HTN 1

Question 1

High blood pressure (or hypertension) is

Answer 1

when your blood pressure or the force of blood flowing through your blood vessels is consistently too high

Question 2

As human get older there blood vessels get

Answer 2

Stiffer

Question 3

VENTRICULAR contraction and blood ejection

Answer 3

= Systole

Question 4

Ventricular relaxation and blood filling

Answer 4

Diastole

Question 5

If blood pressure is elevated constantly,

Answer 5

it damages arteries and blood vessels

Question 6

prevalence of hypertension in the US

Answer 6

Half the US have HTN
24% are well controlled.
45% adults in US have HTN > 130/80 or are taking medication
A greater percent of men (47%) have high blood pressure than women (43%)
Mid Eastern and southern states have high blood pressure
It is not well controlled in many cases.
Black adults have a higher rate of hypertension or prevelance.
40-49 or over 60 the HTN is more prevalent
Compliance with medication is problematic.
Very high % of people stop taking meds in their first years

Question 7

HTN therapy has poor adherence because high blood pressure is

Answer 7

asympotmatic.

Question 8

Etiology of primary HTN:

Answer 8

90% of the cases we do not know what causes. May be genetic. Environmental reasons. There is no actual reason.

Question 9

Etiology of Secondary HTN:

Answer 9

Secondary causes: • Renal artery stenosis • Sleep apnea • Endocrine disorder • Cerebral damage • Drug induced

Question 10

Drug-induced hypertension:

Answer 10

Oral Contraceptives
 Decongestants 
Systemic NSAIDs 
Systemic Corticosteroids 
Cyclosporine
 Herbals (Ma Huang, St. John’s wort) 
Amphetamines MAOIs,
 SNRIs, TCAs 
Recreational drugs (“bath salts”, cocaine) 
High Na+ agents or solutions

Question 11

Uncontrollable risk factors:

Answer 11

Genetics •
Race: African Americans develop HTN more often than Caucasians, occurs earlier, and is more severe
Family history predisposes the patient to develop HTN
Age: BP increases with age > 35 years old
• Men > 45 yo • Women > 55 yo

Question 12

Controllable risk factors

Answer 12

Obesity: BMI of 30.0+ more likely to develop HTN
Poor diet: high Na intake, salt sensitivity, low K intake •
ETOH: Heavy and regular consumption can BP
Sedentary lifestyle: Increased likelihood of becoming overweight and developing HTN
Stress: Possible risk factor, difficult to measure, responses to stress (varies from person to person)
Smoking

Question 13

Consequences of consistently elevated blood pressure

Answer 13

Damage from sustained high blood pressure happens over time
Arteries are damaged from consistent blood flow at high pressure
Cholesterol can form plaques where arteries are damaged
With aging: less flexible, stiffer, and plaque-filled arteries increase the workload of organs and lead to declining function.

Question 14

declining function OF BODY PART Such as

Answer 14

• Heart • Kidney • Vision • Erectile dysfunction in men • Lower libido in women.

Question 15

acute events DUE TO HTN are

Answer 15

TIA or Stroke • Heart attack • Angina • PAD: (peripheral arterial disease)claudication

Question 16

Things caused by high blood pressure in the body are

Answer 16

Protein in urine tells us kidney is not working properly
Left ventricular hypertrophy
Retinopathy

Question 17

difference between JNC8 and 2017acc/aha

Answer 17

JNC8 utilizes blood pressure numbers and studies of those. They want gold standard data.
2017ACC/AHA use Data and analyzed from - RCT - Meta-analysis - Observational data

Question 18

what ASCVD risk calculator will tell us

Answer 18

ASCVD risk calculator will tell us the % of cardiovascular events that will happen in the next 10 years. It is used with statins, aspirin, or someone should be on an antihypertensive.

Question 19

ASVD can be used only for

Answer 19

This is used for the primary invention. It cannot be used with a pt who already has a heart attack or stroke.

Question 20

Diagnosis should only be made with at least 2 elevated readings made on at

Answer 20

At least 2 different days

Question 21

If there is a disparity in the category between the systolic and diastolic pressures, the determines the stage

Answer 21

higher value

Question 22

Initial first-line therapies (4 classes):

Answer 22

ACE inhibitors or Angiotensin receptor blockers (ARB)
Thiazide diuretics
Calcium channel blockers

Question 23

what type of drugs are recommended for stage 2 hypertension and an average BP of 20/10 mm Hg above the BP target.

Answer 23

Two first-line drugs of different classes are recommended

Question 24

Improved adherence can be achieved:

Answer 24

With once-daily dosing, rather than multiple dosing
With combination therapy rather than administration of the free individual components,
Using a weekly med box properly, med delivery, blister packing meds, 90-day supplies

Question 25

No clinical CVD and 10-year ASCVD risk <10% ≥140/90 means What will be the recommendation?

Answer 25

so we recommend starting non-pharmacological therapy.

Question 26

pt already has a stroke and Secondary stroke prevention is≥140/90. what should be our goal BP for this patient.

Answer 26

PT has a stroke already (secondary stroke prevention) but our goal should still be <130/80.

Question 27

Less aggressive BP goals are appropriate when there is a high burden of

Answer 27

co-morbidity, older adults with postural hypotension, severe frailty, dementia, limited life expectancy, or residing in an SNF.

Question 28

Initiating a new or adjusted drug regimen for hypertension should have a follow-up evaluation of adherence and response to treatment at _______ until control is achieved.

Answer 28

monthly intervals

Question 29

Systematic strategies to help improve BP are

Answer 29

Home BP M,
Team-based care,
telehealth

Question 30

for titration of BP-lowering medication what is recommended

Answer 30

Out-of-office BP measurements are recommended

Question 31

Estimated that ___% of patients with elevated BP measured in the office have normal BP measured outside of the office (white coat HTN) . SMBP helps to ensure proper diagnosis

Answer 31

35%

Question 32

Limitations to using wrist cuffs:

Answer 32

BP can be measured only if the sensor is directly over the radial artery.
An accurate reading is obtained only if the wrist is at heart level.
Readings will be too high or too low if the wrist is below or above heart level, respectively.

Question 33

Lowering SBP/DBP by 10/5 mmHg will
translate into significant relative risk
reduction of cardiovascular events
(~20%) this can be achieved by

Answer 33

This can be achieved with 1 medication or Targeted lifestyle changes (now referred to as non-pharmacologic treatment)

Question 34

Statin intensity are

Answer 34

Low risk (<5%): no statin – lifestyle treatment
Borderline risk (5-7.5%): shared decision making
intermediate risk (7.5-19.9%): moderate-intensity statin
High risk (> 20%): high-intensity statin

Question 35

Non-pharmacologic interventions for treatment of HTN per ACC/AHA

Answer 35

Weight loss
Dash diet
Dietary sodium
Dietary potassium
Aerobic physical activity
Alcohol consumption

Question 36

Two first-line drugs of different classes
are recommended with _____
hypertension and average BP of 20/10
mm Hg above the BP targe

Answer 36

stage 2