Assessing a Pt with HTN

Question 1

First answer these questions for untreated patients

Answer 1

1. Does patient have HTN or just an
   elevated BP reading?
2. Is the HTN primary or secondary?
3. Does the patient have evidence of
   target organ damage?
4. Does the patient have other CV risk
   factors? Can changes be made to improve
   BP?
5. What is the patient’s goal?
6. Should medication be started?
7. What monitoring for the medication?

Question 2

Does patient have HTN?
What is a “perfect” BP?

Answer 2

<120/80

Question 3

Redefining HTN

Normal BP

SBP <120
DBP <80

Question 4

Elevated Blood Pressure is what?

SBP–>____________

DBP <80 mmHg

Answer 4

120-129mm Hg

Question 5

What stage of Hypertension is this?

SBP 130-139
DBP 80-89

Answer 5

Stage 1 hypertension

Question 6

What stage of Hypertension is this?
greater than or equal to 140mmHg for systolic blood pressure

greater than or equal to 90mmHg for diastolic blood pressure

Answer 6

Stage 2 hypertension

Question 7

Average of ≥2 “careful” readings on ≥2 separate occasions is needed to diagnosis hypertension

Question 8

Factors affecting BP

Age
Race
__________Rhythm
Weight
__________
Emotions/stress
Medications
Hydration
Sleep quality

Answer 8

Diurnal

Exercise

Question 9

Ambulatory BP Monitoring (ABPM)

Clinic BP 130/80 ≅ ABPM 125/75
average 130/80 day and __________ night

Answer 9

110/65 at night

Question 10

Home BP monitoring

Wait ______________
Feet uncrossed and on floor
________ supported
Arm supported at _________level
No caffeine/cigarettes within 30 minutes

Answer 10

wait 5 minutes

back supported

heart level

Question 11

Using cuff that is too small can lead to a falsely…

Answer 11

high blood pressure

Question 12

Which is more important: SBP or DBP?

Both important!
DBP <50yo
SBP 50yo+

Question 13

HTN crisis

> _________ mmHg

Answer 13

> 180/120 mmHg

Question 14

With acute or progressing target-organ damage = ______________

Answer 14

hypertensive emergency

Question 15

Without acute or progressing target organ injury = ____________

Answer 15

hypertensive urgency

Question 16

Frequent causes of high blood pressure are

Nonadherence
_____________(RAS)
_____________, eclampsia
Pheochromocytoma
Rebound from stopping ___________

Answer 16

Renovascular changes

preeclampsia

beta blockers

Question 17

The following increase blood pressure

OTC/herbal use
Bitter orange
Ephedra(ma-huang)
Gingseng
Guarana
Licorice
_________

Medication
Corticosteroids
____________
___________
_____________
SNRIs: venlafaxine, buproprion

EtOH use

Energy drinks/caffeine

Lifestyle factors:weight,diet, exercise, stress, sleep, water intake

Answer 17

St Johns wort

decongestants

NSAIDs

estrogens

Question 18

Primary (Essential) Hypertension

Elevated BP without an __________ cause

Accounts for most of cases of hypertension

Cause – unknown

Contributing Factors Increased SNS activity Increased RAAS Endothelial dysfunction

Lifestyle factors would be considered primary (_______, _________, _______)

Answer 18

without an identifiable cause

obesity, sodium,smoking

Question 19

Secondary HTN

Coarctation or congenital narrowing of the aorta

Endocrine disorders: Pheochromocytoma, Cushing Syndrome, Hyperaldosteronism

Medications
Neurology disorders – brain tumors / head injury

Pregnancy-induced hypertension

Renal disease

Sleep apnea