HTN-Clinical Overview

Question 1

What is the eqn for BP (aka AP)?

Answer 1

CO x TPR or

(SV x HR) x TPR

Question 2

What things determine SV?

Answer 2

preload

contractility

Question 3

What things determine HR?

Answer 3

ANS

conduction system

Question 4

What things determine TPR?

Answer 4

• Neurohumoral factors

- local auto regulation (pH, hypoxia, etc.)

Question 5

What is a normal BP?

Answer 5

less than 120 over 80 based on the least risk of CV complications from studies

Question 6

What is preHTN?

Answer 6

120-139

80-89

Question 7

What is stage 1 HTN?

Answer 7

140-159

90-99

Question 8

What is stage 2 HTN?

Answer 8

160+

100+

Question 9

JNC 8 HTN treatment goals?

Answer 9

initiate over 150/90 for 60+ and 140/90 for those with chronic kidney disease or diabetes

Question 10

What things could increase preload (and thus SV and thus CO and thus AP)?

Answer 10

increased fluid volume or venous constriction

Question 11

What things could increase contractility (and thus SV and thus CO and thus AP)?

Answer 11

sympathetic activity stimulation

Question 12

T or F. Most patients with uncomplicated HTN have a normal CO

Answer 12

T.

Question 13

What are some behavioral/dietary causes of essential HTN?

Answer 13

• increased salt intake
• alcohol
• obesity
• sleep apnea

Question 14

HTN is a major risk factor for what diseases?

Answer 14

• CV disease
• stroke
• end-stage renal disease
• ischemic heart disease

Question 15

Goals of evaluating hypertensive patients.

Answer 15

1) Obtain an accurate assessment of BP
2) Assess the significance of the BP
3) What is the cause?

Question 16

Which leads to more inaccurate BP readings, a large cuff on a small arm circumference or a small cuff on a larger arm circumference?

Answer 16

a small cuff on a larger arm circumference will overestimate BP much more than a a large cuff on a small arm circumference will underestimate it

Question 17

T or F. Caffeine and tobacco should be avoided for 30+ minutes before a BP reading

Answer 17

T.

Question 18

What things may elevate BP acutely?

Answer 18

• nervousness, stress, anxiety
• drugs (cocaine), alcohol, caffeine, nicotine
• pain
• white coats

Question 19

How do you assess the significance of the BP?

Answer 19

by stratifying CV risk and looking for target organ damage

Question 20

For the most part, headaches are not directly related to HTN in a person who chronically suffers from it.

Answer 20

For the most part, headaches are not directly related to HTN in a person who chronically suffers from it.

Question 21

What are some problems in the vasculature caused by HTN?

Answer 21

atherosclerosis
aneurysm
aortic dissections

Question 22

What are some problems in the kidneys caused by HTN?

Answer 22

hematuria

proteinema

Question 23

What are some problems in the heart caused by HTN?

Answer 23

• pulmonary edema
• MI
• left ventricular hypertrophy

Question 24

What are some problems in the brain caused by HTN?

Answer 24

• Hemorrhage/infarction
• seizures
• vascular dementia

Question 25

What are some problems in the eye caused by HTN?

Answer 25

• Hemorrhage

- papilloedema

Question 26

T or F. Reducing SBP from 180 to 140
reduces CV disease risk by about 25% (RRR), regardless of baseline
risk

Answer 26

T. The absolute risk reduction, however, is proportional to the
baseline risk.

Therefore, subgroups
with the most additional risk
factors benefit the most

Question 27

Secondary HTN is more likely in patients with the following characteristics:

Answer 27

• Age of onset of HTN 50 years
• Target organ damage at presentation
• Presence of features indicative of specific secondary causes:

Question 28

What are some features indicative of specific secondary causes of HTN?

Answer 28

• Abdominal bruit and/or extensive vascular disease (might suggest renal artery stenosis)
• Unprovoked (i.e., not on diuretic) hypokalemia (might suggest primary or secondary hyperaldosteronism)

• Labile pressures with tachycardia, sweating, and tremor (might suggest
pheochromocytoma)

• Known personal or family history of renal disease (which might suggest renal
parenchymal HTN)

• Poor response to combinations of antihypertensive agents known to be
generally effective

Question 29

What is the recommended first line drug for nonblack patients with essential HTN?

Answer 29

ACEIs, ARBs, CCBs, or diuretics

Question 30

What is the recommended first line drug for black patients with essential HTN?

Answer 30

CCBs, or diuretics

Question 31

What is the recommended first line drug for nonblack patients with HTN secondary to diabetes?

Answer 31

ACEIs, ARBs, CCBs, or diuretics

Question 32

What is the recommended first line drug for black patients with HTN secondary to diabetes?

Answer 32

CCBs, or diuretics

Question 33

What is the recommended first line drug for nonblack patients with HTN secondary to chronic kidney disease?

Answer 33

ACEIs, ARBs

Question 34

What is the recommended first line drug for black patients with HTN secondary to chronic kidney disease?

Answer 34

ACEIs, ARBs

Question 35

How should hypertensive emergency be treated?

Answer 35

The important treatment principle is to treat promptly,
but not excessively.

Hypertensive emergencies require
parenteral administration of drugs that can be rapidly titrated. Reduce mean arterial pressure (MAP) no more than 25% of pretreatment level within the first two
hours. BP should then be more gradually reduced over
the next 24 hours.

Question 36

Why is the previously described approach to treating hypertensive emergency the preferred one?

Answer 36

This is to avoid compromising
perfusion by reducing BP below the lowered threshold
established by autoregulation in response to longstanding
hypertension.