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HPN Flashcards

1
Q 
Deaths in hypertensive patients have been shown
to be due to 
1
2
3
4
A

stroke 45%, heart failure 35%,

kidney failure 3% and others 17%.

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2
Q 
Factors increasing chances of dying in hypertensive
patients are: 
1
2
3
4
A

male patient, young patient, family

history, increasing diastolic pressur

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3
Q

For adults aged 18 years

and older hypertension is:

A
  • diastolic pressure >90 mmHg and/or

* systolic pressure >140 mmHg

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4
Q

•__________ is that of
≥ 140 mmHg in the presence of a diastolic
pressure <90 mmHg

A

Isolated systolic hypertension

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5
Q

__________ is the presence of
sustained hypertension in the absence of
underlying, potentially correctable kidney,
adrenal or other factors

A

Essential hypertension

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6
Q

____________is that with a diastolic
pressure >120 mmHg and exudative vasculopathy
in the retinal and kidney circulations

A

Malignant hypertension

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7
Q

_________ is a BP >140/90 mmHg
despite maximum dosage of tw o drugs for 3–4
months

A

Refractory hypertension

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8
Q

90% of HPN are ________

A

essential

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9
Q

What kind of HPN?

It is also more likely in patients
whose BP is responding poorly to drug therapy,
patients with well-controlled hypertension whose BP
begins to increase, and patients with accelerated or
malignant hypertension

A

Secondary hypertension

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10
Q

PE for secondary HPN

Abdominal systolic bruit

A

Kidney artery stenosis

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11
Q

PE for secondary HPN

Proteinuria, haematuria, casts

A

Glomerulonephritis

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12
Q

PE for secondary HPN

Bilateral kidney masses with or without haematuria

A

Polycystic disease

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13
Q

PE for secondary HPN

History of claudication and delayed femoral pulse

A

Coarctation of the aorta

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14
Q

PE for secondary HPN

Progressive nocturia, weakness

A

Primary aldosteronism (check serum potassium)

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15
Q

PE for secondary HPN

Paroxysmal hypertension with headache, pallor,
sweating, palpitations

A

Phaeochromocytoma

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16
Q

Renal Artery Stenosis

_______ kidney artery stenosis accounts for
the majority of cases, while ______
remains an important cause

A

Atherosclerotic

fibromuscular dysplasia

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17
Q

How record HPN?

A

On each occasion when the BP is taken, two or more
readings should be averaged. Wait at least 30 seconds
before repeating the procedure.

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18
Q

When to repeat BP readings?

A

If the first two readings differ by more than 6 mmHg systolic or 4 mmHg diastolic, more readings should be taken

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19
Q

Whom to measure sitting and standing BP?

A

Measure sitting and standing BP in elderly

and diabetic patients

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20
Q

If the initial reading is high (DBP >90 mmHg, SBP

>140 mmHg) repeat the measures after______

A

10 minutes of quiet rest.

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21
Q

The________ influence in the medical
practitioner’s office may cause higher readings so
measurement in other settings such as the home or
the workplace should be managed whenever possible.

A

‘white coat’

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22
Q

Initial diastolic BP readings of 115 mmHg or more,
particularly for patients with __________
may need immediate drug therapy

A

target organ damage,

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23
Q

If mild hypertension is found, observation with
repeated measurement over________months should be
followed before beginning therapy

A

3–6

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24
Q

This is required for the diagnosis and follow-up
of patients with fluctuating levels, borderline
hypertension or refractory hypertension (especially
where the ‘white coat’ effect may be significant

A

Ambulatory 24-hour monitoring

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25
Q 
Guidelines for ambulatory BP measurement:
1
2
3
4
5
A
  • unusual variability of office BP
  • marked discrepancy between office and house BP
  • resistance to drug treatment
  • suspected sleep apnoea
  • when two BP readings >140/90
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26
Q

These people have a
type of conditioned response to the clinic or office
setting and their home BP and ambulatory BP
profiles are normal.

A

‘White coat’ hypertension

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27
Q

T or F

Pts with ‘White coat’ hypertension

They appear to be at low risk of cardiovascular disease but may progress to sustained
hypertension

A

T

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28
Q

If the average diastolic BP at the initial visit is
90–100 mmHg, and there is no evidence of end organ
damage, _____ is indicated

A

non-pharmacological therapy is indicated for a

3-month period

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29
Q

Hovell has estimated that for every

1 kg of weight lost, BP dropped________

A

by 2.5 mmHg

systolic and 1.5 mmHg diastolic

30
Q

Drinking more than _______of alcohol a day
raises BP and makes treatment of established
hypertension more difficult.

