Cardiovascular Risk Reduction: Hypertension

Question 1

What is the UPSTF recommendation for HTN screening in adults over age 18?

Answer 1

Grade A

Question 2

What percentage of patients with elevated BPs in the office will have normal readings outside of the office?

Answer 2

15-30%

Question 3

Based on this, what is the current gold standard for diagnosing HTN?

Answer 3

ambulatory BP monitors

but home-based automated machines are acceptable too

Question 4

What percentage of HTN is “essential HTN”?

Answer 4

90-95%

Question 5

In what patients should you suspect secondary hypertension?

Answer 5

children/adolescents

rapid acceleration of the hypertension

resistant HTN (not controlled on 3 drugs)

Question 6

What are some secondary causes of HTN?

Answer 6

coarctatino of the aorta, RAS, thyroid disorders, hyperaldosteronism, OSA, pheochromocytoma, cushing syndrome

Question 7

What are some medication classes that can increase BP?

Answer 7

estrogen (OCPs), some herbals (ginseng), NSAIDs, Psych meds (Buspiron, tegretol, fluozetine, lithium, TCAs), steroids, decongestants, diet pills

Question 8

Of all the potential lifestyle modifications, which has the greatest effect on BP?

Answer 8

weight loss of at least 9 pounds

Question 9

In the general population over 60 yrs of age, at what BP should you initiate pharmacologic treatment?

Answer 9

> 150/90

grade A rec

Question 10

In the general population less than 60 yo, at what BP should you initiate pharmacologic treatment/

Answer 10

> 140/90

grade A or E depending on age group and diastolic vs systolic

Question 11

In the population over 18 years of age with chronic kidney disease, at what BP should you initiate pharmacologic treatment?

Answer 11

140/90

grade E

Question 12

In the population over 18 yo with diabetes, when should you start treatment/

Answer 12

140/90

grade E

Question 13

In the general non-black population including those with diabetes, what should the initial antihypertensive treamtnet include?

Answer 13

can chose from:

thiazide-type
CCB
ACEI/ARB

(grade B)

Question 14

In the general black population including those with diabetes, initial antihypertensive treatment should include?

Answer 14

a thiazide-type or CCB

grade B for general, grade C for w/ diabetes

Question 15

In the population with CKD, initial antihypertensive treatment should include what?

Answer 15

ACEI or ARB to improve kidney outcomes

regardless of race or diabetes status

Question 16

If goal BP is not reached in ___ month of treatment, increase the dose or add a second agent.

Answer 16

one month

Question 17

True or false: you can you an ACEI and ARB together in the same patient

Answer 17

false

Question 18

How high above goal should the HTN be before you consider starting two drugs at the same time?

Answer 18

greater than 20/10 above the goal

Question 19

Which thiazide diuretic is the most effective?

Answer 19

Chlorthalidone

(HCTZ at current common doses has not been shown to reduce MI, stroke or death and has been found inferior to ace, arb, ccb and beta blockers)