HTN Flashcards
Describe the classification of blood pressure under the new AHA guidelines.
Normotensive is less than 120/80, elevated is 120-129, Stage I is 130-139/80-89, Stage II is 140/90 or higher.
Explain the difference between masked hypertension and white coat hypertension.
Masked hypertension has normal office readings but higher readings at home, while white coat hypertension has higher office readings but normal readings at home.
What are the goals for blood pressure management for all patients?
The goal is to maintain blood pressure below 130/80 for all patients, regardless of age, race, or comorbidities.
Identify risk factors for primary hypertension.
Risk factors include obesity, lack of physical activity, high sodium intake, alcohol consumption, genetic predisposition, and childhood factors.
List some causes of secondary hypertension.
Causes include renal parenchymal disease, renovascular disease, primary aldosteronism, and obstructive sleep apnea.
Explain the importance of supporting the limb during blood pressure measurement.
Supporting the limb ensures that the BP cuff is at heart level and that the correct cuff size is used.
What is the expected impact of weight reduction on blood pressure?
Expect about a 1 mm Hg reduction in SBP for every 1-kg reduction in body weight, with an average of 5-20 mm Hg reduction for every 10-kg weight loss.
Describe the DASH eating plan and its effect on blood pressure.
The DASH eating plan is rich in fruits, vegetables, and low-fat dairy products, which can lower SBP by 8-14 mm Hg.
How can sodium intake affect blood pressure?
Reducing sodium intake to less than 1500 mg/day can help lower blood pressure.
What are the recommendations for physical activity to manage blood pressure?
Recommendations include 90 to 150 minutes of aerobic and/or dynamic resistance exercise per week and/or 3 sessions per week of isometric resistance exercises.
Explain the moderation of alcohol consumption in relation to blood pressure.
Moderation is advised, with 2 or fewer drinks daily for men and no more than 1 drink daily for women.
What substances should be limited or discontinued to manage blood pressure?
Limit or discontinue alcohol, amphetamines, antidepressants, antipsychotics, caffeine, decongestants, NSAIDs, oral contraceptives, and systemic corticosteroids.
Explain the recommended first-line treatment for patients with chronic kidney disease (CKD), stroke, transient ischemic attack (TIA), coronary heart disease (CHD), or heart failure (HF).
Start with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs) regardless of the patient’s color or age.
What is the priority treatment for patients with coronary disease, such as angina or post-myocardial infarction (MI)?
The priority is to start with beta-blockers (BB) and ACEI or ARB to manage hypertension, using both as management therapy after MI for survival.
How often should patients with normal blood pressure be evaluated?
Patients with normal blood pressure should be evaluated yearly and encouraged to make healthy lifestyle changes.
How is the 10-year risk for heart disease and stroke assessed?
Use the atherosclerotic cardiovascular disease (ASCVD) risk calculator.
What action should be taken if a patient’s ASCVD risk is less than 10%?
Start with healthy lifestyle recommendations and reassess in 3-6 months.
What should be done if a patient’s ASCVD risk is greater than 10% or they have known clinical cardiovascular disease, diabetes mellitus, or chronic kidney disease?
Recommend lifestyle changes and initiate BP-lowering medication (1 medication); reassess in 1 month for effectiveness.
What should be considered if the treatment goal is not met after one month for Stage I hypertension?
Consider different medication or titration.
What is the recommended treatment for African American patients with hypertension?
Start with calcium channel blockers (CCB) or thiazides.
What combination of medications may be used if needed for African American patients?
Use CCB + thiazide, or CCB + thiazide + ACEI (or ARB) if needed.
What is the recommendation for patients requiring two medications for hypertension management?
Recommend healthy lifestyle changes and BP-lowering medication (2 medications of different classes).
Explain the initial treatment combination for any patient with hypertension.
The initial treatment combination is (CCB or thiazide) + (ACEI or ARB). If needed, use CCB + thiazide + ACEI (or ARB).
What is the drug of choice for patients with osteoporosis and hypertension?
Thiazide or thiazide-like diuretics are the drug of choice in osteoporosis.
Identify the side effects associated with thiazide diuretics.
Side effects include photosensitivity, and caution is advised in patients with gout and diabetes mellitus.
Explain the role of ACE inhibitors and ARBs in diabetic nephropathy.
ACE inhibitors and ARBs are the drug of choice in diabetic nephropathy, but they are contraindicated in patients with bilateral renal artery stenosis and during pregnancy.
What should be done for patients with a history of angioedema when switching from ACE inhibitors?
