Clinical Series Mutafova

Question 1

T/F prevalence of hypertension depends on age.

Answer 1

True. The prevalence of HTN increases with age.

Question 2

T/F All patients with HTN will feel a physical change as a result of their high blood pressure.

Answer 2

False. Some patients never feel that they have HTN. Sort of asymptomatic.

Question 3

What are the differences b/w men & women when it comes to HTN?

Answer 3

Below age 45, more men w/ HTN.
B/w age 45 & 65 equal amount of men & women w/ HTN.
After age 65, more women have HTN.
More women than men manage their HTN well.

Question 4

What is the most common reason for a scheduled visit to the doctor?

Answer 4

HTN–huge economic burden

Question 5

T/F Approximately 35 million people (around 10%) of Americans have HTN.

Answer 5

False. Around 78 million ppl have HTN in the U.S.

Question 6

What associated diseases cause HTN to be such a high risk for morbidity?

Answer 6

Coronary Artery Disease
Stroke
Kidney Failure

Question 7

What is pre-hypertension?

Answer 7

Ppl w/ blood pressure in these ranges.
Systolic: 120-139
Diastolic: 80-89

Question 8

What is considered Stage 1 HTN?

Answer 8

Ppl w/ blood pressure in these ranges.
Systolic: 140-159
Diastolic: 90-99

Question 9

What is considered Stage 2 HTN?

Answer 9

Ppl w/ blood pressure in these ranges.
Systolic: Over 160.
Diastolic: Over 100.

Question 10

What is the usual BP target? What is the BP target for those w/ Diabetes?

Answer 10

Usual BP target: less than 140/90

Diabetes BP target: less than 130/80

Question 11

What is primary or essential HTN?

Answer 11

It is high blood pressure with no clear cause & is probably caused by genetics, poor diet, lack of exercise, obesity. No clear cause.

Question 12

What is secondary HTN?

Answer 12

High blood pressure caused by a different medical condition. 
Some of these medical conditions include: 
renal parenchymal disease
renovascular HTN
Pheochromocytoma
Obstructive Sleep Apnea
Thyroid Disease
Coarctation of the Aorta

Question 13

What is the difference b/w hypertensive urgency & emergency?

Answer 13

Urgency is a BP over 180/110 w/o organ damage.

Emergency is BP over 180/110 w/ organ damage.

Question 14

What are examples of organ damage that are associated w/ hypertensive emergency?

Answer 14

Stroke
Angina
Pulmonary Edema
Aortic Dissection
Damage to Eyes & kidneys

Question 15

If a patient has a BP of 170/110…what is this considered?

Answer 15

Hypertensive Crisis. Either systolic of 180 or higher OR diastolic of 110 or higher.
This hypertensive crisis can be either a hypertensive urgency or emergency.

Question 16

If a patient has a BP of 190/90…and is using LSD…what is this considered?

Answer 16

Hypertensive Crisis b/c systolic over 180.

Hypertensive Emergency b/c of the use of LSD.

Question 17

If a patient has a BP of 190/110…and is experiencing eclampsia…what is this considered?

Answer 17

Hypertensive Crisis b/c systolic over 180 & diastolic is 110 or higher.
Hypertensive Emergency b/c of eclampsia.

Question 18

What is resistant hypertension?

Answer 18

BP that stays high despite 3 different types of HTN meds (3 different mechanisms of action).

Question 19

What are some risk factors for resistant HTN?

Answer 19

Old age
Obesity
Obstructive Sleep Apnea
Diabetes
Chronic Kidney Disease

Question 20

What is one of the complicating factors in diagnosing resistant HTN in a patient?

Answer 20

True resistant HTN is rare.
Need to make sure that the pt is being adherent to the BP meds.
Need to make sure it is not White Coat Syndrome.
So may be helpful to monitor BP 24 hours.

Question 21

What is malignant HTN?

Answer 21

HTN that is somewhat difficult to treat & is associated w/ rapidly progressive end organ damage.

Question 22

What do you call it when you have a patient w/ somewhat uncontrollable HTN w/ hypertensive encephalopathy?

Answer 22

Malignant HTN

Question 23

What are some possible reasons for resistant HTN?

Answer 23

Sympathetic outflow that is way too high.
Abnormal renal salt & water handling.
Too high aldosterone or renal activity
Cardiac output, venoconstriction, & vasoconstriction that is variable.

Question 24

HTN is a multifactorial disease. Explain in light of this the mosaic theory of BP regulation.

Answer 24

Basically it says, we don’t know what causes HTN. But these are interacting factors.
Environment–salt intake in diet
Genetics–predisposiiton
Anatomical–coarctation of the aorta
Adaptive–like the giraffe needs high BP to get blood to his head.
Hemodynamic–

Question 24

HTN is a multifactorial disease. Explain in light of this the mosaic theory of BP regulation.

Answer 24

Basically it says, we don't know what causes HTN. But these are interacting factors.
Environment--salt intake in diet
Genetics--predisposiiton
Anatomical--coarctation of the aorta
Adaptive--like the giraffe needs high BP to get blood to his head. 
Hemodynamic--like blood volume
Humoral
Intrauterine programming
Endocrine
Neural
Renal

Question 25

What are 2 important factors that play a role in Page’s mosaic theory of HTN?

Answer 25

Reactive Oxygen Species
Inflammation
**they tend to increase sympathetic output, vascular tone, & sodium retention.

Question 26

What are the 2 main mechanisms of creating HTN & what conditions contribute to each?

Answer 26

Increased Cardiac Output:
Hypervolemia...like RAS
Stress
Pheochromocytoma
Increased TPR: 
We don't know-->Primary HTN
Athersclerosis
Diabetes
Stress
Pheochromocytoma

Question 27

What does Chronic BP elevations do to arteriolar blood vessels?

Answer 27

It causes hypertrophy of the blood vessel.
An increase in wall thickness
An increase in TPR
Somehow affects salt & water excretion

Question 28

T/F Healthy eating & exercise should be done at all stages of HTN.

Answer 28

True.

Question 29

What is the main goal of anti-hypertensive treatment?

Answer 29

To reduce the lifetime risk of cardiovascular disease.

For high risk patients: BP less than 130/80

Question 30

When is monotherapy (or one drug therapy) indicated to treat HTN?

Answer 30

With Pre-HTN w/ other problems.

With Stage 1 HTN.

Question 31

When are multiple HTN drugs required for treatment?

Answer 31

With Stage 2 HTN & any form of HTN that has other problems & calls for it.

Question 32

Why would you use a combination of high renin & low renin drugs to treat HTN?

Answer 32

It is important to use drugs with different mechanisms of action in treating HTN.

Question 33

BP control from taking 2 drugs can improve if….

Answer 33

the effects of the 2 drugs are additive or synergistic.

Question 34

What 2 things can superior tolerability refer to in HTN treatment?

Answer 34

It is safer to treat a pt w/ 2 smaller doses of 2 different anti-HTN drugs instead of a higher dose of 1 anti-HTN drugs b/c of dose-dependent side effects.
OR
Side effects of one drug are neutralized by the taking of another drug.