Hypertension

Question 1

120-139 / 80-89 (JNC)

Answer 1

Pre Hypertension (JNC)

Question 2

140-159 / 90-99 (JNC)

Answer 2

Stage I Hypertension (JNC)

Question 3

> 160 / > 100 (JNC)

Answer 3

Stage II Hypertension (JNC)

Question 4

120-129 / < 80 (ACC/AHA)

Answer 4

Elevated BP (ACC/AHA)

Question 5

130-139 / 80-89 (ACC/AHA)

Answer 5

Stage I Hypertension (ACC/AHA)

Question 6

140+ / 90+ (ACC/AHA)

Answer 6

Stage II Hypertension (ACC/AHA)

Question 7

Threshold to Initiate Treatment for JNC and ACC/AHA

Answer 7

JNC:

• > 60yo and >150/90
• <60yo or comorbid conditions (DM, CKD) and >140/90

ACC/AHA

• > 130/80 and hx of CVD or >10% ASCVD risk
• > 140/90 if no CVD or <10% ASCVD risk

Question 8

Treatment Algorithm For JNC and ACC/AHA

Answer 8

JNC:

• Start 1 med then follow up in 1 mo
• Add med or increase dose if not at BP goal

ACC/AHA

• 1 med for stage 1
• 2 meds for stage 2 (both with different MOA)

Question 9

Initiation Medication (first line) Non-AA with or without DM

Answer 9

• Thiazide Diuretic (chlorthalidone preferred)
• CCBs
• ACE or ARBs (not both)
  »> Especially with DM with Albuminuria
  »> CKD3 or higher

Question 10

Initiation Medication (first line) AA with or without DM

Answer 10

• Thiazide Diuretic (chlorthalidone preferred)
  »> Better CV prevention (AA higher risk of stroke)
• CCBs
  »> Better stroke prevention

Question 11

Initiation Medication with CKD (AA or non AA)

Answer 11

ACE or ARB

Question 12

ACE or ARB:

HTN or DM Kidney Disease

Answer 12

ACE OR ARB

Question 13

ACE or ARB:

HF/CAD/post MI

Answer 13

ACE

Question 14

How Many HTN medications to prescribe?

Answer 14

• Most need 2
• Begin with 2 meds IF: sys goal > 20, dias goal > 10
• Use with caution in elderly (2)

Question 15

HTN in Stable Ischemic Heart Disease

Answer 15

FIRST LINE: BB, ACE/ARB
- Post MI: Use BB AND ACE for min 3 years
»> to prevent ventricular remodeling

• If Needed: ADD dihydropyridine CCB (diltiazem or verapamil) (esp. if angina despite BB), thiazide, or mineralocorticoid blocker (aldosterone)
• Can continue BB beyond 3 yrs post MI for treatment of HTN without HFrEF
  »» any BB EXCEPT ATENOLOL
• ACE’s can be used indefinitely

Question 16

HTN in Heart Failure

Answer 16

HFrEF
- Do not use a non-dihydropyridine CCB
>>> NOT DILTIAZEM or VERAPAMIL 
>>> use amlodipine or felodipine 
- Preferred BBs (metop, bisoprolol, carvedilol) 

HFpEF

• Diuretic for volume overload
• If needed, add an ACE/ARB and BB

Question 17

Resistant Hypertension

Answer 17

Pseudo Resistance: white coat, poor adherence, bad regimen, bad BP taking

Other Factors: NSAID use, Na Intake

3 CORE MEDS:
- Diuretic (CKD, use loop like furosemide), ACE/ARB, CCB (bedtime)
4th MED: Aldosterone Antagonist
5th MED: BB unless other indications for first use

** IF THIS DOESNT WORK THEN SCREEN FOR SLEEP APNEA OR ALDOSTERONE SYNDROME **

Question 18

Intensifying Prescriptions for HTN

Answer 18

• If BP Consistently > 130 then can add second med

i. e. on lisinopril 20mg, then can add chlorthalidone