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General Medicine & Family Medicine > Cardiology_HTN > Flashcards

Cardiology_HTN Flashcards

1
Q

What is normal blood pressure (BP) in adults (units = mm Hg)?

A
  • Systolic blood pressure (SBP) <120 mm Hg and
  • diastolic blood pressure (DBP) <80 mm Hg
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2
Q

What is stage 1 HTN?

A

Stage 1 hypertension (HTN)

  • SBP of 120-139 mm Hg or DBP of 80-89 mm Hg

Stage 2 HTN

  • SBP of 140-159 mm Hg or DBP of 90-99 mm Hg
  • SBP ≥160 mm Hg or DBP ≥100 mm Hg
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3
Q

What is stage 2 HTN?

A

Stage 1 hypertension (HTN)

  • SBP of 120-139 mm Hg or DBP of 80-89 mm Hg

Stage 2 HTN

  • SBP of 140-159 mm Hg or DBP of 90-99 mm Hg
  • SBP ≥160 mm Hg or DBP ≥100 mm Hg
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4
Q

List the five important environmental causal factors of primary HTN

A
  1. Excessive weight
  2. Sedentary lifestyle
  3. Excessive sodium intake
  4. Inadequate intake of fruits, vegetables, and potassium
  5. Excessive alcohol intake
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5
Q

How do you diagnose HTN?

A
  • Two or more properly measured elevated BPs on each of two or more office visits
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6
Q

A patient with HTN typically has NO symptoms. True or false?

A
  • True.
  • However, evidence of end-organ damage may appear as the disease progresses.
  • Assess symptoms at each visit: chest pain, shortness of breath, abdominal pain, oliguria, headache, dizziness/syncope, vision changes.
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7
Q

What are the goals of the history and physical examination for a patient with HTN?

A
  • Assess adequacy of disease management and factors that affect prognosis (medications, lifestyle, etc)
  • identify co-morbidities
  • assess overall cardiovascular disease (CVD) risk
  • assess the extent of end-organ damage
  • rule out secondary causes of HTN
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8
Q

What physical examination components are especiallly important to document in the initial assesment of patient with HTN?

A
  • Vital signs (including BP in all extremities and body mass index)
  • cardiopulmonary exam
  • neck exam (thyroid, carotids)
  • optic fundi
  • abdominal exam (check for aneurysm, renal/femoral bruits, organomegaly)
  • extremities (pulses, check for edema)
  • neurologic exam
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9
Q

Effectively controlling BP reduces patient morbidity and mortality by decreasing the incidence of what medical conditions?

A
  • CVD
  • transient ischemic attack/stroke
  • aneurysms, dementia
  • retinopathy
  • chronic kidney disease (CKD)
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10
Q

BP control decreases the incidence of what specific cardiovascular diseases?

A
  • Heart failure
  • left ventricular hypertrophy
  • cardiomyopathy
  • myocardial infarction
  • peripheral vascular disease
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11
Q

The relationship between elevated BP and CVD is independent of other risk factors for CVD. True or false?

A

True

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12
Q

Beginning at a BP of 115/75 mm Hg, each incremental increase in BP of 20/10 mm Hg doubles the risk of CVD. True or false?

A

True

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13
Q

What tests should be performed in patients with HTN before initiating therapy?

A
  • EKG
  • blood glucose and hematocrit
  • serum potassium and calcium
  • creatinine (or calculated GFR)
  • fasting lipid profile
  • urinalysis
  • urine albumin excretion, or albumin to creatinine ratio (optional)
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14
Q

How often should potassium and creatinine be measured/ tested after initial diagnosis?

A
  • Twice a year (additional periodic labs are based on co-morbidities)
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15
Q

How do you measure albumin in the urine?

A
  • Spot urine albumin to urine creatinine ratio (24-hour urine collection is not necessary)
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16
Q

What conditions warrant screening for albuminuria annually in patients with HTN?

A
  • Patients with HTN who also have diabetes or kidney disease
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17
Q

Uncontrolled SBP can accelerate the decline of GFR by as much as 4-8 per year. True or Fals

A

True

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18
Q

Define the goal of BP management in patients without complicated HTN.

A

BP <140/90 mm Hg

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19
Q

Define the goal for BP management in patients with a treatment-altering comorbidity.

A

BP <130/80 mm Hg

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20
Q

Name treatment-altering co-morbidities in hypertension.

A
  • CKD
  • diabetes
  • CVD
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21
Q

Most people will reach their DBP goal when the SBP goal is achieved, so therapy should focus on lowering the SBP. True or false?

A

True

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22
Q

Why is it important to identify patients with prehypertension?

A
  • Patients in this category are twice the risk of developing overt HTN than those with normal BPs
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23
Q

In the absence of co-morbidities, are prehypertensive patients candidates for drug therapy?

A

No, but it is important to intervene early and educate the patient on healthy lifestyle modifications.

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24
Q

Name lifestyle modifications for prehypertension and HTN.

