Hypertension

Question 1

What’s the effect of IV angiotensin 2 injection?

Answer 1

Immediate rise in BP because it’s vasoconsrictor agent

Question 2

BNP & ANP both does what to BP?

Answer 2

Lower BP by natriuresis

Question 3

How to diagnose hypertension?

Answer 3

When the BP is above 130/80 on at least two occasions ( ask the ptn to measure BP for at least 1 week. Morning & night, standing and sitting position.
Aslo try to measure both arms and also in both positions at the GP clinic
Note : try not to push SBP to normal limits in ptn over 80 or with CKD , diabetes. SBP 130 is considered acceptable

Question 4

When to consider secondary hypertension in middle aged ptn? What are the common causes?

Answer 4

Usually the BP is very high.
Hyperthyroidism
Hyperaldosteronism (cons syndrome) Look for electrolyte abnormalities
Pheochromocytoma ( rare ) = symptoms of high catecholamines
Acquired renal artery stenosis ( watch GFR, creatinine ) CT or MRI

Question 5

What are the initial tests required after diagnosing ptn with HTN?

Answer 5

ECG
Glucose, Ha1c
Lipid panel
CMP, Hgb ( electrolyte)
UA, microalbumin/creatinine ratio

Question 6

What are the treatment plan for ptn with HTN? In order

Answer 6

Life style ; diet, wt loss, exercise

Thiazide diuretic ( avoid in ptn with over active bladder or BPH ) watch potassium as thiazide causes hypokalemia

ACEI or ARBs ( good to combine with thiazide to normalise potassium ) because they cause hyperkalemia

CCB ( doesn’t affect electrolytes )

Atenolol ( not recommended as it doesn’t improve mortality rate )

Question 7

What antihypertensive medication that is know to cause angioedema in susceptible ptn?

Answer 7

ACEI

Question 8

What’s the best antihypertensive for black ptn?

Answer 8

CCB or Thiazide

Question 9

What’s the best antihypertensive for ptn with chronic kidney disease?

Answer 9

ACEI or ARB

Question 10

What’s the best antihypertensive for ptn with CAD?

Answer 10

B-Blocker + ACEI or ARB

Question 11

What’s the best antihypertensive for ptn with diabetes?

Answer 11

ACEI or ARB
Non-dihydropyridin CCB if can’t tolerate RAAS inhibitors

Question 12

What’s the best antihypertensive for ptn with HF?

Answer 12

ACEI, ARB
B-Blocker, spironolactone

Question 13

HTN is more common in what sex, race?

Answer 13

Male, black

Question 14

What are the risk factors of HTN

Answer 14

Advanced age
Male
Black
Genetic factors ( FH )
Obesity
Physical inactivity
Diet high in sodium
Smoking, alcohol

Question 15

What are the causes of secondary hypertension?

Answer 15

Medications: oral contraceptives, steroids, NSAIDs, Antidepressants, stimulants

Illicit drugs

Renal: Primary kidney disease, renovascular

Endocrine: Graves disease, cushing syndrome, primary aldosteronism, Pheochromocytoma,

Obstructive sleep apnea

Coartication of aorta

Question 16

What are the classification of HTN?

Answer 16

Normal 120/80
Elevated 120-129/80
1st stage 130-139 or 80-89
2nd stage 140 or 90

Question 17

Name 6 constrictors for peripheral resistance?

Answer 17

Humoral factors include:

Angiotensin 2

Catecholamines

Thromboxane

Leukoterines

Endotherin

Neuronal factors:

@-adrenergics

Question 18

Name 4 dilators for peripheral resistance?

Answer 18

Humoral factors:

Prostaglandin

Kinins

Nitric oxide

Neuronal factors:

B-adrenergic

Question 19

What are the best antihypertensive drugs for diabetic patients with HTN?

Answer 19

ACEI & ARBS