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Assessment Exam 4 > HTN Only > Flashcards

HTN Only Flashcards

1
Q

How did the American College of Cardiology & American Heart Association redefine hypertension in 2017?

A

Systolic BP > 130 mmHg and/or Diastolic BP > 80 mmHg

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2
Q

What percentage of adults in the US does hypertension affect?

A

Nearly 50%

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3
Q

What percentage of African Americans are affected by hypertension?

A

40%

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4
Q

What is the lifetime risk of developing hypertension in the US?

A

90%

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5
Q

What are some complications of chronic hypertension?

A

Ischemic heart disease, stroke, renal failure, retinopathy, PVD, and overall mortality

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6
Q

What is an important risk factor for perioperative morbidity and mortality in the surgical population?

A

Hypertension if untreated

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7
Q

What are the three subtypes of chronic hypertension based on blood pressure measurements?

A

Isolated systolic HTN, isolated diastolic HTN, combined systolic and diastolic HTN

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8
Q

Besides SBP and DBP elevation, what else is considered a risk factor for cardiovascular morbidity in hypertension?

A

Widened pulse pressure

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9
Q

What can result from a wide range of primary & secondary processes that increase cardiac output, vascular resistance, or both?

A

Hypertension

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10
Q

What are some contributing factors to primary HTN?

A

SNS activity, dysregulation of the RAAS, deficiency in endogenous vasodilators

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11
Q

What are some genetic and lifestyle risk factors associated with HTN?

A

Obesity, alcoholism, tobacco

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12
Q

What do a minority of patients with HTN have?

A

Secondary HTN

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13
Q

What are common causes of secondary HTN in middle-aged adults?

A

Hyperaldosteronism, thyroid dysfunction, OSA, Cushings, pheochromocytoma

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14
Q

What do children with HTN generally have?

A

Secondary HTN r/t renal parenchymal disease or aortic coarctation

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15
Q

Drug class that may elevate BP: Antiinfective

A

Ketoconazole

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16
Q

Drug class that may elevate BP: Antiinflammatory

A

Cyclooxygenase-2 inhibitors, NSAIDs

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17
Q

Drug class that may elevate BP: Chemotherapeutic

A

Vascular endothelial growth factor inhibitors

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18
Q

Herbal substances that may elevate BP

A

Ephedra, ginseng, ma huang

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19
Q

Illicit drugs that may elevate BP

A

Amphetamines, cocaine

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20
Q

Drug class that may elevate BP: Immunosuppressive agents

A

Cyclosporine, sirolimus, tacrolimus

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21
Q

Drug class that may elevate BP: Psychiatric

A

Buspirone, carbamazepine, clozapine, lithium, MAO inhibitors, SSRIs, tricyclic antidepressants

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22
Q

Sex hormones that may elevate BP

A

Estrogen, progesterone, androgens

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23
Q

Steroid drugs that may elevate BP

A

Methylprednisolone, prednisone

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24
Q

Drug class that may elevate BP: Sympathomimetic

A

Decongestants, diet pills

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25
Q

What are the most common causes of secondary hypertension in adolescents?

A

Thyroid dysfunction, Fibromuscular dysplasia

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26
Q

What is a common etiology of secondary hypertension in older adults aged 65 and above?

A

Hypothyroidism

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27
Q

What are some consequences of chronic hypertension?

A

Remodeling of arteries, endothelial dysfunction, end-organ damage

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28
Q

How can vasculopathy affect different organs in hypertension?

A

Ischemic heart disease, LVH, CHF, CVA, PAD, aortic aneurysm, nephropathy

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29
Q

What diagnostic tools can provide early detection of vasculopathy?

A

Ultrasound measurement of carotid intimal-to-medial thickness, arterial pulse-wave velocity

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30
Q

How can the progression of left ventricular hypertrophy be tracked?

A

EKG and echocardiogram trends

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31
Q

How can microangiopathic changes due to cerebrovascular damage be monitored?

A

MRI

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32
Q

What is the general therapeutic goal for hypertension treatment?

A

<130/<80

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33
Q

How many people in the US have untreated hypertension?

A

28 million

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34
Q

How many treated patients in the US are above their blood pressure goal?

A

29 million

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35
Q

What is defined as resistant hypertension?

A

Above-goal BP despite 3+ antihypertensive drugs @ max dose

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36
Q

What is included in the usual treatment for resistant hypertension?

