Clinic HTN

Question 1

All patients w/ what BP should be treated?

Answer 1

Stage 2 (140 and above OR 90 and above), assuming they do not have white coat HTN

Question 2

patients w/ 130-139 OR 80-89

Answer 2

Clinical ASCVD, or DM, or CKD, or 10 yr risk 10%, then treat and reassess in 1mo. If BP goal met at 1 mo, reassess in 3-6 mo

Question 3

Only time you can wait a whole year to recheck BP is if BP is ____?

Answer 3

<120 AND <80

Question 4

It is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM under what circumstance?

Answer 4

SBP greater than 130 mm Hg but less than 160 mm Hg or DBP greater than 80 mm Hg but less than 100 mm Hg

Question 5

in Adults with office BP consistently 120-129 or 75-79, screening for _______ is appropriate

Answer 5

masked HTN

Question 6

Patients on multiple drug therapy for HTN who remain w/in 10 points above goal, it is reasonable to screen for _____

Answer 6

white coat effect

Question 7

Anemia can worsen HTN t/f

Answer 7

T

Question 8

early family history of ASCVD, assess fam hx and w/u as needed for _____

Answer 8

HOCM, aldosteronism, familial hyperlipidemias, etc.

Question 9

some ways aldosteronism can present:

Answer 9

resistant HTN, hypokalemia, or “substantial” hypokalemia if diuretic induced

Question 10

Early ASCVD defined as ______

Answer 10

myocardial infarction, angina with coronary revascularization, stroke, or cardiovascular death in ≥1 parent or full sibling at age<55 men <65 women

Question 11

Severe asymptomatic hypertension is defined as ______

Answer 11

180 mm Hg or more systolic, or 110 mm Hg or more diastolic without symptoms of acute target organ injury.

Question 12

The medications used to treat severe asymptomatic HTN depends on a ptns preexisting conditions and race T/F?

Answer 12

T (ACE/ARBS used for most conditions, beta blockers for Aortic aneurysm and angina pectoris and afib; diuretics and CCBs used in black and Asians w/ severe asymptomatic HTN)

See below for side effects/contraindications
https://www.aafp.org/pubs/afp/issues/2017/0415/p492.html#:~:text=Hypertensive%20emergency%20is%20defined%20as%20severe%20blood%20pressure,7%20These%20patients%20require%20urgent%20evaluation%20and%20hospitalization.

Question 13

Difference between severe asymptomatic vs severe symptomatic HTN?

Answer 13

Symptomatic has signs of end organ damage per pt hx or labs. These patients require immediate hospitalization as opposed to asymptomatic

(180/110)

Question 14

indications to refer young onset HTN to secondary care

Answer 14

age<30 w/ no risk factors, resistant HTN, sudden deterioration in BP control, end organ damage, features/tests suggesting secondary cause,

Question 15

guidelines vary as to what age is considered young onset HTN T/F?

Answer 15

T

Question 16

Treating young patients w/ BP <140/90 is based on____

Answer 16

presence of end organ damage or other comorbidities/clinical judgement as 10 year risk cannot be calculated for this population; lifetime risk can be calculated

Question 17

young patients on ACE or ARB should be counseled on what risks

Answer 17

fetal risk in pregnancy and offered alternative if planning to conceive

Question 18

What is the different in HTN treatment for black patients compared to others

Answer 18

thiazide and CCB are first line, not ACE/ARBS vs others all 3 are first line

Question 19

medications to evaluate in pts with severe HTN

Answer 19

NSAIDS, OCPs, antidepressants, cold medications, sympathomimetics, corticosteroids, and herbal

Question 20

Why is it important to get a BP in both arms at least once in a pt?

Answer 20

subclavian stenosis is often undiagnosed in the first several decades of life, Diff between arms can also mean aortic coarct

See table 2 for proper BP taking technique https://www.aafp.org/pubs/afp/issues/2017/0415/p492.html#:~:text=Hypertensive%20emergency%20is%20defined%20as%20severe%20blood%20pressure,7%20These%20patients%20require%20urgent%20evaluation%20and%20hospitalization.

Question 21

in more than 30% of pts w/ severe BP reading, reading improves after in office rest period of _____mins

Answer 21

30 mins

Question 22

combination therapy is preferred for severe asymptomatic HTN T/F

Answer 22

T

Question 23

Pts with sever HTN can have mild symptoms w.out end organ damage T/F

Answer 23

T

Question 24

Severe HTN w/ mild symptoms warrant what treatment

Answer 24

initiation of short acting anti HTN meds or adjusting previous meds, BMP, and f/u in 1 wk

Question 25

Mild symptoms of severe HTN include

Answer 25

nose bleeds, palpitations, dyspnea, lightheadedness, headaches

Question 26

Symptoms of end organ damage in severe HTN include_____and warrant hospitalization

Answer 26

neuro deficits/encephalopathy, CP, SOB, oliguria

Question 27

PE findings that signify end organ damage in severe HTN include_______and warrant hospitalization

Answer 27

new sensory/motor deficits, alveolar hemm/papilledema, S3 heart sound, rales, JVD, pulsing abdominal bruit

Question 28

Patients w/ severe HTN can generally safely resume meds if they were non compliant, but in pts in whom meds are being initiated, safely lowering BP means______

Answer 28

the absence of acute target organ injury, blood pressure should be lowered gradually to less than 160/100 mm Hg, but not acutely by more than 20% to 25% of the mean arterial blood pressure over several days to weeks. Every two to four weeks, antihypertensive intensification is recommended to achieve target blood pressure goal