HTN

Question 1

Stage 1 and 2 HTN in kids

Answer 1

kids <13 years

Normal: systolic and diastolic less than 90th %ile for age, sex, height
HTN: SBP, DBP, or both in 95th + %ile for age, sex, height on three separate occasions
Elevated BP: avg SBP or DBP >90th and 95th %ile (pre-hypertension)
Stage 1: BP 95th-99th %ile
Stage 2: BP >99th %ile

Question 2

Stage 1 and 2 HTN in adolescents > 13 years

Answer 2

elevated: SBP and/or DBP >120/80 to 129/<80
HTN >130/80
Stage 1: BP >130/90 to 139/89
Stage 2: BP >140/90

Question 3

Managing kids HTN / exam

Answer 3

Measure BP annually on all children age 3+
Elevated BP: at least 2 f/u BP measurements w/in 1-2 months of initial
If less than 95th %ile, continue to check with routine annual visits
Goal: reduce systolic or diastolic to <95th %ile

Question 4

Meds given for kids HTN

Answer 4

Medication initiation: consult cardiology
Usually ACE or ARB, beta blocker, long acting CCB or thiazide
Start at lowest recommended dose

Question 5

Type of HTN in pregnancy …
BP >140/90 <20wks, persistent >12 weeks PP
No proteinuria
Asymptomatic

Answer 5

Chronic HTN

Question 6

Type of HTN in pregnancy …
BP >149/90 >20 wks, normal by 12 wks PP
No proteinuria
Asymptomatic

Answer 6

Gestational HTN

Question 7

Type of HTN in pregnancy ...
Mild: >149/90; Severe: >160/110, normal by 12 weeks PP
Proteinuria
Mild: >2g/24hr or >1+ dip
Severe: >5g/24h or >3+ dip
Platelets: <100,000
AST, ALT elevated
LDH elevated
Serum creatinine >1.2

Answer 7

Preeclampsia

Question 8

Sx of ______

Symptoms: AMS, h/a, visual disturbances, pulmonary edema, epigastric pain, <500mL UOP/day, thrombocytopenia, hemolytic anemia

Answer 8

Preeclampsia

Question 9

Type of HTN in pregnancy ...
BP >140/90 <20 wks, persistent >12wks PP
Proteinuria:
New onset: protein >2g/24hrs, >20wks
Sudden increase in BP
Sudden increase in urine protein
Low platelet count <20 wks
Symptoms: same as preeclampsia

Answer 9

Superimposed preeclampsia

Question 10

When to give pregnant woman meds for HTN?

what meds are safe

Answer 10

Antihypertensive if BP >160/80

Nifedipine; labetalol, methyldopa

Question 11

Expectant management for expectant moms with HTN

Answer 11

delivery at 37 wks gestation
Antenatal testing: twice weekly for preeclampsia, once weekly for gestational HTN
US every 3 weeks
BP assessment 2x/wk
CBC, liver enzymes, creatinine 1x/wk
Proteinuria each visit

Question 12

Sx of severe preeclampsia:

Answer 12

Severe headaches that do not resolve with rest, tylenol, fluids, food; RUQ pain, visual changes, SOB

Question 13

catecholamine-producing tumor of the adrenal glands; abnormal production of epinephrine and norepinephrine
Renal effects: sodium retention, increased renin secretion, reduction of hydrostatic pressure
Cardiovascular effects: peripheral vasoconstriction and increased cardiac contraction and workload 2/2 HTN

Answer 13

Pheochromocytomas

Question 14

5 H’s: HTN, headache, hyperhidrosis (sweating), hypermetabolic state, and hyperglycemia

Labile HTN
palpitations

Answer 14

Pheochromocytomas

Question 15

How to tx Pheochromocytomas?

Answer 15

Control htn (alpha blocker followed by beta blocker or alpha-beta blocker); Surgery to check for malignancy

Question 16

HTN when 70-80% blockage of renal artery which activates the renin-angiotensin system.

Answer 16

RAS→ (Renal Artery Stenosis)

Question 17

<30yo caused by fibrodysplasia (tight fibrous bands alternating with normal/thin tissue along artery)
F>M
Tx: percutaneous renal angioplasty w/ or w/o stenting
>50yo atherosclerosis more common cause. Tx: medications, stenting
PE: abdominal bruits
Diag: UA, creat, renal MRA

Answer 17

RAS→ (Renal Artery Stenosis)

Question 18

How to tx RAS→ (Renal Artery Stenosis)

Answer 18

beta blockers to control HTN (NO ACEI), angioplasty, bypass surgery

Question 19

→ unprovoked hypokalemia
PE: weakness, HA, fatigue, HTN, hypokalemia
Diag: aldosterone levels (before and after saline challenge); renin; CT abd/pelvis
Tx: if tumor→ sx; if bilateral hyperplasia→ potassium-sparing diuretics

Answer 19

Hyperaldosteronism

Question 20

Creat > 1.5mg/dL

GFR < 50 mL/min

Answer 20

Renal Disease

Question 21

Suppression of ACTH production when steroid are administered in high doses for long periods (asthma, COPD)
Steroid medications should be given in morning to avoid suppression of morning pulse of ACTH hypersecretion of glucocorticoids by the adrenal cortex, the result of an adrenal tumor or overstimulation by the anterior pituitary.

Answer 21

Cushing’s Syndrome

Question 22

CM: HTN, glucose intolerance, and insomnia
Peds: depressed linear growth and weight gain
PE: central obesity, moon face, buffalo hump (dorsocervical fat pad), muscle wasting and weakness, hirsutism, red-purple abdominal striae (>1cm) and acne. Depression.
Diag: 24hr urine (>100mcg cortisol)

Answer 22

Cushing’s Syndrome

Question 23

How to tx Cushing’s Syndrome

Answer 23

ketaconazole (competes with cortisol); pituitary tumor resection
Obtain BMD (chronic glucocorticoid levels a/w osteoporotic tendencies)

Question 24

Severe elevation in BP (>180/120) with evidence of new or worsening target organ damage
Send to ER

Answer 24

Hypertensive emergency

Question 25

Severe BP elevation in otherwise stable patients without acute or impending change in target end organ damage
Can treat on outpatient basis

Answer 25

Hypertensive urgencies