HTN

Question 1

How is HTN as a risk factor?

Answer 1

Second most important modifiable contributor to early death (after diet), and most common modifiable risk factor for premature cardiovascular disease

Question 2

Diagnosis of HTN:

Answer 2

1. Know how to take BP properly (patient positioning and prep, cuff size)
2. Confirm diagnosis with multiple data points
3. Differentiate white coat and masked HTN (think of ambulatory and home BP monitoring)

Question 3

Evaluation of pt with newly diagnosed HTN:

Answer 3

1. look for end-organ damage (cardio, renal, cerebro, retinal)
2. evaluate for modifiable risk factors for primary HTN (obesity, diet, alcohol use, physical inactivity, OSA, diabetes, dyslipidemia) PODD is Dead On Arrival
3. look for secondary HTN: look for those <30 without risk factors, new onset severe HTN after 55, severe/resistant HTN, acute decompensation in previously controlled HTN, clinical clues for specific secondary etiologies

Question 4

Most commonly prescribed meds that could cause HTN:

Answer 4

NSAIDs, OC pills, antidepressants; think decongestants, weight loss meds, cyclosporin

Shane DOAN won a World Championship

Question 5

Only ___ of HTN adults meeting BP goals; why this number?

Answer 5

50%;

1. Patient factors (adherence)
2. Physician factors (therapeutic inertia)
3. System factors (health care access and med costs)

Question 6

Focus on the ____ in managing HTN; also one should

Answer 6

health care team; engage the patient

Question 7

Nonpharmacologic treatment and impact:

Answer 7

diet, exercise, weight loss

Question 8

Initial pharmacologic monotherapy based on

Answer 8

age and race (younger with ACEi/ARB>BB and elderly/black with chlorthalidone or CCB); based on comorbid conditions