HTN Module Flashcards
True or false, African American males have enhanced renal sodium absorption which causes them to have a higher incidence of hypertension?
True. 60% of African American males have uncontrolled HTN.
Hypertension is more common in _______ (men/women/both) until age 45. Then between ages 45-65 it is more common in (men/women/both). And after age 65 it is more common in (men/women/both).
Answer:
Men higher til 45
Equal risk 45-65
Women higher risk ages 65+
Which increases with age?
a) diastolic BP
b) systolic BP
Answer: b) systolic BP
Systolic BP increases with age (especially after age 50) and correlates with increased risk of stroke.
Which is a more potent CV risk factor until age 50?
a) diastolic BP
b) systolic BP
Answer: a) diastolic BP
Diastolic BP linked to CV risk (diastolic stabilizes with age). Systolic linked to stroke and increases with age.
ACE inhibitors affect what part of the RAAS system?
a) angiotensinogen to Angiotensin I
b) Angiotensin I to Angiotensin II
c) Angiotensin II to aldosterone
d) release of renin
Answer: b) Angiotensin I to Angiotensin II is blocked with ACE-I
What is a dipper and non-dipper, and what BP differential is expected?
Dippers: BP drops 15% at night (normal)
Non-dippers: BP drops <10% (abnormal and at risk for CVD/renal disease)
How can we evaluate dippers/non-dippers?
a) home BP log
b) ABPM
c) EKG
d) Echo
Answer: b) ABPM
When is chronopharmacology useful?
a) elderly patient with orthostatic hypotension
b) male patient with impotence r/t anti-HTN meds
c) non-dippers
d) dosing diuretics for patients without regular access to the restroom
Answer: c) non-dippers
Non-dippers can be dosed in the evening to help facilitate the normal drop in BP.
Which is false regarding BP monitoring in the office:
a) take BP in both arms and use lowest arm for subsequent measurements
b) wait 30 seconds before rechecking same arm
c) patient should sit with arm at chest level for 5 minutes
d) auscultatory measurement preferred
Answer: a) take BP in both arms and use lowest arm for subsequent measurements
For a new patient: measure BP in both arms (use HIGHER arm for subsequent BP measurements)
If ABPM is used, what average readings are considered HTN:
a) 130/80
b) 130/90
c) 135/85
d) 140/80
Answer: c) 135/85
ABPM is useful for white coat HTN, episodic HTN, patients who are hypotensive while taking meds
What medication class is most effective for decreasing LVH?
a) ARBs
b) CCB
c) ACE-I
d) HCTZ
Answer: c)ACE-I
A hypertensive emergency is when the BP is _____ and what other diagnostic criteria is present?
Emergency is 180/120 with TOD & S&S (HA, neuro changes, dizziness, nausea, vomiting). Patient needs to be TRANSPORTED to emergency dept.
Hypertensive urgency is when the BP is ____ and what other diagnostic criteria?
Urgency 180/120 w/o TOD and w/o S&S. Patient’s body has usually compensated to function at this level.
Primary hypertension is due to:
No identifiable cause (95% of patients fall into this category).
Postulated causes: inappropriate retention of water and salt.
Secondary HTN is due to:
ABCDE
Apnea, Bad kidneys, Cushings/Coarctation, Drugs/diet, Endocrine
Which is not a secondary cause of HTN:
a) sleep apnea
b) increased renal retention of salt and water
c) Drugs
d) Endocrine
Answer: b) increased renal retention of salt and water
Choice B is a PRIMARY cause of HTN
When the brachial artery is rigid due to atherosclerosis, and BP appears to be elevated, the right diagnosis is likely:
a) primary HTN
b) secondary HTN
c) pheochromocytoma
d) pseudohypertension
Answer: d) pseudohypertension
The cuff pressure needed to collapse the atherosclerotic artery is elevated so it creates a falsely high reading.
How many blood pressure readings are needed to diagnose HTN?
3 (first elevated pressure, plus 2 subsequent elevated pressures on different visits)
What is not indicated diagnostically for HTN?
a) CBC
b) Cr & UA
c) electrolytes
d) echo
e) EKG
Answer: d) echo
Other choices are appropriate.
Where is a renal artery bruit auscultated?
a) RUQ
b) LUQ
c) RLQ
d) LLQ
RUQ & LUQ
If present: refer to nephrology
IF patient has stage I HTN, how long can we try to manage without medications?
a) 2-4 weeks
b) 1-2 months
c) 4-6 months
d) 6-12 months
Answer: d) 6-12 months
This is dependent on patient past HX of MI,stroke, family history, evidence of target organ damage, etc
How much sodium should an adult diagnosed with HTN consume?
a) 1200 mg/day
b) 1500 mg/day
c) 2000 mg/day
d) 2300 mg/day
Answer: b) 1500 mg/day
Less is ideal but the 1500 is really the max for these patients.
Appropriate treatment option(s) for a patient with stage 2 HTN and TOD:
a) L/S modifications for 4-6 weeks
b) L/S modifications for 6-8 weeks
c) monotherapy with medication
d) combo therapy with medication
Answer: d) combo therapy with medication
The patient needs to be combo therapy which will help achieve normal BP in 6-8 weeks.
A hypertensive patient has elevated LDL and treatment has just been initiated with anti-hypertensive meds. What should be done to address the LDL?
a) nothing at this time, wait for 6-8 weeks to see how the anti-HTN meds are working
b) encourage lifestyle changes/diet modification and recheck the lipid panel in 6 weeks
c) start on statin
d) start on aspirin
Answer: c) start on statin
Patient needs primary prevention with statin. This is especially true for patients with DM, ages 40-75, and those at risk of ASCVD
True or false, ASA should be started for secondary prevention of CVD as soon as hypertensive medications have been initiated.
False. ASA should not be started until blood pressure is controlled. It is not recommended for primary prevention (patients who have not had an atherosclerotic event should not use).
Which is not a top 3 high sodium food:
a)french fries
b) cured meat
c) pizza
d) bread
Answer: a) french fries
