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
2
Q
What percentage of adults in the US does hypertension affect?
A
Nearly 50%
3
Q
What percentage of African Americans are affected by hypertension?
A
40%
4
Q
What is the lifetime risk of developing hypertension in the US?
A
90%
5
Q
What are some complications of chronic hypertension?
A
Ischemic heart disease, stroke, renal failure, retinopathy, PVD, and overall mortality
6
Q
What is an important risk factor for perioperative morbidity and mortality in the surgical population?
A
Hypertension if untreated
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
8
Q
Besides SBP and DBP elevation, what else is considered a risk factor for cardiovascular morbidity in hypertension?
A
Widened pulse pressure
9
Q
What can result from a wide range of primary & secondary processes that increase cardiac output, vascular resistance, or both?
A
Hypertension
10
Q
What are some contributing factors to primary HTN?
A
SNS activity, dysregulation of the RAAS, deficiency in endogenous vasodilators
11
Q
What are some genetic and lifestyle risk factors associated with HTN?
A
Obesity, alcoholism, tobacco
12
Q
What do a minority of patients with HTN have?
A
Secondary HTN
13
Q
What are common causes of secondary HTN in middle-aged adults?
A
Hyperaldosteronism, thyroid dysfunction, OSA, Cushings, pheochromocytoma
14
Q
What do children with HTN generally have?
A
Secondary HTN r/t renal parenchymal disease or aortic coarctation
15
Q
Drug class that may elevate BP: Antiinfective
A
Ketoconazole
16
Q
Drug class that may elevate BP: Antiinflammatory
A
Cyclooxygenase-2 inhibitors, NSAIDs
17
Q
Drug class that may elevate BP: Chemotherapeutic
A
Vascular endothelial growth factor inhibitors
18
Q
Herbal substances that may elevate BP
A
Ephedra, ginseng, ma huang
19
Q
Illicit drugs that may elevate BP
A
Amphetamines, cocaine
20
Q
Drug class that may elevate BP: Immunosuppressive agents
A
Cyclosporine, sirolimus, tacrolimus
21
Q
Drug class that may elevate BP: Psychiatric
A
Buspirone, carbamazepine, clozapine, lithium, MAO inhibitors, SSRIs, tricyclic antidepressants
22
Q
Sex hormones that may elevate BP
A
Estrogen, progesterone, androgens
23
Q
Steroid drugs that may elevate BP
A
Methylprednisolone, prednisone
24
Q
Drug class that may elevate BP: Sympathomimetic
A
Decongestants, diet pills
25
What are the most common causes of secondary hypertension in adolescents?
Thyroid dysfunction, Fibromuscular dysplasia
26
What is a common etiology of secondary hypertension in older adults aged 65 and above?
Hypothyroidism
27
What are some consequences of chronic hypertension?
Remodeling of arteries, endothelial dysfunction, end-organ damage
28
How can vasculopathy affect different organs in hypertension?
Ischemic heart disease, LVH, CHF, CVA, PAD, aortic aneurysm, nephropathy
29
What diagnostic tools can provide early detection of vasculopathy?
Ultrasound measurement of carotid intimal-to-medial thickness, arterial pulse-wave velocity
30
How can the progression of left ventricular hypertrophy be tracked?
EKG and echocardiogram trends
31
How can microangiopathic changes due to cerebrovascular damage be monitored?
MRI
32
What is the general therapeutic goal for hypertension treatment?
<130/<80
33
How many people in the US have untreated hypertension?
28 million
34
How many treated patients in the US are above their blood pressure goal?
29 million
35
What is defined as resistant hypertension?
Above-goal BP despite 3+ antihypertensive drugs @ max dose
36
What is included in the usual treatment for resistant hypertension?
LA CCB, an ACI-I or ARB + a diuretic
37
What is controlled resistant hypertension?
Controlled BP requiring 4+ medications
38
What is refractory hypertension?
Uncontrolled BP on 5+ drugs, present in 0.5% of patients
39
What is pseudo-resistant hypertension?
(Intolerance to drugs) can result from BP inaccuracies or medication noncompliance
40
What lifestyle modifications can help manage hypertension?
Weight loss, decrease alcohol consumption, exercise, quit smoking
41
What is the relationship between BMI and hypertension?
Continuous relationship
42
How does weight loss help with hypertension?
Direct BP reduction and enhances drug efficacy
43
What reduction in blood pressure can overweight adults expect for every 1 kg of weight loss?
1 mmHg
44
What is hypertension?
High blood pressure
45
How is physical activity related to blood pressure?
Even modest increases decrease BP
46
How is excessive alcohol use linked to hypertension?
Associated with increased HTN
47
What is the relationship between dietary potassium/calcium intake and HTN?
Inversely related
48
What is the impact of salt restriction on blood pressure?
Small but consistent BP decreases
49
What is recommended for diagnosis and titration of antihypertensive medications?
Out-of-office BP measurements.
50
When should patients with certain conditions be treated with BP medications according to the ACC/AHA guidelines?
When SBP is >130 mmHg.
51
What does the evidence support regarding BP medication treatment for patients without cardiovascular or cerebrovascular disease?
Limited data.
52
What are the recommended blood pressure goals for hypertensive patients with diabetes mellitus or chronic kidney disease?
Same as for the general hypertensive population.
53
Which medications are useful and effective in nonblack hypertensive patients, including those with diabetes?
ACE-I's, ARBs, CCBs, thiazide diuretics
54
What is the recommended initial antihypertensive therapy in black adult hypertensive patients without heart failure or CKD?
CCB or thiazide diuretics
55
What is the moderate evidence supporting antihypertensive therapy with ACE-I or ARB in patients with CKD?
