Cardio- HTN

Question 1

“HTN its not about BP its about ____”

Answer 1

global cardiovascular risk

Question 2

what is the “key to essential HTN”?

Answer 2

RAAS dysregulation

Question 3

what is “essential” HTN?

Answer 3

aka primary HTN
“essential” = we dont know what causes it
-makes up 95% all HTN cases

other 5% secondary HTN -txt of underlying cause can cure it

Question 4

malignant HTN

Answer 4

usually above 180/120 and causes organ damage

Question 5

Each increment of ______ mmHg ____ the risk of CVD across the entire BP range starting from______ mmHg.

Answer 5

20/10 , doubles, 115/75

Question 6

age-related BP is from what?

Answer 6

As we age, systolic BP goes up, diastolic goes down, = pulse pressure increases

LOSE COMPLIANCE OF BLOOD VESSELS, NOT EXPANDING AND CONTRACTING AS MUCH WITH EACH PULSE,

Question 7

stroke, MI and HF relations to lowering BP?

Answer 7

STROKE- DIRECTLY RELATED TO BP
MI- NOT AS MUCH DIRECTLY RELATED
HF- DIRECTLY RELATED

Question 8

what is he referring to when he says “number needed to treat” ?

Answer 8

epidemiology lingo: effectiveness of therapy - # of pt’s needed to treat to prevent one additional bad outcome

hadley: “With HTN and additional CVD risk factors, achieving a sustained 12 mmHg reduction in SBP over 10 years will prevent 1 death for every 11 patients treated. “

Question 9

3 BP measurement techniques: based on location

Answer 9

1. in-office: 2 readings 5 min apart, sitting in chair
2. ambulatory : measured constantly (like a fitbit) for eval of “white coat”
   * (if BP doesn’t drop 10-20% at night, might have CVD risk
3. self-measurement : info in response to therapy, also for white coat

Question 10

Home measurement of >_____ mmHg is generally considered to be hypertensive.

Answer 10

135/85

Question 11

what are the “target organs” that can be damaged by HTN?

Answer 11

Heart: HF, LVhypertrophy, angina, etc 
Brain: stroke/TIA
Kidney: Chronic kidney disease
(arteries and eyes also but...
heart, brain, and kidney you can actually MEASURE effect)

Question 12

3 objectives of eval of pts w/ HTN

Answer 12

Assess lifestyle and identify other CV risk factors or concomitant disorders that affect prognosis and guide treatment

Reveal identifiable causes of high BP

Assess the presence or absence of target organ damage and CVD

Question 13

urgent vs emergent HTN, what constitutes each and what will you do for each pt?

Answer 13

emergency- high BP and TARGET ORGAN DAMAGE
txt- hospital
urgent- high BP but NO TARGET ORGAN DAMAGE, (may have chronic target organ damage)
txt- immediate anti-HTN meds

Question 14

lifestyle modification for HTN…what is the biggest help?

Answer 14

weight loss

Question 15

BP extremely well correlated with ____

Answer 15

weight gain - get in normal BMI range, BP becomes optimized

Question 16

if BMI goes too low your risk for HTN ____

Answer 16

increases! you can be too thin!

Question 17

preferred thiazide for HTN ?

Answer 17

chlorthalidone is a TRULY ONCE A DAY drug (unlike Hydrochlorothiazide but we use it more bc its cheaper)

-also- required less stringent BP goals (can have higher with DM)

Question 18

old guidelines: what was the BP goal for those under and over 60yo w/ HTN?

Answer 18

under: 140/90
over: 150/90

Question 19

what drugs can African Americans use and not use for HTN?

Answer 19

african american- ACE inhibitors dont work as well - use thiazide or CCB

Question 20

hadley’s strategy to dose HTN drugs

Answer 20

HADLEY’S FAVE- LAST ONE : begin 2 at the same time - two drugs at low dose with low ADRs is better than one drug with high ADRs

Question 21

SPRINT trial: people with chronic kidney and CVD… found lower risk for cardiovasc events with BP lower than _____

Answer 21

140 mmHG systolic goal

found significant decrease in CVD and renal when trying to get them to 120mmHg

Question 22

if you are over 50yo with >1 CV risk factor …

Answer 22

a lower BP goal is recommended- should shoot for 120

Question 23

HTN Drug Txt threshold for CVD risk: if risk is >10% and they are over _____, then you must consider medication. if their CVD risk if <10% but they are over _____, you must consider medication.

Answer 23

if risk >10%, and over 130/80 range, consider medication

if risk <10% and over 140/90 range, consider medication

Question 24

for stage 1 HTN you may consider using how many HTN drugs?

Answer 24

1 (anything past stage 1 will need >1 drug)

Question 25

what are the 1st line drugs for HTN ? (4 groups)

Answer 25

1st line : thiazides, diuertics, CCBs, ACE/ARBs

Question 26

new guidelines: history of CVD, HF,DM? BP needs to be < ____

Answer 26

130/80

Question 27

overall: old vs new guidelines for HTN along w/ other diseases like CVD/HFrEF ?

Answer 27

OVERALL- NEW GOALS ARE

<130/80 RATHER THAN <140/90

Question 28

what anti-HTN combo does Hadley like?

Answer 28

LIKES LISINOPRIL/HCTZ CAUSE ITS CHEAP AND WORKS WELL
1xday is better than twice a day
combo pill better than multiple

Question 29

what HTN med is good for DM pt but not for african americans?

Answer 29

ACEs

Question 30

for choice of HTN therapy… there are a number of potentially favorable effects. which ones would help HTN and osteoporosis? raynauds? bengin prostatic hyperplasia? LVH?

Answer 30

osteoporosis: thiazides
raynauds: CCB
benign prostatic hyperplasia: Alpha-block
LVHypertrophy: ACE/ARB

Question 31

potentially unfavorable effects from HTN drugs? from BB and ACE/ARBS?

Answer 31

BB: not for asthma, DM, CHF (initiate w/ caution-angioedema risk)
ACE/ARB: teratogen, angioedema, CHF

Question 32

4 ADRs from HTN drugs

Answer 32

Beta and alpha block: depression
diuretic: gout
thiazide: low Na+
RAAS drugs: high K+

Question 33

for renovascular disease, ACE/ARBs can raise what levels? good or bad thing?

Answer 33

serum creatinine levels
-these levels are already inc. b/c kidney isnt being perfused and needs even more
= good for impaired kidneys!

Question 34

if you add ___ then african americans can take an ACE

Answer 34

thiazide

Question 35

pt on BP medication should have what levels check twice a year?

Answer 35

potassium and creatinine

Question 36

NSAIDS can raise or lower BP?

Answer 36

raise