HTN Clinical Approaches

Question 1

What is a normal BP?

Answer 1

120/80

Question 2

What are pre-hypertensive BPs?

Answer 2

121-139/81-89

Question 3

What are stage I HTN BPs?

Answer 3

140-159/90-99

Question 4

What are stage II HTN BPs?

Answer 4

> 160/100

Question 5

What can HTN be defined as?

Answer 5

140/90 BP on two or more office visits, or use of anti-HTN meds

Question 6

What % of American population has HTN? In whom is it more prevalent?

Answer 6

30%
African Americans
Prevalence rises with age

Question 7

What % of Americans are pre-hypertensive?

Answer 7

25%

Question 8

What do you do to treat a pre-HTN patient?

Answer 8

Lifestyle modifications

Question 9

What is the cause of essential HTN?

Answer 9

Idiopathic

Multifactorial
Stress, Weight, Blood glucose, Smoking, Caffeine, Sedentary life

Question 10

What is white coat HTN?

Answer 10

BP is higher at the drs office than at home

Question 11

How do you confirm a diagnosis of white coat HTN?

Answer 11

Check their home BP monitor

-Could do ambulatory (24 hr) bp monitoring, but that may be excessive

Question 12

What is malignant HTN?

Answer 12

Rare - BP that is 200/120 with signs and symptoms
HA, encephalopathy, papilledema, renal failure

Can occur without preexisting HTN

Question 13

What is pseudohypertension?

Answer 13

Peripheral arteries become rigid from advanced arteriosclerosis, so the cuff needs to be at a higher pressure to compress the artery

Question 14

What is Isolated Systolic HTN?

Answer 14

High systolic pressures with low or normal diastolic pressures.
Widened pulse pressure
Happens with aging

Question 15

What is resistant HTN? What should you do?

Answer 15

Failure to reach BP goal in pts who are adhering to full doses or an appropriate 3 drug regimen including a diuretic

Look into a potential secondary cause for their HTN

Question 16

Define Hypertensive Urgency

Answer 16

Severe elevation in BP (> or = 180/120) without end organ damage

Often due to patients not taking their meds

Question 17

Define Hypertensive Emergency

Answer 17

Severe elevation in BP with end organ damage

Encephalopathy
Intracerebral hemorrhage
ACS
LV Failure
Aoritc dissection
Renal crisis
Microangiopathic hemolytic anemia

Question 18

How do you treat a hypertensive emergency?

Answer 18

They need immediate lowering of BP.

Reduce their MAP by 25-30% in the first 24 hours.

Question 19

What are the symptoms of HTN?

Answer 19

None! “Silent killer”

There often are no symptoms until they have end organ damage

Question 20

What are the sequelae of HTN?

Answer 20

Ischemic Heart Disease
Heart Failure
CVA
Cardiac Hypertrophy
Aortic dissection
Renal Failure
Retinopathy

Question 21

For each 10 mmHg decrease in systolic pressure, the patient has what lowered risk of heart or stoke mortality?

Answer 21

30% decrease in heart mortality

40% decrease in stroke mortality

Question 22

Smoking Cessation

3 Steps

Answer 22

1. Address nicotine addiction (patch, gum, Chantix)
2. Address Behavior Modification (identify triggers, when they smoke, plan the day)
3. Address Muscle Memory (stress ball, suckers)

Question 23

What are the goals of treatment for HTN? (In specific numbers)

Answer 23

BP of less than 140/90 in patients less than 60yo

BP of less than 150/90 in patients older than 60