ACCSAP HTN and hypotension

Question 1

What are indications to start medication in stage I hypertension?

Answer 1

stage 1 hypertension (HTN; systolic BP 130-139 mm Hg or diastolic BP 80-89 mm Hg). For patients with stage 1 HTN and clinical ASCVD or an estimated 10-year ASCVD risk score ≥10%, initiation of antihypertensive therapy along with nonpharmacological therapy is recommended.

In all patients with newly diagnosed hypertension, counseling regarding lifestyle—including sodium restriction, DASH (Dietary Approaches to Stop Hypertension) diet, weight loss, treatment of sleep apnea, exercise regimen, alcohol reduction, and avoidance of nonsteroidal anti-inflammatory drugs—is fundamental. Patients with stage 1 hypertension and an ASCVD risk score of <10% should be managed with lifestyle modifications alone.

For patients not on drug therapy with an office BP >130/80 mm Hg but <160/100 mm Hg after 3 months of lifestyle modifications, it is recommended to proceed with ABPM or HPBM to establish a diagnosis of either white-coat hypertension or hypertension.

Question 2

What is first line therapy for HTN related to fibromuscular dysplasia with renal artery stenosis?

Answer 2

First-line therapy for patients with FMD-related renal artery stenosis is antihypertensive medical therapy, typically requiring multiple agents that include an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. For cases of resistant hypertension despite optimal medical treatment, percutaneous balloon angioplasty can be considered.

Question 3

What is the definition of resistant hypertension?

Answer 3

Resistant hypertension is defined as persistent hypertension despite the use of three antihypertensive agents at or near maximal dose, of different classes including a diuretic if possible.

Question 4

From an epidemiologic perspective, which of the following risk factors present in this patient is most responsible for an increased population burden of heart failure with preserved ejection fraction (HFpEF)?
A. Diabetes mellitus.
B.	Obesity.
C.	Obstructive sleep apnea.
D.	Female sex.
E.	Hypertension.

Answer 4

E. Hypertension.