CAD/Obesity

Question 1

What are definitions/stages of hypertension?

Answer 1

• Normal: < 120 SBP, < 80 DBP
• Pre-HTN: SBP 120-129
• Stage I HTN: 130-139 SBP, 80-89 DBP
• Stage 2 HTN: 140+ SBP, 90+ DBP

Question 2

Treatment of each stage of HTN

Answer 2

• Normal: lifestyle choices, yearly check-up
• Pre-HTN: lifestyle choices, q3-6 mo check-up
• Stage I HTN: depends on HD/stroke risk
  If < 10%, then lifestyle modifications, q3-6 mo follow-up
  If > 10%, then start med + lifestyle, monthly follow-up until good control
• Stage II HTN: consider 2 agents; esp if 20 pts above goal

Question 3

What are lifestyle modifications for high blood pressure?

Answer 3

• Diet: DASH diet, goal of sodium intake 1500 mg/day, K 3500-5000 mg/day
• Exercise 90-150 min/week
• ETOH reduction; goals women 1 or fewer drink/day, men 2 or fewer drinks/day

Question 4

What are good first line agents?

Answer 4

• Thiazides- watch for hypoNa and hypoK; not great for pts with gout or on uric acid lowering medications
• CCBs: avoid in reduced EF heart failure; pedal edema is common side effect
• ACEs
• ARBs

Question 5

What should black patients get?

Answer 5

if no CKD, and no CHF, then best first line options are thiazides or caclium channel blockers

Question 6

what should diabetics get?

Answer 6

ARBs or ACEs, particularly if albinuria and HTN

Question 7

what is target BP?

Answer 7

130/80

Question 8

what is work-up for pt with HTN?

Answer 8

• CBC
• BMP
• EKG
• UA
• Lipid panel
• fating BG

Question 9

what is a realistic weight loss goal for a patient?

Answer 9

• 5-10% body weight loss over 6 months

Question 10

when can medications be offered for obesity? when can bariatric surgery be considered?

Answer 10

medications: BMI > 30, or 27 with heatlh risks (i.e. DM, HTN)
surgery: BMI > 40 or 35 with high risks

Question 11

Metabolic syndrome criteria

Answer 11

at least 3:

• fasting BG > 100
• BP > 130/85
• HDL < 50
• LDL > 150
• waist circumference > 35 inch or 88 cm