HTN

Question 1

HTN double the risk of…?

Answer 1

Cardiovascular Disease

Question 2

A 65yo pt with a very high SBP reading is predictive of what?

Answer 2

Death

Question 3

A 32yo pt with a very high DBP is at high risk of what?

Answer 3

CV Disease and Death

Question 4

Give 5 risk factors for Primary HTN

Answer 4

Race, age, 1st degree relative, obesity, high Na/salt diet, excess EtOH, metabolic syndrome, smoking, inactivity, dyslipidemia, polycythemia, Vit D deficiency, low K intake

Question 5

Pts with white coat HTN are at increased risk of developing what?

Answer 5

Primary HTN

Question 6

What is the most common form of HTN? Who is primarily affected (race and age group)?

Answer 6

Primary (Essential) HTN
Race: 10-15% whites, 20-30% blacks
Age: 25-55 yo onset

Question 7

How do you Dx HTN in a pt?

Answer 7

2 or more BP readings on 2 or more separate occasions
SBP > 140
DBP > 90

Question 8

What are the 4 main complications of HTN?

Answer 8

Hypertensive CV Disease
Hypertensive Cerebrovascular Disease & Dementia
Hypertensive Kidney Disease
Atherosclerotic Complications

Question 9

What is the MC COD in HTN pts?

Answer 9

Hypertensive CV Dz

Question 10

What is the best way to prevent HTN CV Dz in HTN pts?

Answer 10

Treatment

LVH regresses with Tx

Question 11

How does Hypertensive CV Dz progress?

Answer 11

LVH –> CHF –> Ventricular arrhythmias –> MI –> Sudden Death

Question 12

What are the 2 biggest risk factors for a HTN pt to develop hypertensive cerebrovascular disease/dementia?

Answer 12

Ischemic stroke

Hemorrhagic stroke

Question 13

What is the most common cause of Secondary HTN?

Answer 13

Primary renal Dz

Question 14

How does renal disease influence HTN?

Answer 14

Related to SBP

Question 15

A 40 yo black male presents with morning HA in his occipital region, dizziness, palpitations, fatigue, and impotence. On exam you find that he is obese with a displaced PMI. His BP is 160/90 and his HR is 110 bpm. What should you recommend for this pt?

Answer 15

HTN shouldn’t be diagnosed until you have 2 hypertensive BP readings (> 140/90). However, since he is symptomatic you should start him on treatment. Start him on a thiazide diuretic or CCB. Recommend lifestyle changes.

Question 16

What non-pharmaceutical treatment should you recommend to a pt with HTN?

Answer 16

Lifestyle changes: salt restriction, weight loss, DASH, exercise (30 min/d), decrease EtOH consumption

Question 17

What causes primary HTN?

Answer 17

Idiopathic

Secondary to genetic & environmental factors

Question 18

What are the common causes of secondary HTN?

Answer 18

Primary renal disease (CKD is MC cause of HTN)
Drug induced (NSAIDs, BCP, antidepressants, decongestants, cocaine, steroids)
Renovascular Dz (AS, fibromuscular dysplasia)
Adrenal (Pheo, aldosteronism, Cushing’s)
Endocrinopathy
OSA
Coarctation of the aorta
Pregnancy

Question 19

A 45 yo white male presents for his annual exam. His only complaint is non-specific headaches. His PE shows a BP of 150/95 and a BMI of 32. You recommend he go to Walmart this week and check his BP at a free BP reader there and come back to the office in 2 weeks. On F/U he reports a BP of 155/95, and on exam his BP is 150/95. What are the best treatment options for this pt at this time?

Answer 19

Hypertension
Recommend he start an ACE-I (or ARB)
Recommend lifestyle changes including DASH diet, salt restriction, weight loss, exercise 30 min/d, and decrease EtOH consumption (smoking cessation if pt smoked)
Educate pt about how HTN is a silent disease, and it’s long-term effects (organ damage)

Question 20

A 24 yo black female presents to your office for her annual physical. She has no complaints, but you find she has a family Hx of CHF. On exam you note a BP of 155/100 and a BMI of 30. You run a BMP and all findings are WNL but glucose is 250. What treatment should you recommend for this pt?

Answer 20

Have pt get a 2nd BP reading before Dx’ing HTN

Once HTN is Dx’d, prescribe a CCB or thiazide diuretic

Question 21

A 34 yo white female w/ a 3 year Hx of HTN tells you that she wants to become pregnant. She is currently well-controlled on an ACE-I and has minor ADRs. Should you make any changes to this pt’s medications?

Answer 21

Yes! ACE-I’s are CI’d in pregnancy (as are ARBs)
Consider switching the pt to Methyldopa (sympatholitic agent & drug of choice in pregnancy)
Have pt switch and F/U to ensure she is controlled on Methyldopa before becoming pregnant

Question 22

A 55 yo white male presents complaining of something strange that’s going on with his hand’s. Every time he goes out to shovel snow they turn white, then a few minutes later they turn red and throb, occasionally they are painful. He has a 10 year Hx of HTN, which is well controlled on an ARB and a B-blocker. What should you do for this pt?

Answer 22

Nothing
He is most likely experiencing Raynaud’s Phenomenon, a side effect of the B-blocker he is taking
Recommend he stay warm and protect his hands from injury
If he is unable to deal with the Raynaud’s consider switching him to a CCB and/or a-adrenergic sympatholytic (to Tx the Raynaud’s and HTN)

Question 23

A pt presents for a F/U visit for his HTN. At today’s visit you get a BP reading of 165/100, which is about the same as in the past (170/100, 165/95, 170/95, etc.) He is currently taking an ACE-I, B-blocker, and thiazide diuretic. He states that he is adhering to his treatment plan and has also made several life-style modifications including salt restriction, weight loss, and exercising 30 min/d every day. You run lab tests which show elevated catecholamines. What treatment should you recommend for this pt?

Answer 23

Secondary HTN d/t a pheochromocytoma!!!
Perform a VMA or CT of the adrenals to confirm pheo
Refer to an endocrinologist/take appropriate Tx steps (refer for surgery)

Question 24

Your 68yo white male pt presents for F/U. His BP is 145/95 and he is currently taking an ACE-I and a thiazide diuretic, which he states that he adheres to. He has also made significant lifestyle changes without any noticeable improvement in his HTN. You consider starting him on a 3rd HTN medication. What should you also start to consider at this point?

Answer 24

Secondary HTN

Start to look for underlying systemic Dz (renal Dz, renovascular, adrenal, endocrinopathy, etc.)

Question 25

You have just Dx’d your 68 yo white male pt with HTN. After educating him about the importance of controlling his HTN and how he can accomplish that, what should you tell him your treatment goals are? What if the pt was 58 yo? What if he was a diabetic?

Answer 25

Goal BP