HTN

Question 1

For essential HTN what therapy would you recommend?

Answer 1

both lifestyle and antihypertensive therapy

Question 2

Why is systolic BP worse than diastolic?

Answer 2

harder to control

much more cardiovascular risk

Question 3

Prevalence of HTN in US?

Answer 3

60 million

Question 4

How many indiv have their BP controlled?

Answer 4

30%

70% are aware

Question 5

what is the life time risk of developing HTN?

Answer 5

people who are normotensive at age 55 have a 90% lifetime risk for developing HTN

Question 6

Why is it bad if people are hypertensive?

Answer 6

starting at 115/75, CVD risk DOUBLES with each increment of 20/10 mmhg

Question 7

Pathogenesis of High blood pressure

Answer 7

MAP = CO x SVR

*HTN is due to either of the two
long standing HTN is due to increase SVR

Question 8

cellular Hypothesis of HTN

Answer 8

1. Na/K exchanger gets inhibited, and Na+ builds up in the cell
2. This in turn downregulates Na+/Ca+ exchanger
3. Ca2+ builds up in the cell
   - potent activator of vasoconstriction (increase in SVR)–> increase in BP

Question 9

Guyton Hypothesis of HTN

Answer 9

1. defect in Renal Na+ excretion
2. increase in plasma volume
3. increase in CO
4. autoreg increase in SVR
5. increase in BP

• diuretic agents will be useful in this hypothesis

Question 10

What is preHTN is why is that imp

Answer 10

120-139 systolic

these people have a 4 year incidence of HTN

Question 11

what is stage 1 and 2 HTN?

Answer 11

140-159

> 160

Question 12

Whats better?

• stop smoking
• diet (lose weight)
• exercise (not lose weight)
• change stressful jobs
• stop drinking

Answer 12

STOP SMOKING

Question 13

Whats better?

• lose weight via diet
• exercise (not lose weight)
• change stressful jobs
• stop drinking

Answer 13

lose weight

if pt doesnt smoke

Question 14

based off the classification table
what is the initial drug therapy for these indiv w/o compelling indication
- PreHTN
- Stage 1 HTN
- Stage 2 HTN

Answer 14

PreHTN:
- nothing (no antihypertensive drugs)

Stage 1:

• Thiazide diuretics
• maybe ACEI, ARBS, BB, CCB, or combo

Stage 2:
Two drug combo
(thiazide and ACE-I, ARB, BB, CCB)

Goals: reduce BP to

Question 15

Who should you consider for secondary HTN?

Answer 15

young indivs (18 yr olds) w/ no fam history - new HTN

old people - new onset or severe HTN

Question 16

Emergent HTN

Answer 16

High BP

with end organ failure

Question 17

Ang II has two effects to raise arterial pressure, what are they?

Answer 17

1. direct arteriolar constriction
2. prox tubule Na/water retention

(it also stimulates aldosterone release to help with prox tubule reabsorption)