HTN

Question 1

The higher the BP the greater the risk of?

Answer 1

MI
HF
Stroke
Renal dz

Question 2

Peripheral Arterial Dz major risk factors are?

Answer 2

HTN, DM, smoking

Question 3

PAD
risk of death from CVD is associated w/

Answer 3

Symptomatic PAD d/t diffuse atherosclerosis, CAD and renal dz that are often present

Question 4

PAD
Renovascular dz should be considered in these pts if?

Answer 4

BP is not controlled

Question 5

Categories of HTN in Adults
Normal
Elevated
HTN Stage 1
HTN Stage 2

Answer 5

SBP < 120 and DBP < 80
SBP 120-129 and DBP < 80
SBP 130-139 or DBP 80-89
SBP >/= 140 or DBP >/= 90

Question 6

HTN Causes & Prevention
90-95% of HTN is primary - no identifiable cause. However, there are identifiable behaviors that contribute including:

Answer 6

Obesity
Diets high in Na, low in fruits, veggies
Physical inactivity
Excess ETOH

Question 7

Patient Evaluation
Assess Lifestyle & ID CV risk factors including?

Answer 7

HTN
Age
DM
Elevated chol/low HDL
GFR < 60 ml/min
family hx
microalbuminuria
BMI > 30
inactivity
tobacco

Question 8

Patient Evaluation
Hx: meds

Answer 8

Decongestants
oral contraceptives
appetite suppressants
NSAIDs
Thyroid replacement
ETOH
drugs

Question 9

Patient Evaluation
Physical Exam should include

Answer 9

BP
Optic fundi
BMI
waist circumference
Hear lungs auscultation
Abdomen palpation for enlarged kidneys, masses, distended bladder, & AA pulsations
LE for edema
pulses
neuro
Auscultate carotids, abd, femoral bruits
Palpate thryoid

Question 10

Patient Evaluation
Basic Testing for Primary HTN

Answer 10

Fasting blood glucose
CBC
Lipid panel
BMP for electrolytes, sCR w/ eGFR
Thyroid - stimulating Hromone
Urinalysis
Electrocardiogram

Question 11

Patient Evaluation
Optional Testing for Primary HTN

Answer 11

Echocardiogram
Uric acid
Urinary albumin to creatinine ratio

Question 12

Conditions that should prompt a provider to evaluate for secondary HTN include?

Answer 12

Drug-resistant/induced HTN
Abrupt onset HTN
Onset of HTN at < 30y/o
Exacerbation of previously controlled HTN
Disproportionate TOD for degree of HTN
Accelerated/malignant HTN
Onset of diastolic HTN ini older adults (>/= 65y/o)
Unprovoked or excessive hypokalemia

Question 13

Drug resistant HTN is a BP that remains uncrontrolled above goal despite?
also includes pts whose BP is controlled at or below goal but requiring?

Answer 13

Concurrent use of 3 antihypertensive drugs of different classes (CCB, ACEI or ARB, & diuretic)

> /= 4 antihypertensives of different classes to achieve target

Question 14

Assess for presence of target organ damage including?

Answer 14

Heart (LVH, angina/MI, HF)
CKD
PAD
Retinopathy
Brain (stroke, dementia)

Question 15

Treatment
Overall Goal?
BP goal?
Starts w/?
Stop what?

Answer 15

Decrease CV and renal M&M
< 130/80 mmHg for most adults
Lifestyle modification
Smoking

Question 16

Lifestyle modifications to decrease HTN inlcude?

Answer 16

Weight loss
Healthy diet
Reduced intake of dietary sodium
Enhanced intake of dietary potassium
Physical activity
Moderation in alcohol intake

Question 17

Initial Drug Choices & subsequent add-on therapy includes?

Answer 17

Thiazide or thiazide-type diuretics
CCB
ACEIs
ARB
Spironolactone or eplerenone - for resistant HTN

Question 18

Special Populations
DM: all recommended classes of meds, including diuretics are similarly effective for prevention of?
If heavy proteinuria or advanced kidney disease use?
A combo of how many durgs is usually required to achieve BP targets?

Answer 18

CVD
ACEI
2 or 3 agents

Question 19

Special Populations
CKD
What is the BP goal for all CKD patients not on dialysis?

Answer 19

SBP < 120

Question 20

Secondary Agents to use?