A

LA CCB, an ACI-I or ARB + a diuretic

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37
Q

What is controlled resistant hypertension?

A

Controlled BP requiring 4+ medications

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38
Q

What is refractory hypertension?

A

Uncontrolled BP on 5+ drugs, present in 0.5% of patients

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39
Q

What is pseudo-resistant hypertension?

A

(Intolerance to drugs) can result from BP inaccuracies or medication noncompliance

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40
Q

What lifestyle modifications can help manage hypertension?

A

Weight loss, decrease alcohol consumption, exercise, quit smoking

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41
Q

What is the relationship between BMI and hypertension?

A

Continuous relationship

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42
Q

How does weight loss help with hypertension?

A

Direct BP reduction and enhances drug efficacy

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43
Q

What reduction in blood pressure can overweight adults expect for every 1 kg of weight loss?

A

1 mmHg

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44
Q

What is hypertension?

A

High blood pressure

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45
Q

How is physical activity related to blood pressure?

A

Even modest increases decrease BP

46
Q

How is excessive alcohol use linked to hypertension?

A

Associated with increased HTN

47
Q

What is the relationship between dietary potassium/calcium intake and HTN?

A

Inversely related

48
Q

What is the impact of salt restriction on blood pressure?

A

Small but consistent BP decreases

49
Q

What is recommended for diagnosis and titration of antihypertensive medications?

A

Out-of-office BP measurements.

50
Q

When should patients with certain conditions be treated with BP medications according to the ACC/AHA guidelines?

A

When SBP is >130 mmHg.

51
Q

What does the evidence support regarding BP medication treatment for patients without cardiovascular or cerebrovascular disease?

A

Limited data.

52
Q

What are the recommended blood pressure goals for hypertensive patients with diabetes mellitus or chronic kidney disease?

A

Same as for the general hypertensive population.

53
Q

Which medications are useful and effective in nonblack hypertensive patients, including those with diabetes?

A

ACE-I’s, ARBs, CCBs, thiazide diuretics

54
Q

What is the recommended initial antihypertensive therapy in black adult hypertensive patients without heart failure or CKD?

A

CCB or thiazide diuretics

55
Q

What is the moderate evidence supporting antihypertensive therapy with ACE-I or ARB in patients with CKD?

A

Improve kidney outcomes

56
Q

What is an important component of a comprehensive blood pressure management approach?

A

Nonpharmacologic interventions

57
Q

What type of patients are β blockers reserved for in first-line therapy for hypertension?

A

CAD or tachydysrhythmia

58
Q

How many different drug classes have been approved for hypertension?

A

15

59
Q

How is secondary HTN often treated?

A

Interventional, including surgical correction

60
Q

What can be done if renal artery repair is not possible in secondary HTN?

A

BP controlled with ACE-I’s or diuretics

61
Q

What treatment is recommended for primary hyperaldosteronism?

A

Aldosterone antagonist like spironolactone

62
Q

Why are ACE-I’s, ARBs, and direct renin inhibitors not recommended in bilateral renal artery stenosis?

A

Can accelerate renal failure

63
Q

How should certain disease processes like pheochromocytoma be treated?

A

Combined pharmacologic and surgical approach

64
Q

Why is preoperative blood pressure assessment complicated?

A

Anxiety (white-coat HTN)

65
Q

What are patients often instructed to do with their blood pressure medications on the day of surgery?

A

Pause ACE-I’s & diuretics

66
Q

Why is assessing blood pressure in a single moment not ideal?

A

Doesn’t give accurate overall BP trends

67
Q

What is necessary for a diagnosis of hypertension according to current guidelines?

A

Multiple elevated BP readings over time

68
Q

What should be done if BP is elevated in a patient with suspected secondary HTN?

A

Check pressure on contralateral arm

69
Q

What helps provide an overall picture of cardiovascular health in patients with secondary HTN?

A

Review clinic data, home BP’s, and history

70
Q

Should surgery be delayed in asymptomatic patients without risk factors solely due to elevated BP?

A

No

71
Q

When should surgery be delayed in patients with transient HTN and secondary HTN?

A

Extreme HTN (SBP >180 or DBP >110) or end-organ injury

72
Q

What are symptoms that may indicate pheochromocytoma as the cause of secondary HTN?

