General Evaluation and Management of HTN

Question 1

PRA

Answer 1

PRA > 0.65 ng/mL/h (typically seen in younger Caucasians) may have HTN associated with vasoconstriction and respond well to ACEI or ARB, β-blockers.

PRA < 0.65 ng/mL/h (typically seen in African Americans, Afro-Caribbeans, and older Caucasians) may indicate volume expansion–related HTN, and may respond well to diuretics and CCB.

Question 2

Lifestyle modifications in the management of HTN (JNC 7)

Answer 2

Weight reduction: maintain normal body weight (e.g., body mass index 18.5 to 24.9 kg/m2) → SBP reduction ~5 to 20 mm Hg per 10-kg weight loss.

Question 3

Lifestyle modifications in the management of HTN (JNC 7)

Answer 3

Adopt DASH eating plan (consume diet rich in fruits, vegetables, low-fat dairy products with reduced content of saturated and total fat) → SBP reduction ~8 to 14 mm Hg.

Question 4

Lifestyle modifications in the management of HTN (JNC 7)

Answer 4

Sodium restriction (<2.4 g sodium or 6 g of NaCl daily) → SBP reduction ~2 to 8 mm Hg.

Question 5

Lifestyle modifications in the management of HTN (JNC 7)

Answer 5

Physical activity: regular aerobic activity, for example, 30-minute brisk walk daily, most days of week → SBP 4 to 9 mm Hg.

Question 6

Lifestyle modifications in the management of HTN (JNC 7)

Answer 6

Moderation of alcohol consumption (<2 drinks daily in most men, <1 drink daily in women and lighter-weight persons) → SBP reduction ~2 to 4 mm Hg.

For overall cardiovascular risk reduction, stop smoking.

Question 7

Clinical clues suggesting secondary HTN

Answer 7

Severe (e.g., BP > 180/110 mm Hg) or drug resistant HTN

Acute rise in BP in a patient with previously stable values
Age < 30 years in nonobese, non-black patients with a negative family history of HTN and no other risk factors for HTN

Malignant or accelerated HTN

Onset of HTN age < 20 or >50