Answer 20

Loop Diuretics
Potassium sparing diuretics
Aldosterone Antagonist diuretics
Beta blockers
Beta blockers - cardioselective and vasodilatory
Beta blockers - noncardioselective
Beta blockers - intrinsic sympathomimetic activity
Beta blockers - combined alpha and beta receptor
Direct renin inhibitor
Alpha-1 beta blockers
Central Alpha2 agonists and other centrally acting drugs
Direct vasodilators

Question 21

Screening for Secondary Causes of HTN should include?

Answer 21

Primary aldosteronism (elevated aldosterone/renin ratio)
CKD (eGFR < 60ml/min/1.73msq)
Renal Artery Stenosis (young female, known atherosclerotic disease, worsening kidney function)
Pheochromocytoma (episodic hypertension, palpitations, diaphoresis, HA)
OSA (snoring, witnessed apnea, excessive daytime sleepiness)

Question 22

Thiazide diuretics (HCTZ):
Inhibits what?
1/2 life is how long?
Common SEs?
Monitor what?

Answer 22

distal convoluted tubule Na & Cl resoprtion
5.6-14.8hrs
hypo K, Cl, Na; Hyper Ca, uricemia, lipidemia, glycemia, hypotension, weakness, cramps
BUN/Cr @ baseline then periodically

Question 23

Beta blocker MOA

Answer 23

competitive inhibition of catecholamine effects @ beta-adrenergic receptors leading to decreased HR and CO.
Also decreases renin levels, releases vasodilatory prostaglandins, & decrease plasma volume

Question 24

2 classes of beta blockers
Cardioselective includes? primary effects?
Non-cardioselective includes? primary effects?

Answer 24

metoprolol, esmolol - beta 1 blocking effects causing decreased HR

Labetalol, carvedilol - beta 1 & 2, alpha blocking effects causing decreased HR & BP

Question 25

Beta Blocker Side Effects include

Answer 25

AV block
HF
Raynaud’s
impotence
hypotension
increased triglycerides
decreased HDL - mainly w/ nonselectives

Question 26

Caution in using Beta blockers with what diseases? why?

Answer 26

COPD, PVD, DM
@ higher doses beta 1 blockers lose their selectivity

Question 27

CCB MOA

Answer 27

Inhibits calcium ion influx into vascular smooth muscle & myocardium, relaxing smooth muscle, decreasing PVR, dilating coronaries, prolonging AV node refractory period

Question 28

Dihydropyridine CCB’s include?
Can cause?

Answer 28

Amlodipine, felodipine, nicardipine
LE edema, flushing, HA, Rash

Question 29

NonDHP CCBs include?
Effects?
SE’s?

Answer 29

Dilt, verapamil
negative inotropic and chronotropic effects
dilt - nausea, HA, rash
Verapamil - hypotension, nausea, constipation, HA

Question 30

Avoid CCB in which patients? d/t what?

Answer 30

HF d/t Increased mortality

Question 31

Aldosterone receptor blocker:
example?
MOA
1/2 life
Common SE?
Monitor?

Answer 31

aldactone
antagonizes distal convoluted tubule aldosterone receptors (K sparing diuretic)
1.3-2hrs
Hyperkalemia
BUN/Cr, electrolytes @ baseline then periodically

Question 32

ACEIs
Examples?
MOA?
Monitor?

Answer 32

the prils
inhibit RAS system; inhibits ACE, interfering w/ conversion of angiotensin I to II
BUN/Cr @ baseline then periodically, electrolytes, BP

Question 33

ACEIs SE’s?

Answer 33

dry cough
edema
hypotension
dizziness
worsening renal fxn if decreased renal perfusion d/t vasodilation of efferent arteriole in kidney
hyperkalemia

Question 34

Central alpha 2 agonists/centrally acting
example?
use?
SEs?

Answer 34

clonidine
potent antiHTN agent
Bradycardia, hypotension

Question 35

ACEI considerations/Contraindications
Renal insufficiency - generally safe w/ Cr < ?
Hypotension - from?
Cough - how many will develop w/n first week - 6mos? continue if?
Hyperkalemia - w/ ?
Angioedema - rare, usually w/n but how long? but can occur @ any time.
RAS stands for?

Answer 35

3mg/dL
volume depletion, vasodilators, acute CHF, HD
5-20%; if able to tolerate
renal insufficiency, DM
1st wk
Renal Artery Stenosis

Question 36

HTN in AAs is?

Answer 36

more common
more severe
develops earlier
results w/ more clinical sequelae compared to non-Hispanic Whites

Question 37

HTN control rates are lower among who compared to non-Hispanic Whites & AAs?

Answer 37

Mexican Americans & Native Americans