Patients with a history of angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after the ACE inhibitor is discontinued.
Describe the effectiveness of beta-blockers in preventing stroke.
Beta-blockers are less effective in preventing stroke in the general population.
Identify the drug of choice for heart failure (HF) among beta-blockers.
The drug of choice for heart failure is beta-blockers.
What precautions should be taken when prescribing beta-blockers to patients with asthma or COPD?
Caution should be exercised when prescribing beta-blockers to patients with asthma, COPD, diabetes mellitus, or depression.
Explain the potential side effects of metoprolol and an alternative option.
Metoprolol may cause sexual dysfunction, so switching to atenolol, which has fewer side effects, is recommended.
What is the maximum daily dose for atenolol if symptoms persist at a lower dose?
If a patient is on atenolol 25 mg and symptoms still exist, the dose can be increased to the maximum daily dose of 100 mg.
Identify the only beta-blocker used in erectile dysfunction and its mechanism.
Nebivolol is the only beta-blocker used in erectile dysfunction as it is a nitric oxide producer.
Describe a common side effect of CCBs in patients.
Edema or pedal edema is a common side effect of CCBs, occurring more frequently in women than in men.
Do patients with cold symptoms and controlled blood pressure have options for treatment?
Yes, patients can use any XYZ Formula containing pseudoephedrine as long as their blood pressure is controlled.
Explain the safety of antihypertensive medications during pregnancy.
Most antihypertensive medications, except for ACE inhibitors, ARBs, and aliskiren, can be safely continued during pregnancy.
How should a pregnant woman currently taking an ACE inhibitor manage her medication?
A pregnant woman taking an ACE inhibitor must stop it and initiate methyldopa as an alternative.
List two second-line antihypertensive drugs that are considered safe for pregnant women.
Methyldopa (Aldomet) and Hydralazine are two second-line antihypertensive drugs considered safe for pregnant women.
Identify a common side effect of CCBs and its prevalence in different genders.
Edema or pedal edema is a common side effect of CCBs, and it is more common in women than in men.
Describe hypertensive crises and their characteristics.
Hypertensive crises are severe blood pressure elevations (≥ 180/110 mmHg) with target-organ damage.
Explain the management approach for hypertensive emergencies.
Manage hypertensive emergencies with IV drugs in an ICU, aiming to lower diastolic BP to 100-110 mmHg within 1 hour.
Define the management strategy for severe hypertension without acute organ damage.
Use oral drugs and resume home medications; reevaluate in 7 days.
How should acute heart failure and pulmonary edema be treated in hypertensive crises?
Use Nitroglycerin, Nitroprusside, Nesiritide, or Clevidipine.
What is the recommended treatment for acute myocardial infarction in hypertensive crises?
Use Nitroglycerin with a beta-blocker (e.g., Esmolol or Labetalol).
Describe the management of eclampsia and preeclampsia in hypertensive crises.
Use Nicardipine, Labetolol, and Hydralazine.
Explain the treatment options for cerebrovascular accidents in hypertensive crises.
Use Nicardipine and Labetolol (avoid Labetolol if low heart rate or asthma).
What are the preferred treatments for acute renal failure in hypertensive crises?
Use Nicardipine, Clevidipine, and Fenoldopam.
How should aortic dissection be managed in hypertensive crises?
Use Esmolol or Labetolol.
Describe the treatment options for encephalopathy and perioperative hypertension.
Use Nitroglycerin, Nicardipine, Esmolol, or Clevidipine.
What are the contraindications for using Clevidipine?
Consider specific contraindications.
Describe the caution associated with Fenoldepam.
Use cautiously in patients with glaucoma or a history of cerebrovascular accident.
Explain why sublingual drugs are not recommended for certain patients.
Risk of acute blood pressure drop and serious events (e.g., myocardial infarction).
Define the recommended dose and onset time for Captopril (Capoten).
Recommended dose: 6.5-50 mg; onset: 15-30 minutes.
Identify the primary use of Captopril in patients.
Used for heart failure and microalbuminuria.
List the contraindications for Clonidine.
Contraindicated in severe carotid artery stenosis.
What are the contraindications for Nifedipine?
Contraindicated in severe aortic stenosis and coronary artery disease.
Describe the caution associated with Labetalol.
Consider general contraindications and patient factors.
Explain the significance of defective lipid metabolism in relation to allergies.
Health concern, specifics not provided.
Identify the potential risks of using dopamine agonists in patients with stroke symptoms.
Can cause cerebral vasodilation, risking ischemic areas.
