HTN Flashcards
What combination in treating HF is ALWAYS appropriate?
A. ACEI or ARB + BB
B. ACE or ARB + CCB
C. ARB + Aldosterone antagonists
A
Which beta blockers are indicated for use in HEART FAILURE?
Metoprolol extended release (Toprol XL)
Carvedilol
Bisoprolol
(ONLY these 3!)
Which of the following is usually added to standard therapy with BB and ACEI in AA pts who are persistently symptomatic? A. ISMN + Hydralazine B. ISDN + Hydralazine C. ISDN + Minoxidil D. NTG + Minoxidil
B
In pts with POST MI use at least…. (unless contraindicated)
A. ACE + CCB
B.ACE or ARB + BB
C. Diuretic + CCB
A.
SATA: If you must add-on therapy to pts with POST MI what would you add?
A. DHP CCB
B. Aldosterone Antagonist
C. non-DHP CCB
A & B
If your pt has MI + HF, you should give them which aldosterone antagonist?
EPLERENONE
What are the usual “go to” DHP CCBs?
amlodipine
nifedipine
In patients with DM, start with _____ or _______ ;then add ______ & ________ & ___________.
A. ARB or renin inhibitor; DHP CCB + Thiazide + ACE
B. Thiazide or Loop; non-DHP + ACE + BB
C. ACEI or ARB; DHP-CCB + Thiazide + Beta blocker (BB)
C
What is first line therapy in patients with HTN?
THIAZIDE DIURETICS (HCTZ, chlorthalidone, metolazone, indapamide)
ACE’s are contraindicated with. . .
Pregnancy
Anti-HTN therapy can reduce the risk of stroke by:
a. 40-50%
b. 30-40%
c. 20-30%
b. 30-40%
What is considered a form of HTN-associated target-organ damage?
Ischemic stroke
In what conditions do Beta blockers show effectiveness?
HF and post-MI
What is the most common medical problem during pregnancy?
A. gestational DM
B. HTN
C. Dyslipidemia
B. HTN
what is the amount of tension exerted by blood against the arterial walls measured in mmHg
(the amount of force required for the heart to circulate the blood through the body)
blood pressure (BP)
What is the maximal blood pressure during ventricular systole?
(cardiac contraction)
Systolic Blood Pressure (SBP)
What is the minimal blood pressure in the vasculature at the end of diastole?
(cardiac filling)
Diastolic blood pressure (DBP)
indicator of arterial wall tension
Pulse pressure
PP = SBP - DBP
average blood pressure throughout the cardiac cycle
Mean Arterial Pressure
MAP = (1/SBP) + (2/3 DBP)
CO X SVR =
BP (blood pressure)
What is the main determinant of SBP?
Cardiac Output (CO)
-increased CO caused by: increased HR, increased Contractility, increased fluid volume from excess Na+ or Na+ retention, increased stimulation of RAAS or increased SNS activityWhat is the major determinant of DBP?
SVR (Systemic Vascular Resistance)
-increased SVR is caused by: increased RAAS, increased SNS activity, hyperinsulinemia resulting from metabolic syndrome
abnormal elevation of arterial pressure
hypertension (HTN)
~caused by elevated SBP and/or elevated DBP
HTN that has an UNKNOWN cause
90% of HTN pts
multifactorial
genetic factors may play a role
ESSENTIAL HTN
HTN that is a consequence of another disorder
<10% of patients
Secondary HTN
what type of HTN occurs ONLY when the patient is IN the clinic
~ Can be due to nervousness or fear
white coat HTN
What type of HTN only has high SBP?
isolated systolic HTN (ISH)
Which type of HTN is most prevalent in the elderly?
Isolated Systolic HTN
What type of HTN has elevated HTN in the lungs?
Pulmonary HTN
What type of HTN is caused by rigid arteries that just don’t move?
Pseudohypertension
If a patient has DM, what drug will we put them on FIRST?
ACE Inhibitor
If a patient has DM, what drug will we put them on SECOND?
CCB (DHP) Amlodipine Nifedipine Felodipine Nicardipine etc.
If your patient has had a stroke, what would you put them on?
ACE I + Thiazide diuretic (PROGRESS trial)
OR
ACE I + CCB (ACCOMPLISH trial)
If your patient is African American, what drug works really well to treat heart failure?
ISDN + Hydralazine combination (Bidil)
The only time you’d see an ACE & and ARB used together is in ________?
Heart Failure!
__________ HTN is high blood pressure that is present prior to pregnancy or diagnosed prior to the 20th week of gestation
Chronic
You cannot use what HTN drug in pregnancy?