Improve kidney outcomes
56
What is an important component of a comprehensive blood pressure management approach?
Nonpharmacologic interventions
57
What type of patients are β blockers reserved for in first-line therapy for hypertension?
CAD or tachydysrhythmia
58
How many different drug classes have been approved for hypertension?
15
59
How is secondary HTN often treated?
Interventional, including surgical correction
60
What can be done if renal artery repair is not possible in secondary HTN?
BP controlled with ACE-I's or diuretics
61
What treatment is recommended for primary hyperaldosteronism?
Aldosterone antagonist like spironolactone
62
Why are ACE-I's, ARBs, and direct renin inhibitors not recommended in bilateral renal artery stenosis?
Can accelerate renal failure
63
How should certain disease processes like pheochromocytoma be treated?
Combined pharmacologic and surgical approach
64
Why is preoperative blood pressure assessment complicated?
Anxiety (white-coat HTN)
65
What are patients often instructed to do with their blood pressure medications on the day of surgery?
Pause ACE-I’s & diuretics
66
Why is assessing blood pressure in a single moment not ideal?
Doesn't give accurate overall BP trends
67
What is necessary for a diagnosis of hypertension according to current guidelines?
Multiple elevated BP readings over time
68
What should be done if BP is elevated in a patient with suspected secondary HTN?
Check pressure on contralateral arm
69
What helps provide an overall picture of cardiovascular health in patients with secondary HTN?
Review clinic data, home BP's, and history
70
Should surgery be delayed in asymptomatic patients without risk factors solely due to elevated BP?
No
71
When should surgery be delayed in patients with transient HTN and secondary HTN?
Extreme HTN (SBP >180 or DBP >110) or end-organ injury
72
What are symptoms that may indicate pheochromocytoma as the cause of secondary HTN?
Flushing, sweating & palpitations
73
What symptom suggests renal artery stenosis as the cause of secondary HTN?
Renal bruit
74
What condition does hypokalemia suggest as the cause of secondary HTN?
Hyperaldosteronism
75
What is the common practice with antihypertensive medications when surgery is planned for secondary HTN?
Continue, exclude ARBs and ACE-I’s
76
What can be associated with rebound effects if stopped before surgery in secondary HTN?
BBs or clonidine
77
What is associated with increased perioperative cardiovascular events if stopped in secondary HTN?
CCBs
78
Why don't guidelines support delaying surgery for poorly controlled BP?
Increases blood loss, MI, and CVA
79
What risks does perioperative hypertension pose?
Increased blood loss, MI, CVA
80
Why are hypertensive patients prone to intraoperative hemodynamic volatility?
Physiologic factors, BP meds
81
What are the consequences of even brief periods of hypotension in hypertensive patients?
Acute kidney injury, myocardial injury, death
82
What should clinicians consider regarding acute intraoperative BP changes?
End-organ functional reserve
83
Why are hypertension patients considered hemodynamically vulnerable to induction of general anesthesia?
HTN pt’s are hemodynamically vulnerable to induction of GA
84
What effects do induction drugs have on hypertension patients?
Produce HoTN; DL & intubation elicit HTN & tachycardia
85
What could be beneficial before induction in a hypertensive patient?
Pre-induction A-line, multimodal induction with SA BB (Esmolol)
86
What might accompany poorly controlled hypertension, especially in patients on diuretics?
Volume depletion
87
When might modest volume loading before induction be helpful in hypertensive patients?
In some patients
88
When might volume loading before induction be counterproductive?
In patients with LVH and diastolic dysfunction
89
What factors should be considered when choosing vasoactive drugs for hypertensive patients?
Age, functional reserve, medications, planned operation
90
What is a hypertensive crisis categorized as?
Urgent or emergent
91
Who tend to tolerate a higher SBP than normotensive patients?
Pts with chronic HTN
92
What may perioperative emergencies include related to hypertensive crisis?
CNS, kidney, cardiovascular
93
Which patients with pregnancy-induced hypertension may show evidence of end-organ dysfunction with a DBP >100?
Women
94
What is the immediate intervention recommendation for peripartum hypertension regarding SBP and DBP?
>160 / >110
95
What is a first-line drug for peripartum HTN?
Labetalol
96
What is the gold standard for rapid arterial dilation?
SNP infusion
97
What is the advantage of Clevidipine over Nicardipine in arterial dilation?
Ultrashort DoA
98
What are the primary agents used for treating hypertensive emergencies?
Clevidipine, nitroprusside, labetalol, nicardipine
99
How should hypertensive emergencies in preeclampsia and eclampsia be treated?
Labetalol, nicardipine
100
What caution should be taken in treating hypertensive emergencies to avoid cerebral ischemia?
Cerebral ischemia may result from lower BP due to altered autoregulation
101
What is a risk associated with nitroprusside?
Cyanide toxicity
102
What effect can nitroprusside have on intracranial pressure?
Increases it
103
What may a marked drop in blood pressure from vasodilators lead to?
End-organ ischemia
104
How may beta blockers affect uterine blood flow?
Reduce it and inhibit labor
105
What worsens hypertension following alpha-blockade?
Unopposed alpha-adrenergic stimulation
106
In intracerebral hemorrhage, how may lowering blood pressure affect bleeding?
Lessen it
107
What is the goal in managing elevated BP?
Lessening of pulsatile force of left ventricular contraction
108
What may be required if elevated BP progresses to renal failure?
Emergent hemodialysis
109
What is the definitive therapy for managing elevated BP?
Delivery
110
Why are ACE inhibitors and ARBs contraindicated during pregnancy?
Teratogenicity