A
  1. Weight loss
  2. DASH diet
  3. Regular aerobic exercise
  4. Reduced alcohol intake
  5. Smoking cessation
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25
What does DASH stand for?
Dietary Approaches to Stop Hypertension
26
Describe DASH diet
1. Rich in fruits, vegetables, and dairy products 2. Low in cholesterol and sturated and total fat 3. Rich in potassium and calcium 4. Less than 2.4 g (preferably 1.6 g ) of sodium per day
27
Following the 1.6 g sodium DASH diet has similar effects to single-drug therapy. True or false?
True
28
Unless there is a compelling indication to start another medication, what drug should be initiated in cases of uncomplicated stage 1 HTN?
* Low-dose thiazide diuretic
29
Thiazide diuretics are usually first line treatment, but for the following compelling indications, what anti-hypertensives are acceptable alternatives to thiazides or should be used in conjunction with a thiazide? - Heat failure
* Heart failure * Beta-blocker (BB) * angiotensin-converting enzyme inhibitor (ACEI) * angiotensin receptor blocker (ARB) * aldosterone antagonist
30
Thiazide diuretics are usually first line treatment, but for the following compelling indications, what anti-hypertensives are acceptable alternatives to thiazides or should be used in conjunction with a thiazide? - Post MI
* Beta blockers * ACEI * aldosterone antagonist
31
Thiazide diuretics are usually first line treatment, but for the following compelling indications, what anti-hypertensives are acceptable alternatives to thiazides or should be used in conjunction with a thiazide? - High risk of coronary artery disease
* Beta blockers * ACEI * calcium-channel blocker (CCB)
32
Thiazide diuretics are usually first line treatment, but for the following compelling indications, what anti-hypertensives are acceptable alternatives to thiazides or should be used in conjunction with a thiazide? - DM
* BB * ACEI * ARB * CCB
33
Thiazide diuretics are usually first line treatment, but for the following compelling indications, what anti-hypertensives are acceptable alternatives to thiazides or should be used in conjunction with a thiazide? - Chronic kidney disease
* ACEI or ARB
34
Thiazide diuretics are usually first line treatment, but for the following compelling indications, what anti-hypertensives are acceptable alternatives to thiazides or should be used in conjunction with a thiazide? - recurrent strokes
ACEI
35
What are the contraindications to beta-blocker use?
* Severe reactive airway disease * uncompensated heart failure * severe peripheral arterial disease * bradycardia or hypotension * high-grade AV block, or * sick sinus syndrome
36
When should you initiate treatment with two anti-hypertensive agents?
* Patient’s BP is \>20/10 mm Hg than the target BP, even if current drug dosage is not maxed out.
37
About what percentage of HTN patients can have controlled BP on only one medication?
30%
38
After initiation of antihypertensive drug therapy, how often should patients follow up for medication adjustments?
* Monthly, until BP goal is reached (more often if patient has stage 2 HTN or co-morbidities)
39
Once desired BP is achieved, approximately how often should patients follow up?
* Every 3-6 months
40
When should ambulatory BP monitoring be considered?
* Wide variation in self-reported BP readings * evaluation of White Coat HTN * assessment of drug effectiveness * side effects, or * resistance
41
What percent of patients have no direct identifiable cause of their HTN?
90%-95%
42
90-95 % of patients have no direct identifiable cause of their HTN? what do we call this hypertension?
Primary (essential) hypertension
43
What percent of patients have secondary HTN ( do have an identifiable cause)?
5%-10%
44
What is the most common cause of secondary HTN?
Renovascular hypertension
45
What processes cause renovascular HTN?
* Atherosclerotic renal artery stenosis * fibromuscular dysplasia * vasculitis
46
Common cause of renovascular HTN in - older women - younger women
* Older women --\> Atherosclerotic renal artery stenosis * younger women --\> fibromuscular dysplasia
47
Cause of hypertension - abdominal bruit on PE
Renovascular HTN
48
Cause of hypertension - headache, sweating, and palpitatons with periods of acute BP elevation
Pheochromocytoma
49
Cause of hypertension associated with wiminished or delayed peripheral pulses, a bruit heard over the back, higher SBP in the upper extremities than in the lower extremities
Aortic coarctation
50
Cause of HTN associated wtih truncal obesity, glucose intolerance, and abdominal striae
Cushing Syndrome
51
Evaluation of OSA
Sleep study with Oxygen saturation
52
Evaluation of drug-induced or drug related HTN
* Review patient’s medications and identify potential BP elevators * eg, nonsteroidal anti-inflammatory drugs * steroids * estrogens * ask patient about current or recent use of * herbal remedies * alcohol * illicit drugs * nicotine.
53
Evaluation of Primary aldosteronim or other mineralocorticoid excess state
* 24-hour urine aldosterone level or specific measurements of other mineralocorticoids
54
Evaluation of Renovascular disease
Doppler flow study or magnetic resonance angiography
55
Evaluation of cushing syndrome or other sterid excess
Dexamethasone suppression test
56
Evaluation of Pheochromacytoma
24-hour urinary catecholamines
57
Evaluation of coarctation of the aorta
CT angiography
58
Evaluation of Thyroid or parathyroid disease
TSH and serum parathyroid
59
How common is HTN among patients with OSA?
50% of patients with OSA have HTN
60

General Medicine & Family Medicine (150 decks)

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