CASE ON HTN

Question 1

defined as sustained abnormal elevation of the
arterial blood pressure

Answer 1

HYPERTENSION

Question 2

• BP of >140/90 (average of 2 or more readings taken on 2 or more visits)
• DBP ≥90 on a single occasion

Answer 2

Repeated, Elevated Blood Pressure Levels

Question 3

Often asymptomatic until overt organ damage is imminent or has occurred

Answer 3

HYPERTENSION

Question 4

BLOOD PRESSURE CLASSIFICATION – JNC VII

Answer 4

1. Normal
2. Pre-HTN
3. Stage 1
4. Stage 2

Question 5

SBP: < 120 and
DBP: < 80

Answer 5

Normal

Question 6

SBP: 120 – 139
or
DBP: 80 – 89

Answer 6

Pre-HTN

Question 7

SBP: 140 – 159
or
DBP: 90 – 99

Answer 7

Stage 1

Question 8

SBP: ≥ 160
or
DBP: ≥ 100

Answer 8

Stage 2

Question 9

CO x TPR

Answer 9

Blood Pressure

Question 10

Stroke volume (SV) x Heart rate (HR)

Answer 10

CO

Question 11

CO

Answer 11

Cardiac Output

Question 12

TPR

Answer 12

Total Peripheral Resistance

Question 13

size of arterioles

Answer 13

TPR

Question 14

SITES OF BP REGULATION

Answer 14

1. Resistance Arterioles
2. Capacities Venules
3. Pump Output Heart
4. Volume Kidneys

Question 15

TYPES OF HTN

Answer 15

• Primary or Essential
• Secondary Hypertension

Question 16

• Age
• Hyperlipidemia
• Overweight
• Genetic/Family history
• Diet (high salt)
• Stress
• Smoking
• Sedentary lifestyle
• Excessive alcohol use
• Diabetes
• Sleep apnea
• Race

Answer 16

Risk factors include in Primary or Essential Hypertension

Question 17

• Renal causes
• Endocrine causes
• Coarctation of the aorta (narrowing of the aorta)
• Use of drugs (NSAIDS, OCA, cocaine, amphetamines)
• Obesity, DM, Pregnancy, Neurologic disorders

Answer 17

Secondary Hypertension

Question 18

Renal causes:

Answer 18

• Parenchymal
• Renovascular

Question 19

Endocrine causes

Answer 19

• Phaeochromocytoma
• Cushing’s disease
• Hyperthyroidism
• Hyperaldosteronism

Question 20

• ↓ salt intake (Japan, ↑ intake ↑ ↑ BP)
  2.5gm/day (250meq) ↓ 1gm/day (100meq)
• ↓ calorie intake, weight loss
• ↓ alcohol consumption (low dose ↓ BP)
• ↑ physical activity
• ↓ stress factors
• ↓ smoking
• ↓ caffeine intake

Answer 20

Non DrugTreatment – Life Style Modification

Question 21

Effects of Lifestyle Modification

Answer 21

Weight reduction
Adopt DASH eating plan
Dietary sodium reduction
Physical activity
Moderation of alcohol consumption

Question 22

5–20 mmHg/10 kg weight loss

Answer 22

Weight reduction

Question 23

8–14 mmHg

Answer 23

Adopt DASH eating plan

Question 24

2–8 mmHg

Answer 24

Dietary sodium reduction

Question 25

4–9 mmHg

Answer 25

Physical activity

Question 26

2–4 mmHg

Answer 26

Moderation of alcohol consumption

Question 27

PHARMACOLOGY OF ANTIHYPERTENSIVE AGENTS

Answer 27

1. Diuretics 2. Direct Vasodilators 3. Angiotensin Blockers 4. Sympathoplegic agents

Question 28

Decrease Na+ and leads to decrease in blood volume

Answer 28

Diuretics

Question 29

— Relax vascular Smooth Muscle — Dilate resistance vessels capacitance

Answer 29

Direct Vasodilators

Question 30

Dec peripheral vascular resistance Decrease blood volume

Answer 30

Angiotensin Blockers

Question 31

Dec peripheral vascular resistance Dec cardiac function venous pooling

Answer 31

Sympathoplegic agents

Question 32

Agents which promote the excretion of solutes (electrolytes) with iso-osmotic excretion of water

Answer 32

DIURETICS

Question 33

Osmotic diuretics, Carbonic anhydrase inhibitors, xanthine derivatives, acidifying salts

Answer 33

Proximal Convoluted tubule

Question 34

Loop diuretics

Answer 34

Ascending limb of the Loop of Henle (AHL/TAL)

Question 35

Thiazide

Answer 35

Early Part of the distal convoluted tubule (DCT)

Question 36

Potassium sparing diuretics

Answer 36

Late Distal Convoluted Tubule and Collecting Duct (CCT)

Question 37

CLASSIFICATION OF DIURETICS

Answer 37

1. Proximal convoluted tubule 2. Descending loop of Henle 3. Ascending loop of Henle 4. Distal convoluted tubule 5. Collecting duct

Question 38

— Carbonic anhydrase inhibitors which inhibits the reabsorption of HCP3- in the proximal convoluted tubule. — weak diuretic properties

Answer 38

ACETAZOLAMIDE

Question 39

— Inhibit the Na+/ K+ / Cl- co—transport in ascending loop of Henle, resulting in retention of Na+, Cl- and water in the tubule. — These drugs are the most efficacious of the diuretics.

Answer 39

BUMETANIDE, FUROSEMIDE, TORSEMIDE, ETHACRYNIC ACID

Question 40

— Inhibit reabsorption of Na+ and Cl- in distal tubule, resulting in retention of water. — most commonly used diuretics

Answer 40

THIAZIDES

Question 41

These agents can prevent loss of K+ that occurs with thiazide or loop diuretics

Answer 41

Spironolactone, Amiloride, Triamterene

Question 42

An aldosterone antagonist, inhibits the aldosterone - mediated reabsorption of Na+ and secretion of K+

Answer 42

SPIRONOLACTONE

Question 43

Block Na+ chanels

Answer 43

AMILORIDE and TRIMTENE