HTN

Question 1

HTN prevalence

Answer 1

> 100 million people
African Americans > non-Hispanic Whites
Women > men, older than 60 years
Leading risk factor for morbidity and mortality in ppl

Question 2

Systolic htn

Answer 2

Sustained systolic BP > 130 mm Hg

Question 3

Diastolic htn

Answer 3

Sustained diastolic BP > 80 mm Hg

Question 4

Isolated systolic hypertension

Answer 4

Systolic > 130 mm Hg and diastolic < 80 mm Hg

Question 5

Isolated diastolic hypertension

Answer 5

Systolic < 130 mm Hg with diastolic > 80 mm Hg

Question 6

Combined systolic and diastolichypertension

Answer 6

Systolic > 130 mm Hg and diastolic > 80 mm Hg

Question 7

Elevated htn

Answer 7

120-129
<80

Question 8

Stage 1 htn

Answer 8

130-139
80-89

Question 9

stage 2 htn

Answer 9

> 140
90

Question 10

Primary HTN (Essential) etiology

Answer 10

Specific etiology unclear

Question 11

Primary HTN (Essential) contributing factors

Answer 11

SNS activity
Dysregulation of the renin-angiotensin-aldosterone system
Deficient production of endogenous vasodilators
Oxidative stress -> stiff vessels

Question 12

RAAS controls…..

Answer 12

Extracellular fluid volume-> aldo release for na reabsprtion
Peripheral resistance-> maintain
Blood pressure

Question 13

Dysregulated renin release leads to….

Answer 13

Elevated renin levels
Angiotensin II overproduction
Increased aldosterone
HTN

Question 14

Angiotensin I cleaved into Angiotensin II by …..

Answer 14

chymase (human mast cell protease = bypass angiotensin cleaves to)

Acei don’t work on chymase = cant take acei

Question 15

Angiotensin produced in…..

Answer 15

Production of angiotensin II in fat, blood vessels, heart, adrenals, and brain

Question 16

Major regulators of vascular tone

Answer 16

Nitric oxide and endothelin
No – vasodilation
Endothelin = vasodilation or constriction

Question 17

Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), and urodilatin….

Answer 17

Blunts RAAS…

Question 18

Oxidative stress causes

Answer 18

Impaired endothelial function
Disruption of NP release or receptor response-> HTN

Question 19

Secondary htn prevalence

Answer 19

Secondary HTN
5% of population
Correctable cause
Age-dependent or drug-induced
Stop drug = htn goes away

Question 20

herbals that cause htn

Answer 20

ephedra, ginseng, ma huang

Question 21

% of children with htn w/ an underlying cause

Answer 21

birth -12yr = 70-85, most common etiologies = renal parenchymal disease

Question 22

Resistant HTN

Answer 22

Above goal BP despite ≥3 antihypertensive drugs of different classes

Question 23

Controlled resistant HTN

Answer 23

Need for ≥4 drugs to achieve control

Question 24

Refractory HTN

Answer 24

Uncontrolled BP on ≥5 drugs
Drug intolerance or pseudo-resistant HTN (0.5% of pop)

Question 25

Lifestyle modifications for htn

Answer 25

Weight reduction
Moderation of alcohol intake
Increased aerobic exercise
Smoking cessation
Dietary potassium and calcium intake
Salt restriction

Question 26

Non-black hypertensive population (w/ or w/o DM) medications

Answer 26

ACE inhibitors, ARBs, CCBs, or thiazide-type diuretics

Question 27

ACC/AHA Guidelines for bp

Answer 27

Multiple BP readings for diagnosis
Nonpharmacologic interventions
Pt w/ IHD, cerebrovascular disease, CKD, or with an elevated risk of atherosclerotic CV disease treat SBP > 130 mm Hg and DBP > 80 mm Hg

Question 28

Black hypertensive population w/o HF nor CKD (w/ or w/o DM) medications

Answer 28

Initiating treatment w/ CCBs or thiazide-type diuretic

Question 29

Chronic kidney disease htn medications

Answer 29

ACE inhibitor or ARB

Question 30

First-line antihypertensive therapy

Answer 30

Diuretics, CCBs, ACE inhibitors, and ARBs

Question 31

Beta-blockers given for ……

Answer 31

CAD or tachydysrhythmias
Multi-drug therapy in resistant HTN

Question 32

Interventional tx for secondary htn

Answer 32

Correction of renal artery stenosis
Direct arterial repair
Adrenalectomy

Question 33

med tx for secondary htn

Answer 33

ACE-Is or in combination with diuretics

Question 34

Urgent/emergent htn crises

Answer 34

Urgent or emergent
Progressive organ damage

Question 35

Central nervous system injury from htn emergencies

Answer 35

Hypertensive encephalopathy,
intracerebral hemorrhage,
subarachnoid hemorrhage, and
acute stroke

Question 36

PIH

Answer 36

Systolic pressure > 160 mm Hg and/or diastolic pressure > 110 mm Hg

require immediate intervention

can have Encephalopathy-> end organ dysfunction

Question 37

First-line drug for peripartum hypertension

Answer 37

labetalol

Question 38

Aortic dissection with htn crises treatment

Answer 38

β-blocker (esmolol, labetalol) plus arteriolar dilator

Question 39

Medication for Rapid arterial dilation and BP reduction

Answer 39

sodium nitroprusside infusion

Question 40

Pressure to cancel surgery

Answer 40

> 180 mmhg

Question 41

Htn medications to DC prior to surgery

Answer 41

High-dose ARBs and ACE inhibitors

Question 42

BP Medications to DC prior to sx

Answer 42

High-dose ARBs and ACE inhibitors–24 hrs