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Cardiology-Exam 2 > HTN > Flashcards

HTN Flashcards

1
Q

Most common disease-related reason for visits to primary care providers

A

HTN

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2
Q

Numerical definition for HTN (Stage 1) (new standards)

A

Systolic: >130 mmHg
Diastolic: >80 mmHg

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3
Q

How should you measure a BP

A

Pt seated for >5 min., feet on floor, arm at heart level

No caffeine, exercise or smoking for >30 min

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4
Q

At least ____ measurements should be made over multiple visits and averaged to diagnose and treat HTN

A

2

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5
Q

Alternatives to office BP measurement

A

Home BP monitoring

Ambulatory BP monitoring

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6
Q

How should patients monitor BP at home?

A

Made after 5 min. of rest
2-3 made in morning and again in evening
7 days of consecutive measurements prior to office visits

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7
Q

BP measured repeatedly over 24 hours with an automated device; acquired at set intervals; average daytime, nighttime and 24-hr BPs are calculated

A

Ambulatory BP monitoring

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8
Q

(Systolic/Diastolic) blood pressure increases steadily with age

A

Systolic

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9
Q

(Systolic/Diastolic) blood pressure increases steadily until ~50 years old, then begins to decline

A

Diastolic

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10
Q

__________ have the highest prevalence of HTN

A

African Americans

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11
Q

Younger patients (<40yo) have a higher incidence of isolated (systolic/diastolic) hypertension

A

Diastolic

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12
Q

Older patients (>50yo) have a higher incidence of isolated (systolic/diastolic) hypertension

A

Systolic

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13
Q

African Americans have a _______ fold greater risk for HTN related renal disease and a _____% higher heart disease mortality

A

5-fold; 50% higher

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14
Q

It is suggested that in order to reduce coronary heart disease rates, physicians should focus on not only decreasing high BP but also…

A

address other risk factors (Cholesterol, DM, smoking, LVH)

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15
Q

Neurologic regulation of BP

A

a1 and b2 receptors

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16
Q

With increasing age, cardiac output tends to (inc./dec.) and peripheral resistance tends to (inc./dec.)

A

CO: decrease
PR: increase

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17
Q

_________ contributes to isolated systolic HTN in the elderly

A

Vascular stiffness

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18
Q

% of hypertension diagnosis that are considered essential/primary

A

90

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19
Q

Top three causes of secondary hypertension

A

Chronic Kidney Disease
Primary Aldosteronism
Renovascular

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20
Q

The pathogenesis of major consequences of HTN can be divided into what two categories

A

Inc. Afterload

Arterial Damage

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21
Q

HTN affects most vascular structures except…

A

veins

22
Q

Organs at most risk to damage via HTN

A

Heart
Arteries
Brain
Kidney

23
Q

Inc. afterload can result in what heart pathology

A

Hypertrophy

24
Q

Why does the heart compensate for inc. afterload by hypertrophy and not hyperplasia?

A

Because these cells have very limited capacity to undergo mitosis

25
Q

What causes the enlarged nuclei in ventricular hypertrophy?

A

increased ploidy (normal is 2N; these nuclei can be 4N, 8N or 16N)

26
Q

Increased mass in the left ventricle (LVH) is manifest as what on an EKG

A

Greater positive voltage (taller R waves) in leftward leads (1, aVL and V6)
Greater negative voltage (deeper S waves) in rightward leads (V1-3)
Downsloping ST depressions/T wave inversions in lateral leads

27
Q

Effects of chronic HTN on microvasculature

A

Thickened vessel wall (inc. elastin and collagen) for strength
Can progress to stenotic lumen

28
Q

Most commonly used EKG criterion for LVH

A

S in V1 + R in V5/V6 >35mm

29
Q

pathogenesis of chronic HTN on microvasculature; results in thickened walls with elastin and collagen; small arteries

A

Benign arteriosclerosis

30
Q

pathogenesis of chronic HTN on microvasculature; results in thickened walls with collagen and plasma proteins; arterioles

A

Benign/Hyaline arteriolosclerosis

31
Q

common cause of renal failure; benign nephrosclerosis

A

Chronic HTN causing stenotic lumen resulting in ischemia

32
Q

Stenosis of occipital microvasculature (does/doesn’t) affect vision

A

Doesn’t (is useful for viewing affected vessels)

33
Q

pathogenesis of severe/malignant HTN on microvasculature; results in either thickened walls with more smooth muscle cells or fibrinoid necrosis

A

Malignant arteriosclerosis

Malignant ateriolosclerosis

34
Q

characterized by an abrupt and severe elevation in blood pressure that results in acute end-organ damage

A

Malignant hypertension

35
Q

“onion skinning” in cases of severe HTN

A

Thickened wall with increased layers of smooth muscle cells

36
Q

Why do you treat 140/90 mmHg in general population, but 130/80 mmHg in high-risk individuals?

A

Need more aggressive/proactive treatment to prevent future complications

37
Q

Treatment goal for hypertensive patients (what numerical value)

A

<130/80 mmHg

38
Q

Lifestyle interventions for those with HTN

A 
Weight reduction
DASH diet (fruits, veg., low fat milk)
Reduce sodium
More physical activity
Moderation of alcohol
39
Q

What two situations are characterized by severe elevations in BP >180/120 mmHg

A
  1. Hypertensive Emergency

2. Hypertensive Urgency

40
Q

What is the evidence that it is a hypertensive emergency?

A

Evidence of new or worsening target organ damage

  • requires immediate reduction of BP with IV drugs in ICU
41
Q

What is the evidence that it is a hypertensive urgency?

A

No acute target organ damage

  • requires drug therapy to reduce BP w/o hospitalization
42
Q

What are the goals of HTN drug therapy?

A
  1. Reduction of CV and renal morbidity/mortality

2. BP <130/80 mmHg

43
Q

What is the most important benefit of lowering BP?

A

treatment of htn with meds decreases CV risk such as stroke, MI, and HF

44
Q

At each level of risk of CVD (11%, 15%, 21%), there was

A

similar relative risk reduction

45
Q

In high risk patients, there was

A

greater ABSOLUTE reduction

46
Q

What is the threshold for drug treatment in patients with uncomplicated HTN

A

BP > or = 140/90 mmHg

47
Q

What is the threshold for drug treatment in HTN patients with complications or other medical conditions (CVD, Chronic kidney disease, diabetes, 10-year ASCVD risk >10%)

A

BP > or = 130/80 mmHg

48
Q

Age, sex, race, BP, cholesterol, diabetes, tobacco use are risk factors that are counted to determine

A

a patient’s 10-year risk of CVD

49
Q

What are the first line of treatment of hypertension?

A
  1. Thiazide diuretics
  2. Calcium channel blockers
  3. ACE inhibitors
  4. Angiotensin receptor blockers (ARB)
50
Q

What two drugs are NOT recommended to be used in combinations?

A

ACE inhibitors & ARBs

Cardiology-Exam 2 (23 decks)

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