Htn

Question 0

pre hypertention

Answer 0

130-30/80-89, range are at an increased risk for dev. htn as those with lower values.

Question 1

how to classify bp

Answer 1

is based on the average of two or more properly measured, seated bp readings each of two or more office visits.
new chatagory prehytn, stages 2 and 3 combined.

Question 2

individuals at age 55 and have a normotensive bp, have what risk of dev. htn?

Answer 2

90% risk for development of htn

Question 3

age 40-70, each increment of 20 mmhg in sbp or 10 in dbp, doubles the risk of

Answer 3

cvd across the entire range from 115/75 to 185/115

Question 4

norm bp?
pre htn?
stage 1?
stage 2?

Answer 4

160/ or >100, d/e, 2 drug combo usually with diuretic, and other.

Question 5

benefits of lowering bp

Answer 5

35-40% reduction in stroke
20-25% reduction in MI
50% reduction in heart failure

Question 6

percent of population unaware of htn?

Answer 6

30%

Question 7

accurate bp measurement

Answer 7

Properly calibrated and validated instrument.
Persons should be seated quietly for at least 5 minutes in a chair (rather than on an exam table), with feet on the floor and arm supported at heart level.
Measurement of BP in the standing position is indicated periodically, especially in those at risk for postural hypotension.
Appropriate size cuff (cuff bladder encircling at least 80 percent of the arm) should be used to ensure accuracy.

Question 8

three objectives when assessing bp

Answer 8

Assess lifestyle and identify other cardiovascular risk factors or concomitant disorders than my affect prognosis and guide treatment
Reveal identifiable causes of high BP
Assess the presence or absence of target organ damage and CVD.
data needed are acquired through medical history, physical exam, routine lab tests, and other diagnostic procedures.

Question 9

bp considerations in hx taking

Answer 9

Age at onset, duration, and severity
Onset at younger (< 25 years) or older (> 55 years) age suggests secondary hypertension New-onset, severe hypertension may be secondary
Contributing factors
Significant salt intake, inactivity, psychosocial stress, sleep apnea may contribute to higher blood pressure; some can be addressed separately
Concomitant medications
Common offenders include non-aspirin nonsteroidal anti-inflammatory drugs, oral contraceptives, corticosteroids, licorice, cough/cold/weight-loss sympathomimetics (pseudoephedrine, Ma Huang, ephedrine)

Question 10

Symptoms suggesting secondary causes

Answer 10

Palpitations or tachycardia, spontaneous sweating, migraine-like headaches in paroxysms (catecholamine excess) Muscle weakness, polyuria (decreased potassium from aldosterone excess)
Personal or family history of renal disease or findings (proteinuria, hematuria) or symptoms such as ankle edema Thinning of skin and stigmata of cortical excess
Snoring and daytime somnolence (sleep apnea) Heat intolerance and weight loss (hyperthyroidism)

Question 11

Target organ damage

Answer 11

Chest pain or chest discomfort (possible coronary artery disease) Neurologic symptoms consistent with stroke or transient ischemic attack Dyspnea and easy fatigue (possible heart failure)
Claudication (peripheral arterial disease)

Question 12

physical exam

Answer 12

Verify bp in the contralateral arm
Exam the optic fundi
Calculate BMI
Auscultation for carotid, abdominal, femoral bruits, palpation of the thyroid gland; thorough exam of the heat and lungs; exam of the abdomen for enlarged kidneys, masses, and abnormal aortic pulsation; palpation of the lower extremities for edema and pulses; and neurological assessment.

Question 13

Things to note in the physical examination of hypertensive patients

Answer 13

General appearance, skin lesions, distribution of body fat
Patient may fit criteria for metabolic syndrome (added cardiovascular risk)
Evidence of prior stroke from gait and posture
Rarely, secondary forms are evident as striae (Cushing syndrome) or mucosal fibromas (multiple endocrine neoplasia type II)
Funduscopy
See text for lesion grades
Retinal changes reflect severity of hypertension (target organ damage to the eye) as well as future cardiovascular risk
Examination of neck for thyroid enlargement, carotid bruits
Diffuse multinodular goiter indicating Graves disease Presence of carotid bruits suggests potential stroke risk
Cardiopulmonary examination
Rales and cardiac gallops consistent with target organ damage (heart enlargement or heart failure) Interscapular murmur during auscultation of the back (coarctation of the aorta)
Abdominal examination
Palpable kidneys suggest polycystic kidney disease Mid-epigastric bruits may indicate renal arterial disease
Neurologic examination
Signs of previous stroke (reduced grip, hyperreflexia, spasticity, Babinski sign, muscle atrophy, gait disturbances)
Pulse examination
Delayed or absent femoral pulses may reflect coarctation of the aorta or atherosclerosis

