HTN

Question 0

Stages of hypertension?

Answer 0

Pre-hypertension: 120-139/80-89

Stage one hypertension: 140 – 159/90 – 99

Stage two hypertension: greater than 160/100

Question 1

Patient with hypertension. Next steps?

Answer 1

1. Assess renal and cardiac function
2. Start two drug antihypertensive regimen that includes thiazide
3. Stop smoking

Question 2

A secondary cause of hypertension should be suspected if?

Answer 2

1. Age of onset before 25 or after 55
2. Presenting with malignant hypertension
3. Requiring three or more antihypertensives
4. Suddenly uncontrolled hypertension
5. Rising creatinine with use of ACE inhibitors

Question 3

Renal causes of hypertension?

Answer 3

Renovascular

Parenchymal (glomerulonephritis , polycystic renal disease, diabetic nephropathy)

Question 4

Endocrine causes of hypertension?

Answer 4

Primary aldosteronism, Cushing’s, pheochromocytoma, hyperthyroidism, growth hormone excess, OCP

Question 5

Non-renal and non-endocrine causes of hypertension?

Answer 5

Coarctation of the aorta, posttransfusion, hypercalcemia, medications (sympathomimetics, glucocorticoids)

Question 6

Major risk factors for cardiovascular disease?

Answer 6

Age, smoking, dyslipidemia, diabetes, obesity, kidney disease, family history

Question 7

Target organ damage of hypertension?

Answer 7

Cardiomyopathy, nephropathy, retinopathy

Question 8

Clues to renovascular HTN?

Answer 8

Flank bruits, malignant hypertension, hypertension refractory to three drug treatment, sudden worsening hypertension,

Question 9

HTN tx?

Answer 9

Pre-hypertension: Lifestyle modifications unless pt has hypertension or diabetes (start Antihypertensive)

Stage one hypertension: Single hypertensive agent

Stage two hypertension: At least two hypertensive agents

Question 10

Target blood pressure?

Answer 10

135/85

If patient has diabetes or renal disease 130/80

Question 11

Consider what drug in all patients? Why?

Answer 11

Thiazide diuretics. Associated with a decrease in mortality in all types of patients (OLD -now can start in anything)

Question 12

In patients with uncomplicated hypertension, use which drugs first?

Answer 12

Thiazide diuretics and beta blockers

Question 13

First-line antihypertensives in diabetics and heart failure pts?

Problem with thiazides?

Answer 13

Ace inhibitors.

Thiazides can exacerbate hypoglycemia. Add thiazides if blood pressure remains uncontrolled

Question 14

Potassium levels in patients with renal artery stenosis?

Answer 14

Low due to secondary hyperaldosteronism

Question 15

Diagnostic tool for renal artery stenosis?

Answer 15

Captopril enhanced radio nuclide renal scan

MRI angiography, spiral CT

Question 16

Patient with bilateral flank masses, flank pain, elevated blood pressure, and hematuria?

Answer 16

Polycystic kidney disease

Question 17

Patient with hypertension hypokalemia?

Answer 17

Primary hyperaldosteronism

Question 18

Obesity-related cause of hypertension? MoA?

Answer 18

Obstructive sleep apnea. Hypoxemia and hypercarbia leads to Vasoconstriction, systolic hypertension and pulmonary hypertension

Question 19

Patients with HTN, widened pulse pressure and hyperdynamic precordium?

Answer 19

Hyperthyroidism

Question 20

Patient with hypertension, truncal obesity, moon face, purple striae. Test to confirm?

Answer 20

Cushing’s syndrome. Dexamethasone suppression test

Question 21

Patient with upper limb hypertension, cold extremities and decreased femoral pulses?

Answer 21

Coarctation of the aorta

Question 22

Patient with hypertension, cutaneous flushing, headache, diarrhea, wheezing? Mech?

Answer 22

Carcinoid syndrome. Production serotonin from the chromaffin cells of the G.I. tract and the lungs

Question 23

Patients with episodic hypertension, headaches, palpitations, chest pain, anxiety, nervousness?

Answer 23

Pheochromocytoma

Question 24

Prognosis in hypertension depends on?

Answer 24

Cardiovascular RFs and observed and end-organ effects of the HTN