A

20 g

31
Q

Reduction or withdrawal of regular alcohol intake

reduces BP by ______

A

5–10 mmHg

32
Q

Reduction of sodium intake to less than ______

sodium per day is advised

A

100 mmol

33
Q

_____ and_______ exercise helps to

reduce BP

A

Regular aerobic or isotonic

34
Q

There is evidence that _______ and _______ supplementation can reduce BP

A

lacto–vegetarian diets and

magnesium

35
Q

HPN Tx

A period of _______weeks is needed for the effect to
become fully apparent

A

4–6

36
Q

Relatively ineffective combinations of anit HPN

A
  • Diuretic and calcium-channel blocker

* β -blockers and ACE inhibitors

37
Q 
Undesirable combinations
• More than one drug from a particular
pharmacological group:
— \_\_\_\_\_\_\_\_\_\_\_(heart block, heart
failure)
— \_\_\_\_\_\_\_\_\_\_ (hyperkalaemia)
A

β -blockers and verapamil

potassium-sparing diuretics and ACE
inhibitors or ARB

38
Q

_________ are good first-line therapy for

hypertension

A

Thiazides

39
Q

___________ are less potent as antihypertensive
agents but are indicated where there is
concomitant cardiac or kidney failure and in
resistant hypertension

A

Loop diuretics

40
Q

________ are less effective where there is kidney

impairment

A

Thiazides

41
Q

_______ may antagonise the antihypertensive

and natriuretic effectiveness of diuretics

A

NSAIDs

42
Q

A diet high in potassium and magnesium should
accompany _______ therapy (e.g. lentils, nuts,
high fibre

A

diuretic

43
Q

_______ has different properties to the thiazide

and loop diuretics and has less effect on serum lipids

A

Indapamide

44
Q

NSAIDs may interfere with the hypotensive

effect of ________

A

β -blockers.

45
Q

___________plus a β -blocker may unmask

conduction abnormalities causing heart block

A

Verapamil

46
Q

• These drugs reduce BP by vasodilatation.
• The properties of individual drugs vary,
especially their effects on cardiac function

A

CCB

47
Q

The ________ compounds (nifedipine and
felodipine) tend to produce more vasodilatation
and thus related side effects

A

dihydropyridine

48
Q

Unlike verapamil or diltiazem (which slow the
heart), ___________ drugs can be used safely
with a β -blocker

A

dihydropyridine

49
Q

_________ is contraindicated in second and third

degree heart block

A

Verapamil

50
Q

______ and _______ should be used with

caution in patients with heart failure

A

Verapamil and diltiazem

51
Q

Angiotensin-converting enzyme is responsible for

1
2
3

A 
1. converting angiotensin I to angiotensin II (a potent
vasoconstrictor and
2.  stimulator of aldosterone
secretion) and 
3. for the breakdown of bradykinin
(a vasodilator).
52
Q

Cough, which occurs in about _______of patients, may disappear with time or a reduction in dose but it often persists and requires a change in drug in some patients.

A

15%

53
Q

_______ a potentially life-threatening condition,

may occur in 0.1–0.2% of subjects.

A

Angioedema,

54
Q

These agents competitively block the binding of
angiotensin II to type I angiotensin receptors and
block the effects of angiotensin more selectively
than the ACE inhibitors

A

Angiotensin II receptor

antagonists (sartans

55
Q

They
are useful alternatives for hypertensive patients who
discontinue an ACE inhibitor because of cough and
may be used in combination with thiazide diuretics.

A

Angiotensin II receptor

antagonists (sartans

56
Q

A specific problem of this alpha blocker is the ‘firstdose
phenomenon’; this involves acute syncope about
90 minutes after the first dose, hence treatment
is best initiated at bedtime

A

Prazosin

57
Q

Prazosin potentiates_______ and works best if used with them

A

β -blockers

58
Q

Other than calcium-channel blockers these include
hydralazine, minoxidil and diazoxide, which are
not used for first-line therapy but for refractory
hypertensive states and hypertensive emergencies

A

Vascular smooth muscle relaxants

59
Q

example of such a central acting agent is______
which apparently stimulates the imidazoline
receptors in the brain to inhibit sympathetic outflow
in the body

A

moxonidine,

60
Q

Typical
presentations of hypertensive emergencies (which
are rare) include

A

hypertensive encephalopathy, acute
stroke, heart failure, dissecting aortic aneurysm and
eclampsia.

61
Q

BP goals in HPN Emergencies

A

Aim to reduce the
BP by no more than 25% within the first 2 hours then
towards 160/100 mmHg within 2 to 6 hours.

62
Q

Isolated systolic hypertension is most frequently seen

in __________

A

elderly people

63
Q

T or F

A

Patients with isolated systolic hypertension
should be treated in the same way as those with
classic systolic/diastolic hypertension

64
Q

________exists where control has not
been achieved despite reasonable treatment for 3–4
months

A

Refractory hypertension

65
Q

_____ and_____ are preferable in the young hypertensive, with______ a second agent.

A

ACE inhibitors or calcium-channel blocking agents

diuretics

66
Q

Older patients may respond to ______

A

nonpharmacological

treatment.

67
Q

Reducing dietary sodium is more beneficial than

with _______

A

younger patients.

68
Q

Add only one agent at a time and wait about_______

weeks between dosage adjustments

A

4

69
Q

Older patients may respond better to
1
2
3

A

diuretics,

calcium-channel blockers and ACE inhibitors.

70
Q

Younger patients may respond better to
1
2

A

β -blockers

or ACE inhibitors

MC (90 decks)

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