HTN- Resistant HTN

Question 1

Who should these patients be referred to?

Answer 1

expert to manage

Question 2

What is resistent HTN

Answer 2

pts with persistent HTN despite 3+ HTN meds

Question 3

What is the danger of resistent HTN

Answer 3

high risk of adverse CV outcomes

Question 4

What things should you rule out when evaluating resistant HTN?

2

Answer 4

• use accurate OBMP or ABPM
• evaluate adherence

Question 5

What is likely the cause of resistant hypertension?

Answer 5

increased risk of secondary causes of HTN

Question 6

What are some indirect and direct measures to look at when you suspect resistant HTN

Answer 6

direct- theraputic drug monitoring
indirect- pill count, pharmacy refill data

Question 7

What medical condition should you assess for in patients with resistent HTN

Answer 7

sleep apnea

Question 8

What are 5 common causes of secondary HTN

Answer 8

Sleep apnea
Primary aldosteronism
Renovascular HTN
Pheochromocytoma
Paraganglioma

Question 9

What should you suspect in a patient who has 2 or more of the following:
* sudden onset or worsening HTN <30 or >55
* abdominal bruit
* resistant HTN
* increased creatinine when using ACE or ARB
* atherosclerotic vascular disease
* recureent pulmonary edema

Answer 9

renovascular HTN

Question 10

A patient with:
unexplained hypokalemia
+
resistant HTN
+
an incidental adrenal adenoma
should be suspected of having what secondary cause of HTN

Answer 10

primary hyperaldosteronism

Question 11

Patients with:
* paroxsmal labile and or severe resistant HTN
* symptoms of catecholamine excess like h/a, palpitations, sweating
* HTN triggered by bbs, MAOIs, micturition, surgey
* adrenal masses

should be suspected of having which secondary cause of HTN

Answer 11

pheochromocytoma or paraganglioma

both are rare types of neuroendocrine tumors

also 5 H’s of pheochromocytoma:
HTN
Headache
Hyperhidrosis
Hypermetabolic state
Hyperglycemia

pheochromocytoma tumor of adrenal glands that produces catecholamines

Question 12

What 3 things can improve pt adherence to medications

Answer 12

• tailor pill taking to fit pts lifestyle habits
• simply to once daily dosing
• use combo pills instead of multiple pills

Question 13

What add on therapy can be considered with resistent HTN

Answer 13

diuretic

Question 14

What labs should be monitored if combining potassium sparing diuretics, ACE-I, and/or ARBs

2

Answer 14

Creat and K

same with when on ACE-Is