A

Flushing, sweating & palpitations

73
Q

What symptom suggests renal artery stenosis as the cause of secondary HTN?

A

Renal bruit

74
Q

What condition does hypokalemia suggest as the cause of secondary HTN?

A

Hyperaldosteronism

75
Q

What is the common practice with antihypertensive medications when surgery is planned for secondary HTN?

A

Continue, exclude ARBs and ACE-I’s

76
Q

What can be associated with rebound effects if stopped before surgery in secondary HTN?

A

BBs or clonidine

77
Q

What is associated with increased perioperative cardiovascular events if stopped in secondary HTN?

A

CCBs

78
Q

Why don’t guidelines support delaying surgery for poorly controlled BP?

A

Increases blood loss, MI, and CVA

79
Q

What risks does perioperative hypertension pose?

A

Increased blood loss, MI, CVA

80
Q

Why are hypertensive patients prone to intraoperative hemodynamic volatility?

A

Physiologic factors, BP meds

81
Q

What are the consequences of even brief periods of hypotension in hypertensive patients?

A

Acute kidney injury, myocardial injury, death

82
Q

What should clinicians consider regarding acute intraoperative BP changes?

A

End-organ functional reserve

83
Q

Why are hypertension patients considered hemodynamically vulnerable to induction of general anesthesia?

A

HTN pt’s are hemodynamically vulnerable to induction of GA

84
Q

What effects do induction drugs have on hypertension patients?

A

Produce HoTN; DL & intubation elicit HTN & tachycardia

85
Q

What could be beneficial before induction in a hypertensive patient?

A

Pre-induction A-line, multimodal induction with SA BB (Esmolol)

86
Q

What might accompany poorly controlled hypertension, especially in patients on diuretics?

A

Volume depletion

87
Q

When might modest volume loading before induction be helpful in hypertensive patients?

A

In some patients

88
Q

When might volume loading before induction be counterproductive?

A

In patients with LVH and diastolic dysfunction

89
Q

What factors should be considered when choosing vasoactive drugs for hypertensive patients?

A

Age, functional reserve, medications, planned operation

90
Q

What is a hypertensive crisis categorized as?

A

Urgent or emergent

91
Q

Who tend to tolerate a higher SBP than normotensive patients?

A

Pts with chronic HTN

92
Q

What may perioperative emergencies include related to hypertensive crisis?

A

CNS, kidney, cardiovascular

93
Q

Which patients with pregnancy-induced hypertension may show evidence of end-organ dysfunction with a DBP >100?

A

Women

94
Q

What is the immediate intervention recommendation for peripartum hypertension regarding SBP and DBP?

A

> 160 / >110

95
Q

What is a first-line drug for peripartum HTN?

A

Labetalol

96
Q

What is the gold standard for rapid arterial dilation?

A

SNP infusion

97
Q

What is the advantage of Clevidipine over Nicardipine in arterial dilation?

A

Ultrashort DoA

98
Q

What are the primary agents used for treating hypertensive emergencies?

A

Clevidipine, nitroprusside, labetalol, nicardipine

99
Q

How should hypertensive emergencies in preeclampsia and eclampsia be treated?

A

Labetalol, nicardipine

100
Q

What caution should be taken in treating hypertensive emergencies to avoid cerebral ischemia?

A

Cerebral ischemia may result from lower BP due to altered autoregulation

101
Q

What is a risk associated with nitroprusside?

A

Cyanide toxicity

102
Q

What effect can nitroprusside have on intracranial pressure?

A

Increases it

103
Q

What may a marked drop in blood pressure from vasodilators lead to?

A

End-organ ischemia

104
Q

How may beta blockers affect uterine blood flow?

A

Reduce it and inhibit labor

105
Q

What worsens hypertension following alpha-blockade?

A

Unopposed alpha-adrenergic stimulation

106
Q

In intracerebral hemorrhage, how may lowering blood pressure affect bleeding?

A

Lessen it

107
Q

What is the goal in managing elevated BP?

A

Lessening of pulsatile force of left ventricular contraction

108
Q

What may be required if elevated BP progresses to renal failure?

A

Emergent hemodialysis

109
Q

What is the definitive therapy for managing elevated BP?

A

Delivery

110
Q

Why are ACE inhibitors and ARBs contraindicated during pregnancy?

A

Teratogenicity

Assessment Exam 4 (9 decks)

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