HTN

Question 1

Postural hypotension is defined as

Answer 1

20 mmHg or higher drop in systolic

OR 10 mmHg in diastolic

Question 2

Essential hypertension risk factors

Answer 2

1- Age
2- obesity
3- family history
4- race (Black)
5- reduced nephron number
6- high Na diet
7- alcohol
8- inactivity

Question 3

When do we start screening for HTN?

Answer 3

At 18 years old

Question 4

When do we repeat the screening?

Answer 4

If normal;
Annually

If prehypertensive or risk factors;
Semiannually (every 6 months)

Question 5

Initial lab tests for HTN

Answer 5

Electrolytes 
FBG
Urinalysis 
CBC
TSH
lipid profile
ECG
ASCVD risk

Additional tests;
Albumin to creatinine ratio (for kidney function)
Echo (for LVH)

Question 6

Highest non pharmacological intervention impact on blood pressure is

Answer 6

DASH diet

Question 7

Recommended sodium intake

Answer 7

<1500 mg/day

Question 8

Who should be treated with pharmacological therapy?

Answer 8

1- stage 2 HTN (140/90 or more)

2-stage 1 HTN (130 or 80 or more) if;

• established CVD
• T2DM
• CKD
• 65 or older
• ASCVD risk is 10 or more

Question 9

Initial monotherapy for black patients

Answer 9

Thiazide diuretic OR calcium channel blocker

Question 10

Initial monotherapy for patients with diabetic nephropathy or chronic kidney disease

Answer 10

ACE inhibitor OR ARB

Question 11

ACE I and ARB arr compelling indications

Answer 11

1- heart failure
2- post MI
3- chronic kidney disease

Question 12

Beta blockers compelling indications

Answer 12

Heart related conditions!

1- heart failure 
2- post MI
3- angina 
4- a. Fib
5- atrial flutter

Question 13

Beta blockers have a favorable effect on what?

Answer 13

Hyperthyroidism (it reduces heart rate and BP)

Migrain (reduces BP)

Question 14

Alpha blockers have a favorable effect on what?

Answer 14

MEN LIKE TO BE ALPHA MALES

So it is Benign prostatic hyperplasia

Question 15

Beta blockers CONTRAindications

Answer 15

Bronchospastic disease

Heart block

Question 16

Mythldopa contraindication

Answer 16

Liver disease

Question 17

ACEI and ARB are contraindicated in what?

Answer 17

Pregnancy!

Question 18

Diuretics have an adverse effect on what?

Answer 18

Gout, you goat!

Question 19

If combination therapy is indicated, what drug classes are recommended?

Answer 19

ACEI or ARB with calcium channel blocker

Question 20

When is INITIAL combination therapy is indecated?

Answer 20

When above their goal by;
- 20 mmHg systolic
Or
- 10 mmHg diastolic

Question 21

If the patient is uncontrolled despite using two drugs, what is the next step?

Answer 21

ACEI or ARB with calcium channel blocker and diuretic

Question 22

Leg swelling is caused by what drug?

Answer 22

Dihydropyridine calcium channel blocker (amlodipine)

Question 23

If the patient is compaining of leg swelling, what do you use instead of amlodipine?

Answer 23

Non-dihydropyrifine calcium channel blocker ( verapamil and diltiazm)

Question 24

If we can’t use thiazide diuretic, we use…

Answer 24

Potassium sparing diuretics

ie, spironolactone and eplerenone

Question 25

Drug resistant hypertension is…

Answer 25

If the patient took 3 drugs at a reasonable dose and is still uncontrolled

Question 26

What is the goal blood pressure of most hypertensive patients?

Answer 26

Less than 130/80 mmHg