HTN

Question 1

Normal BP- JNC 7

Answer 1

<120/80

Question 2

Pre-HTN- JNC 7

Answer 2

120-139/ 80-89

Question 3

Stage 1 HTN- JNC 7

Answer 3

140-159/ 90-99

Question 4

Stage 2 HTN- JNC 7

Answer 4

> =160/ >=100

Question 5

Essential HTN- Eti

Answer 5

95% of patient with HTN. 10-15 % white pts, 20-30% black. Men, elderly

Question 6

Essential HTN- Sx

Answer 6

Asymptomatic for many years- HA, retinal changes, pulse abnormalities
- Eyes: av nicking, flame hemorhhages, wool spots, exudates

Question 7

Essential HTN- Risk factors

Answer 7

Obesity, apnea, salt, alcohol, smoking, polycythemia, NSAIDs, potassium.

Question 8

Essential HTN- Dx

Answer 8

3 high BP readings over weeks to months

Question 9

Hypertension- Tx

Answer 9

Medications (ca channel, thiazide, ARB, ACE) & lifestyle modification

Question 10

Hypertension- Initial workup

Answer 10

Hg, UA, creatinine, CBG, lipids, uric acid, electrolytes

Question 11

2 HTN- Primary aldosteronism- Eti

Answer 11

Elevated plasma aldosterone with suppressed renin.

• Middle aged 40-64
• lesion: adrenal adenoma, bilateral adrenal hyperplasia.

Question 12

2 HTN- Pheochromocytoma

Answer 12

<0.1% pts. Tumor of adrenal medulla. Excess catecholamine leads to chronic vasoconstriction and reduction in plasma volume.

Question 13

Pheochromocytoma- Sx

Answer 13

Paroxysmal HTN, palpations, HA

Question 14

Pheochromocytoma- Dx

Answer 14

Plasma metanephrines

Question 15

2nd HTN- Renovascular disease- Eti

Answer 15

1-2% HTN pts. atherosclerotic stenosis Young= due to fibromuscular dysplasia.

Question 16

2nd HTN- Renovascular disease- Sx

Answer 16

• Onset before 20, >50,
• resistant to 3+ drugs,
• renal bruits, -atherosclerotic disease of aorta
• Increase in creatinine
• pulmonary edema

Question 17

2nd HTN- Renal parenchymal disease-

Answer 17

Most common cause of 2 HTN.

• Increased intravascular volume or activity of renin,-angiotensin-aldosterone system
• more blood forced through kidneys

Question 18

2nd HTN- Coarction of aorta-

Answer 18

Uncommon congenital condition causing narrowing of aorta. Dx at young age

Question 19

HTN- Complications

Answer 19

• CV disease- 1 cause of morbidity & mortality
• Cerebrovascular disease & dementia
• Kidney disease
• Aortic dissection
• Atherosclerotic complications

Question 20

End/ target organ damage

Answer 20

Damage to major organs due to uncontrolled hypertension in circulatory system

Question 21

Target organ- Heart

Answer 21

• Left ventricular hypertrophy
• Angina or prior MI
• Coronary revascularization (stent)
• Heart failure

Question 22

Target organ- Brain

Answer 22

• TIA or stroke, encepholpathy

Question 23

Target organ- Eyes

Answer 23

Retinal damage- AV nicking, cotton wool spots, flame hemorrhage, hard exudates

Question 24

Isolated systolic HTN- Eti

Answer 24

Functional of structural changes in aorta/ large arteries. Elderly, atherosclerosis. Elevated systolic, diastolic normal.

Question 25

Isolated systolic HTN- Complications

Answer 25

Difficult to tx- meds lower both systolic/diastolic. May cause decreased perfusion, increased risk of MI

Question 26

Primary aldosteronism- Sx

Answer 26

Moderate to sever, difficult to control HTN

• Hypokalemia- musc weakness, fam hx
• Abn aldosterone & renin

Question 27

Renal parenchymal disease- Risk factors

Answer 27

DM, kidney damage, nephrotoxicity

Question 28

Renal parenchymal disease-Sx

Answer 28

Fatigue, weakness, brusing, abn urine, edema