How to treat high blood pressure

Question 1

Why is high blood pressure?

Answer 1

More than or equal to 130 mmHg for systolic and more than or equal to 80 mmHg for diastolic

Question 2

What is normal blood pressure?

Answer 2

Less than 120 mmHg- systolic

Less than 80 mmHg for diastolic

Question 3

What is elevated blood pressure?

Answer 3

Systolic: 120-129 mmHg
Diastolic: less than 80 mmHg

Question 4

What is stage 1 hypertension?

Answer 4

Systolic: 130-139 mmHg or 80-89 for diastolic

Question 5

What’s is stage 2 hypertension?

Answer 5

Systolic: 140-149 mmHg or more than or equal to 90 mmHg for diastolic

Question 6

What is the follow up for a patient with normal blood pressure?

Answer 6

Promote optimal lifestyle habits and reasses them in a year

Question 7

What is the treatment and follow up for a person who has elevated blood pressure?

Answer 7

Non pharmacological therapy (class I) and reasses them in 3-6 months

Question 8

What should you check for if a patient comes into your office with stage 1 hypertension?

Answer 8

check the estimated 10 year cardiovascular risk

Question 9

What happens if a patient has a 10 year cardiovascular risk of more than or equal to 10%?

Answer 9

You prescribe blood pressure lowering medication and non pharmacological therapy

Question 10

What happens if a patient has a 10 year cardiovascular risk of less than 10%?

Answer 10

You initiate non pharmacological therapy

Question 11

For those patients who have stage 1 hypertension but do not have a 10 year cardiovascular risk of more than 10%, how often should you reasses them?

Answer 11

3-6 months

Question 12

For those patient who have stage 1 hypertension but do have a 10 year cardiovascular risk of more than or equal to 10%, how often should you reasses them?

Answer 12

1 month

Question 13

If you are treating a patient with hypertension and their blood pressure goals have been met, when should you reasses?

Answer 13

In 3-6 months

Question 14

If you a treating a patient with high blood pressure but their blood pressure goals have not been met, what should you do?

Answer 14

Asses and optimize adherence to therapy and consider intensification of therapy

Question 15

What is the treatment plan for someone who has stage 2 hypertension?

Answer 15

Non pharmacological therapy and BO lowering medications

Question 16

Are those patients with stage 2 hypertension evaluated for a 10 year cardiovascular risk?

Answer 16

No

Question 17

What is the impact of the DASH diet on hypertension?

Answer 17

Loss of 11 mmHg

Question 18

What is the effect on hypertension by reducing sodium intake?

Answer 18

A loss of 5/6 mmHg

Question 19

Losing weight has how much impact on hypertension?

Answer 19

A loss of 5 mmHg

Question 20

Use of blood lowering medications is used for what type of patients?

Answer 20

They are used for primary prevention of CVD in adults with no history of CVD and with an estimated 10-year ASCVD risk of less than 10% but with a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher

Question 21

How should a patient with stage 2 hypertension be treated?

Answer 21

combination of non pharmacological and anti hypertensive drug therapy (with agents of two different classes)

Question 22

A patient with stage 2 hypertension should be reevaluated in?

Answer 22

1 month

Question 23

Should a patient with hypertension be treated with an ace inhibitor, renin inhibitor and a angiotensin receptor blocker?

Answer 23

No! This is not recommended

Question 24

What is a recommended blood pressure for someone who has confirmed hypertension with a 10 year ASCVD risk of 10% or higher ?

Answer 24

Systolic: 130 mmHg
Diastolic: 80 mmHg

Question 25

What is a reasonable blood pressure for someone who has confirmed hypertension but a 10 year cardiovascular risk of less than 10%?

Answer 25

Systolic: 130 mmHg
Diastolic: 80 mmHg

Question 26

Initiation of an anti hypertensive drug therapy with a single anti hypertensive drug is reasonable for adults with what stage hypertension?

Answer 26

Stage 1

Question 27

Initiation of an anti hypertensive drug therapy with 2 first line agents of different classes either as separate agents or in a fixed-dose combination is recommended in adults with…

Answer 27

Stage 2 hypertension and an average BP that is more than 20/10 mmHg above their blood pressure target

Question 28

What should a physician do first if he or she suspects of treatment resistance?

Answer 28

Confirm the treatment resistente aka check the blood pressure again

Question 29

What are some indications of treatment resistance?

Answer 29

1. If a patient was prescribed more than or the same as 3 anti hypertensive medications at optimal doses including a diuretic
2. If the office BP reading is 130/80 mmHg but the patient was prescribed more than or the same as 4 anti hypertensive medications

Question 30

How do we make sure that a patient is truly experiencing resistance to the lowering blood pressure medications?

Answer 30

1. Ensure accurate blood pressure readings
2. Asses for non adherence with prescribed regimen
3. Obtain work, hole or ambulatory BP readings to exclude the white coat effect

Also you have to asses for other factors that may be contributing to the high blood pressure such as obesity, physical inactivity, high salt diet, excessive alcohol intake

Also discontinue substances that can increase the sítienos blood pressure such as: NSAID’s,sympathomimetic ( amphetamines-decongestants), stimulants, oral contraceptives, licorice, ephedra

Screen for secondary causes of high blood pressure such as: renal stenosis, pheochromocytoma, obstructive sleep apnea, primary aldosteronism , and chronic kidney disease

Question 31

What other drug is used with an ace inhibitor for best results?

Answer 31

Hydrochlorothiazide