HTN Small Group

Question 1

What is the hyperdynamic phase of HTN

Answer 1

When most of an elevated BP is due to increased CO contribution
More likely in younger pts
Would present with forceful point of maximal

Question 2

What are the first line drugs for HTN in African Americans

Answer 2

Chose 1 - see what the reduction is, then maybe add the other
Ca2+ blocker
- Dihydropyridines (you’re going with this one overall 1st!!)
Diuretics
- Thiazides - also vasodilators but worsen metabolism (glucose, lipids, etc)
(Loop diuretics are not anti-HTNs)

Question 3

What are some factors that might help you decide which 1st line anti-HTN to use?

Answer 3

Family history
Smoking N/A - doesn’t change drug choice
Whether or not he has LVH - check EKG
- Wouldn’t really change management b/c 4 1st line drugs reverse LVH
Diabetic - stay away from thiazides, toward RAS inhibitors b/c protective against diabetics
Athlete - avoid BBs
High salt diet - go with thiazides

Question 4

Lab changes after 6mo therapy of w/o change:
Thiazide
ACE inhibitor or ARB
BB
Ca CB

Answer 4

"Rule of 10s"
Thiazide - add dihydro Ca CB 
ACE inhibitor or ARB + thiazide
BB - stop and regroup lol
Ca CB + thiazide

Question 5

Why do you always include thiazide if taking multiple anti-HTNs?

Answer 5

B/c enhances the effects of all the other drugs

Thiazides included in all multiple pill treatments

Question 6

If a diabetic pt presents with proteinuria and HTN, what drug MUST this pt on if nothing else?

Answer 6

RAS inhibitor
- ACE or ARB
- B/c proteinuria 
These drugs reduce rate of progression of kidney disease 
Also best way to reverse LVH

Question 7

What indicates stiff vessels?

Answer 7

High PP

Question 8

3 signs of end organ damage (2ary HTN)

Answer 8

1. Bruits over renal artery - within 1 cm of naval
2. Focal neural deficits - ischemic strokes or eye findings (flame shaped hemorrhages)
3. S4 gallop - diastolic dysfxn (impaired relaxation of ventricles) - LVH

Question 9

What lab values might make you think about renal artery stenosis?

Answer 9

Low plasma K & high urine K due to increased aldosterone

Question 10

What do you think of when you hear h/o “attacks” of palpitations, chest tightness, pounding headache, sweating

Answer 10

Pheochromocytoma

Question 11

Why alpha before beta blockers?

Answer 11

Would have unopposed alpha vasoconstriction

Could cause HTN crisis

Question 12

Rule of 10s for pheochromocytoma

Answer 12

10% are bilateral
10% are familial
10% are malignant
10% are extra-adrenal