HTN

Question 1

Primary HTN

Answer 1

Underlying physiologic alteration of unknown cause; 95% of cases of HTN

Question 2

Secondary HTN

Answer 2

Resulting from a specific cause such as renal or endocrine disorders; 5% of cases

Question 3

Characteristics of primary HTN

Answer 3

Usually of gradual onset
Usually develops between the ages of 30 and 50
Tends to remain asymptomatic for 10 to 20 yrs
Triggers include obesity, psychological stress, high-sodium intake, and alcohol intake over 1 oz/day

Question 4

Causes of secondary HTN

Answer 4

Renal parenchymal disease
Renal artery stenosis
Pheochromocytoma
Hyperaldosteronism
Hypercortosolism
MIThyroid dz
Neurologic dz
Meds
-TZDs (thiazolidinedione)
-NSAIDs
-Cyclosporin

Question 5

Goals of therapy

Answer 5

Reduce CVD and renal morbidity and mortality
Treat to BP <140/90 mmHg
-Elderly (>60 yrs) goal is <150/90
Achieve SBP goal esp in persons greater than or equal to 50 yoa

Question 6

Benefits of lowering BP

Answer 6

35-40% stroke incidence reduction
20-25% MI reduction
50% heart failure reduction

Question 7

Lifestyle modifications

Answer 7

Weight reduction
Adopt DASH eating plan
Dietary sodium reduction
Physical activity
Moderation of EtOH consumption

Question 8

Examples of ACEIs

Answer 8

Banazepril
Lisionopril
Enalapril

Question 9

Common side effects of ACE inhibitors

Answer 9

Hyperkalemia
Dry cough
Decrease in GFR upon initiation
Angioedema- rare but serious
Pregnancy category X

Question 10

Organ damage that occurs with HTN

Answer 10

Heart
-LV hypertrophy
-Angina or prior MI
-Prior coronary vascularization
-Heart failure
Brain
-Stroke or TIA
CKD
PAD
Retinopathy

Question 11

CVD risk

Answer 11

The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors
Each increment of 20/10 mmHg doubles the risk of CVD across the entire BP range starting from 115/75 mmHg

Question 12

Nl albumin excretion

Answer 12

<30 mg/24 hrs

Question 13

Microalbuminuria

Answer 13

Urine collection: 30-299 mg/24 hr

Progression: 20-40% develop overt nephropathy

Question 14

Albuminuria (overt nephropathy)

Answer 14

Urine collection: Greater than or equal to 300 mg/24 hrs

Progression: 20% develop end stage renal disease

Question 15

Examples of ARBs

Answer 15

Losartan
Valsartan
Candesartan

Question 16

Common SEs of ARBs

Answer 16

Hyperkalemia
Decrease in GFR upon initiation
Do not cause cough
Angioedema is a rare but serious side effect
Can try an ARB after an ACE, but not the opposite way bc there is higher angioedema occurrence with ACEs

Question 17

What are the two types of CCBs?

Answer 17

Dihydropyridines

Nondihydropyridines

Question 18

MOA of dihydropyridines

Answer 18

Work in the peripheral vasculature, cause vasodilation

Question 19

MOA of nondihydropyridines

Answer 19

Work centrally in the heart; have ionotropic and chronotropic effects

Question 20

Examples of dihydropyridines

Answer 20

Amlodipine

Felodipine

Question 21

Common side effects of dihydropyridines

Answer 21

Dizziness
Flushing
HA
Gingival hyperplasia
Peripheral edema

Question 22

Examples of nondihydropyridines

Answer 22

Verapamil

Diltiazem

Question 23

Common side effects of nondihydropyridines

Answer 23

Bradycardia
Anorexia
Nausea
Peripheral edema

Question 24

Examples of thiazide diuretics

Answer 24

Chlothiadone
Indapamide
HCTZ

Question 25

Examples of loop diuretics

Answer 25

Bumetanide
Furosemide
Torsemide

Question 26

Examples of aldosterone agonists (diuretics)

Answer 26

Spironolactone

Eplerenone

Question 27

Examples of K-sparing diuretics

Answer 27

Amiloride

Triamterene

Question 28

When does loss of efficacy occur in thiazides?

Answer 28

When GFR <30 ml/min

Question 29

Common side effects of thiazide diuretics

Answer 29

Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Sexual dysfunction