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Therapeutics 2 - Exam 5 > HTN 1 - olenik > Flashcards

HTN 1 - olenik Flashcards

1
Q

what is the most significant risk factor for CVD?

A

HTN

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2
Q

what are the long term consequences of HTN?

A

left ventricular hypertrophy
angina
MI
coronary revascularization
HF
stroke or TIA
CKD
peripheral vascular disease
retinopathy

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3
Q

what is essential HTN?

A

elevated arterial BP with an unknown etiology

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4
Q

what is secondary HTN?

A

elevated arterial BP due to concurrent medical conditions or medications
identifiable cause

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5
Q

what is isolated systolic HTN?

A

systolic BP values are elevated
diastolic BP values are not

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6
Q

what is resistant HTN?

A

fail to attain goal BP while adherent to regimen that includes at least 3 agents at max dose (including a diuretic) or when 4+ agents are needed

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7
Q

what is orthostatic hypOtension?

A

a systolic Bp decrease of over 20 mmHg
a diastolic BP decrease of over 10 mmHg within 3 minutes of position change
AND/OR
an increase in heart rate over 20 BPM

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8
Q

what is the pathophysiology of essential HTN?

A

humoral abnormalities
neuronal mechanisms
vascular endothelial mechanisms
peripheral auto regulation defects
electrolyte distrubances

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9
Q

how should blood pressure be solved?

A

CO x TPR

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10
Q

how should cardiac output be solved?

A

HR x SV

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11
Q

what are modifiable HTN risk factors?

A

high sodium intake
obesity
low potassium intake
excessive alcohol intake

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12
Q

what are non-modifiable HTN risk factors?

A

age
ethnicity
genetic predisposition
gender

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13
Q

how does age and gender correlate to risk factors of HTN?

A

under 55: male > female
55-64: female > male
over 64: female&raquo_space; male

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14
Q

why do females have a higher risk factor of HTN as they age?

A

during menopause, females lose the hormones that help control it better

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15
Q

what are substances that can increase BP?

A

illicit drugs
caffeine
nicotine
decongestants
amphetamines
antidepressants
atypical antipsychotics
immunosuppressants
OCs
NSAIDs
systemic steroids
oncology agents

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16
Q

what are the types of BP measurement techniques?

A

in-office
ambulatory BP monitoring (ABPM)
home BP monitoring (HBPM)

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17
Q

how should in-office BP readings be taken?

A

two readings 5 minutes apart with the patient sitting in a chair
confirmed elevated reading in opposite arm

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18
Q

what are the indications of ambulatory BP monitoring?

A

white coat and masked HTN
nighttime BP dipping

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19
Q

what are the indication of home BP monitoring?

A

white-coat and masked HTN
to evaluate the response to therapy
to improve adherence

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20
Q

how is normotensive classified in each setting?

A

no HTN in all

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21
Q

how is sustained HTN classified in each setting?

A

HTN in both

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22
Q

how is masked HTN classified in each setting?

A

office/clinic/healthcare –> no HTN
home –> HTN

23
Q

how is white coat HTN classified in each setting?

A

office/clinic/healthcare –> HTN
home –> no HTN

24
Q

what are benefits of HBPM and ABPM?

A

confirm diagnosis
aide in medication titration
identify white coat and masked HTN
better predictor of long-term CV outcomes

25
Q

what are the cons of HBPM and ABPM?

A

user error
equipment cost
insurance reimbursement

26
Q

what is normal BP?

A

under 120/80

27
Q

what is elevated BP?

A

120-129 / under 80

28
Q

what is HTN stage 1?

A

130-139 / 80-90

29
Q

what is HTN stage 2?

A

+140 / +90

30
Q

how should normal BP be treated?

A

promote a healthy lifestyle
reassess BP in 1 year

31
Q

how should elevated BP be treated?

A

recommend non-pharm tx
reassess BP in 3-6 months

32
Q

how should HTN stage 1 be treated?

A

pt has ASCVD risk >10% or specific comorbidity –> use non-pharm, a medication, and reassess BP in 1 month
none –> nonpharm with reassess BP in 3-6 months

33
Q

how should HTN stage 2 be treated?

A

non-pharm interventions and 2 meds
reassess BP in 1 month

34
Q

what is BP threshold for most treatment initation?

A

130/80

35
Q

what is BP threshold for secondary stroke prevention or no clinical CVD and 10 year ASCVD risk under 10%?

A

140 / 90

36
Q

what is goals of treatment for HTN?

A

decrease morbidity/mortality
reach BP targets
select agents with proven CV benefit

37
Q

what is the BP goals per ACC/AHA guidelines?

A

under 130/80 but under 140/90 for elderly

38
Q

why is the BP goal for elderly less strict?

A

high comorbidity burden
limited life expectancy
greater chance of a hypoglycemia risk and fall risk

39
Q

what is BP goal per KDIGO guidelines?

A

SBP under 120 for adults with elevated BP and CKD

40
Q

what were the outcomes of the SPRINT trial?

A

intensive treatment group had 25% lower risk of primary CV composite outcomes
27% reduced risk of death
2.8 meds required on average
increased risk of electrolyte abnormalities, hypotension, and AKI

41
Q

what are the outcomes of the ACCORD trial?

A

intensive treatment group had no benefit in primary composite outcome
41% reduced risk of stroke
increased risk of AE

42
Q

how does weight loss decrease SBP?

A

by 5 mmHg

43
Q

how does the DASH diet decrease SBP?

A

by 11 mmHg

44
Q

how does decreasing sodium intake decrease SBP?

A

by 5 to 6 mmHg

45
Q

what is the recommend sodium intake levels?

A

under 1500 mg/day or 1000mg reduction per day

46
Q

how does enhancing potassium intake decrease SBP?

A

by 4 to 5 mmHG

47
Q

what is the recommended potassium intake per day?

A

3500 to 5000 mg

48
Q

how does physical activity impact SBP?

A

decrease by 4 to 8 mmHg

49
Q

how does moderate alcohol intake impact SBP?

A

decrease by 4 mmHg

50
Q

what is the recommended alcohol intake?

A

2 for men
1 for women

51
Q

what foods are apart of the DASH diet?

A

vegetables
fruits
whole grains
fat-free or low-fat dairy products
fish
poultry
beans
nuts and vegetable oils
foods rich in K, Ca, Mg, fiber, protein, and lower in sodium (1500mg/day)

52
Q

what foods should be limited while on DASH diet?

A

high in saturated fats (fatty meals, full-fat dairy products, tropical oils)
sugar-sweetened beverages and sweets

53
Q

what is pharm treatment options for HTN?

A

ACEi
ARBs
CCB
direct renin inhibitors
beta blockers
diuretics
alpha-1 blockers
central alpha-2 agonists
vasodilators

Therapeutics 2 - Exam 5 (14 decks)

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