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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
Q

What does DASH stand for?

A

Dietary Approaches to Stop Hypertension

26
Q

Describe DASH diet

A
  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
Q

Following the 1.6 g sodium DASH diet has similar effects to single-drug therapy. True or false?

A

True

28
Q

Unless there is a compelling indication to start another medication, what drug should be initiated in cases of uncomplicated stage 1 HTN?

A
  • Low-dose thiazide diuretic
29
Q

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
A
  • Heart failure
    • Beta-blocker (BB)
    • angiotensin-converting enzyme inhibitor (ACEI)
    • angiotensin receptor blocker (ARB)
    • aldosterone antagonist
30
Q

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
A
  • Beta blockers
  • ACEI
  • aldosterone antagonist
31
Q

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
A
  • Beta blockers
  • ACEI
  • calcium-channel blocker (CCB)
32
Q

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
A
  • BB
  • ACEI
  • ARB
  • CCB
33
Q

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
A
  • ACEI or ARB
34
Q

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
A

ACEI

35
Q

What are the contraindications to beta-blocker use?

A
  • Severe reactive airway disease
  • uncompensated heart failure
  • severe peripheral arterial disease
  • bradycardia or hypotension
  • high-grade AV block, or
  • sick sinus syndrome
36
Q

When should you initiate treatment with two anti-hypertensive agents?

A
  • Patient’s BP is >20/10 mm Hg than the target BP, even if current drug dosage is not maxed out.
37
Q

About what percentage of HTN patients can have controlled BP on only one medication?

A

30%

38
Q

After initiation of antihypertensive drug therapy, how often should patients follow up for medication adjustments?

A
  • Monthly, until BP goal is reached (more often if patient has stage 2 HTN or co-morbidities)
39
Q

Once desired BP is achieved, approximately how often should patients follow up?

A
  • Every 3-6 months
40
Q

When should ambulatory BP monitoring be considered?

A
  • Wide variation in self-reported BP readings
  • evaluation of White Coat HTN
  • assessment of drug effectiveness
  • side effects, or
  • resistance
41
Q

What percent of patients have no direct identifiable cause of their HTN?

A

90%-95%

42
Q

90-95 % of patients have no direct identifiable cause of their HTN? what do we call this hypertension?

A

Primary (essential) hypertension

43
Q

What percent of patients have secondary HTN ( do have an identifiable cause)?

A

5%-10%

44
Q

What is the most common cause of secondary HTN?

A

Renovascular hypertension

45
Q

What processes cause renovascular HTN?

A
  • Atherosclerotic renal artery stenosis
  • fibromuscular dysplasia
  • vasculitis
46
Q

Common cause of renovascular HTN in

  • older women
  • younger women
A
  • Older women –> Atherosclerotic renal artery stenosis
  • younger women –> fibromuscular dysplasia
47
Q

Cause of hypertension

  • abdominal bruit on PE
A

Renovascular HTN

48
Q

Cause of hypertension

  • headache, sweating, and palpitatons with periods of acute BP elevation
A

Pheochromocytoma

49
Q

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

A

Aortic coarctation

50
Q

Cause of HTN associated wtih truncal obesity, glucose intolerance, and abdominal striae

A

Cushing Syndrome

51
Q

Evaluation of OSA

A

Sleep study with Oxygen saturation

52
Q

Evaluation of drug-induced or drug related HTN

A
  • 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
Q

Evaluation of Primary aldosteronim or other mineralocorticoid excess state

A
  • 24-hour urine aldosterone level or specific measurements of other mineralocorticoids
54
Q

Evaluation of Renovascular disease

A

Doppler flow study or magnetic resonance angiography

55
Q

Evaluation of cushing syndrome or other sterid excess

A

Dexamethasone suppression test

56
Q

Evaluation of Pheochromacytoma

A

24-hour urinary catecholamines

57
Q

Evaluation of coarctation of the aorta

A

CT angiography

58
Q

Evaluation of Thyroid or parathyroid disease

A

TSH and serum parathyroid

59
Q

How common is HTN among patients with OSA?

A

50% of patients with OSA have HTN

60
Q
A

General Medicine & Family Medicine (150 decks)

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