ACE Inhibitors or ARBs
Diuretics are not first line for initiation in pregnancy (b/c they draw away fluids)
Is there a goal blood pressure for pregnancy?
No, it hasn’t been established
[SATA] Which of the following drugs CAN be initiated in pregnancy? A. Methyldopa B. Lisinopril C. Labetalol D. Atenolol E. Long-acting nifedipine F. Hydralazine
A, C, E, F
Which of the following drugs would you start first in pregnancy and why? A. Methyldopa B. Labetalol C. Atenolol D. Long-acting nifedipine E. Hydralazine
A. methyldopa, it has the longest safety history
If the mother has eclampsia, and we are getting ready to deliver the baby, what are the go to drugs?
IV therapy with hydralazine or labetolol
Patients >65 yo are more likely to have HTN-related complications such as ______ or _______.
CVD or renal insufficiency
Be careful with older patients and medicines that affect volume changes such as ACE Inhibitors or diuretics because they have a higher risk of __________ _________.
orthostatic hypotension (can make them fall)
*start patients on low dose and titrate up
Elderly patients have a blood pressure goal of ____________.
t let diastolic get less than 50!
Don’t let your diastolic blood pressure get below _______.
50
it can cause blood clots
What drugs are usually considered first line in elderly patients with ISH?
Thiazides or long-acting DHP CCB
both are good at lowering SBP without overly lowering DBP
What drug class is less efficacious in elderly patients compared to other drug classes as initial agents for HTN?
Beta blockers
What is the most common cause of secondary HTN in children?
renal disease
What is one of the main reasons for HTN in children?
obesity
True/False? HTN affects African Americans at a higher rate and target-organ damage is more prevalent
True
What are the most effective drugs to treat HTN in AA pts?
Thiazides and DHP-CCB (as monotherapy)
Usually in AA pts with HTN, we will start with ___________ then add ________.
DHP-CCB; thiazide
In what trial, were thiazides more effective in AAs at improving CV outcomes, HF, and cerebrovascular outcomes than ACEIs?
ALLHAT trial
BP > 180/120 without evidence of progressive end-organ damage
Hypertensive Urgency
can be treated as an outpatient
BP > 180/120 with end-organ damage that is either progressive or present at the time of initial evaluation
Hypertensive Emergency
pt usually says “i feel like my bp is up and my head hurts” –>send to ER immediately
What is the goal of therapy for hypertensive urgency?
lower BP at a SAFE rate (lower slowly, rapid bp reduction can be harmful)
Which drug is used to treat volume overload when the patient has hypertensive urgency? A. Clonidine B. Labetolol C. Furosemide D. Captopril
C. Furosemide
What is the goal of therapy for Hypertensive Emergency?
to reduce and maintain diastolic BP at 100-110 mmHg for 1-2 days
*ideally, for most hypertensive emergencies, mean arterial pressure should be reduced by no more than 25% within the first hour followed by a further 5-15% over the next 23 hours.
What is the dose of clonidine when treating hypertensive urgency?
0.1-0.2 mg po repeated hourly prn to total dose of 0.7 mg
What is the dose of labetolol when treating hypertensive urgency?
200-400 mg po, repeat every 2-3 hours
What is the dose of captopril when treating hypertensive urgency?
25 mg po, repeat prn
What is the dose of furosemide when treating hypertensive urgency?
20-40 mg po
How can we improve compliance in patients on anti-HTN meds?
- -maintain patient contact (see q 1-3 months)
- -keep medication regimens simple & inexpensive
- -reduce BP slowly to prevent adverse symptoms
Educate HTN patients on. . .
~benefits & ARs of therapy
~awareness of normal & abnormal BP
~consequences of uncontrolled HTN
~need for chronic therapy (meds on control BP, they do not cure the disease)
~benefits of lifestyle modifications & setting realistic goals
How would you counsel on a “heart healthy diet”?
DASH diet
emphasize veggies, fruits & whole grains
eat LOW-fat dairy, poultry, fish, legumes, non-tropical oils & nuts
limit sweets, sugar-sweetened beverages & red meat
keep saturated fats around 5-6% and lower trans fat
lower SODIUM intake (1500mg-2400mg/d)
How much exercise should you counsel your patient on?
GOAL = 40 min of aerobic exercise 3-4 x a week
if patient needs to they can start with10 min increments and build up to 40 minutes
What are some examples of aerobic exercise?
brisk walking swimming laps raking leaves dancing heavy home cleaning *all at a moderate level
What drug class is really good at just decreasing systolic bp?
CCBs
