Start at lower doses in elderly patients who may be very sensitive to medication effects.
May slow demineralization in osteoporosis.

Question 20

ACEI side effects

Answer 20

Monitor potassium and creatinine levels.

A rise of up to 20% above baseline in creatinine is acceptable after initiating use.

cough is common (5-20%) due to bradykinin production.

Question 21

ACEI contra

Answer 21

pregnant woman

History of angioedema

Question 22

ARBs contra

Answer 22

pregnant woman

Question 23

what other disorders are CCBS useful for

Answer 23

Raynaud syndrome.

supraventricular tachyarrhythmias.

Question 24

CCBs common side effect

Answer 24

leg edema

Question 25

Blood pressure (BP) control rates are lowest in which races

Answer 25

Mexican Americans and Native Americans