HTN

Question 1

% of adults that will experience HTN in their life

Answer 1

90%

Question 2

% of adults that have HTN

Answer 2

1/3

Question 3

M vs F:

• At young age, who is more likely to have HTN?
• At older age, who is more likely to have HTN?

Answer 3

Young: M>F
Older: F>M

Question 4

Hallmark of HTN

Answer 4

Systemic peripheral vascular resistance

Question 5

How is HTN diagnosed?

Answer 5

Avg of 2+ elevated readings at 2+ visits

Question 6

Pre-HTN range

Answer 6

120-139 / 80-89

Question 7

Stage 1 HTN range

Answer 7

140-159 / 90-99

Question 8

Stage 2 HTN range

Answer 8

160+ / 100+

Question 9

___% of pts with BP of 120-139 / 80-89 will develop HTN in ___ years?

Answer 9

50% in 4 years

Question 10

Why do you need to be careful about aggressively treating HTN in elderly?

Answer 10

Increased risk of hypoTN –> falls

Question 11

When to treat a pt under 60? (AHA says under 80)

Answer 11

140/90

Question 12

When to treat a pt over 60? (AHA says over 80)

Answer 12

150/90

Question 13

How to treat black pt vs non-black pt?

Answer 13

Black: thiazide or CCB

Non-black: thiazide, ACEI, or ARB

Question 14

Primary Essential HTN etiology + sx

Answer 14

• Idiopathic

- Usually asympt or mild HA, tachy

Question 15

Sx of chronic uncontrolled primary essential HTN

Answer 15

Retinopathy, papilledema, LVH, S4 (poor ventricular compliance)

Question 16

How to treat primary essential HTN

Answer 16

1. lifestyle changes for 6 months

2. treat w/ 2 meds >140

Question 17

HTN Urgency definition

Answer 17

• Severe asympt HTN >180/120

- No evidence of organ dysfx (eyes, kidneys, brain, heart)

Question 18

How to treat HTN urgency

Answer 18

Lower BP to 160/90 then you can d/c pt

Question 19

HTN Emergency definition

Answer 19

> 180/120 w/ evidence of impending organ dysfx

• CV: acute MI, LV dysfx, unstable angina, aortic dissection
• Encephalopathy
• Acute renal insuff
• Retinopathy, papilledema

Question 20

How to treat HTN emergency

Answer 20

Lower BP by no more than 25% in minutes, continue lowering over next 1-2 hrs (or body will not be able to perfuse).
Goal BP = 160/90

Question 21

Secondary HTN definition

Answer 21

<30 y/o

New onset >50 y/o becomes refractory to tx

Question 22

Causes of Secondary HTN

Answer 22

• Renal parenchymal disease (most common)
• Renal artery stenosis
• Primary hyperaldosteronism
• Cushing’s
• Pheochromocytoma
• Preeclampsia/ eclampsia

Question 23

Renal parenchymal disease

Answer 23

Disturbance in urine filtration + formation

- Caused by DM or lupus nephritis

Question 24

Renal artery stenosis

Answer 24

New onset HTN refractory to 3+ drugs

• Young: fibromusc dysplasia
• Older: atherosclerosis

Question 25

Primary hyperaldosteronism

Answer 25

Hypokalemia, refractory HTN’

• Caused by idiopathic adrenal hyperplasia or aldosteronomas
• D/c all meds, reintroduce meds one at a time

Question 26

Cushing’s

Answer 26

Excess cortisol + aldosterone

• Caused by pituitary adenoma, adrenal secretion, ACTH secreting tumor, or exogenous use
• Dexamethasone suppression, 24 hr urine, or late night salivary cortisol

Question 27

Pheochromocytoma

Answer 27

Catecholamine secreting tumor in adrenal medulla

- 24 hr urine

Question 28

Preeclampsia/ eclampsia

Answer 28

Proteinuria and edema (seizures=eclampsia)

- Early delivery, bed rest, or hospitalization