Question 14

labs/diagnostics for htn

Answer 14

Routine laboratory tests recommended before initiating therapy include and EKG, Urinalysis, blood glucose and hematocrit; serum potassium, creatinine (or the corresponding estimated glomerular filtration rate [GFR]), and calcium; and a lipid profile, after 9-12 hour fast, than includes HDL, LDL, total cholesterol, triglycerides.
Optional tests includes measurement of urinary albumin excretion or albumin/creatinine ratio. More extensive testing for identifiable causes is not indicated generally unless BP control is not

Question 15

goals of therapy

Answer 15

Goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality.
Treating SBP and DBP to targets that are < 130/80.

Question 16

lifestyle modifications

Answer 16

Major lifestyle modifications shown to lower bp include weight reduction, adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan which is rich in potassium and calcium, dietary sodium reduction, physical activity, and moderation of alcohol consumption.

Question 17

2014 Evidence-Based Guideline for the Management
of High Blood Pressure in Adults
Report From the Panel Members Appointed
to the Eighth Joint National Committee (JNC 8)

Answer 17

There is strong evidence to support treating hypertensive persons aged 60 years or older to a
BP goal of less than 150/90mmHg and hypertensive persons age 30 through 59 years of age to a diastolic goal of less than 90mmHg

Question 18

person’s younger than 60 sbp and dbp for those younger than 30 for bp goals?

Does this include people w/htn and dm, ckd?

Answer 18

insufficient evidence in hypertensive
persons younger than 60 years for a systolic goal, or in those younger than 30 years for a
diastolic goal, so the panel recommends a BP of less than 140/90mmHg for those groups
based on expert opinion. The same thresholds and goals are recommended for hypertensive
adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general
hypertensive population younger than 60 years.

Question 19

ACEI   
ARB  
BP  
CCB  
CKD  
CVD  
ESRD  
GFR  
 HF

Answer 19

ACEI angiotensin-converting enzyme
inhibitor
ARB angiotensin receptor blocker
BP blood pressure
CCB calcium channel blocker
CKD chronic kidney disease
CVD cardiovascular disease
ESRD end-stage renal disease
GFR glomerular filtration rate
HF heart failure

Question 20

In adults withhypertension,doesinitiating antihypertensivepharmacologic
therapy at specific BP thresholds improve health outcomes?

Answer 20

In the general population aged 60 years or older, initiate pharmacologic
treatment to lowerBPat systolic blood pressure (SBP) of 150
mmHg or higher or diastolic blood pressure (DBP) of 90mmHg or
higher and treat to a goal SBP lower than 150mmHg and goal DBP
lower than 90mmHg.
Strong Recommendation – Grade A
in the general population aged 60 years or
older, treating high BP to a goal of lower than 150/90 mm Hg reduces
stroke, heart failure, and coronary heart disease (CHD). There
is also evidence (albeitlowquality)fromevidence statement6,question
2 that setting a goal SBP of lower than 140 mm Hg in this age
group provides no additional benefit compared with a higher goal
SBP of 140 to 160mmHg or 140 to 149mmHg.9

Question 21

In adults with hypertension, does treatment with antihypertensivepharmacologic therapy to a specified BP goal lead to improvements
in health outcomes

Answer 21

Strengths,limitations,and other considerations related to this evidence review are presented in the evidence statementnarratives and clearly
support the benefit of treating to a BP lower than 150mmHg. There are many treated hypertensive patients aged 60 years or older in whom SBP
is currently lower than 140mmHg, based on implementation of previous guideline recommendations.The panel’s opinion is that in
these patients, it is not necessary to adjust medication to allow BP to increase.

Question 22

In adults with hypertension, do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific
health outcomes?

Answer 22

In the general nonblack population, including those with diabetes,
initial antihypertensive treatment should include a thiazide-type diuretic,
calcium channel blocker (CCB), angiotensin-converting enzyme
inhibitor (ACEI), or angiotensin receptor blocker (ARB).α-Blockers were not recommended as first-line therapy because
in one study initial treatment with an α-blocker resulted in
worse cerebrovascular, heart failure, and combined cardiovascular
outcomes than initial treatment with a diuretic (question 3, evidence
statement 13)

In the general black population, including those with diabetes, initial
antihypertensive treatment should include a thiazide-type diuretic
or CCB.

Question 23

Recommendation 9

Answer 23

The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment,
increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type
diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and
an ARB together in the same patient. If goal BP cannot be reached using the drugs in recommendation 6 because of a contraindication
or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the
management of complicated patients for whom additional clinicalconsultation is needed.