HYPERTENSION

Question 1

what are the stages of HTN?

Answer 1

Normal BP: < 120/80
elevated: 120-129, < 80
stage 1: 130-139/ > 80
stage 2: >140, > 90

Question 2

Hypertensive urgency vs emergency

Answer 2

BOTH have BPs > 180/120

Urgency

• no immediate organ damage
• give oral meds

Emergency

• immediate organ damage
• give IV meds

Question 3

What is BP a product of?

Answer 3

BP = cardiac ouput X systemic vascular resistence

Question 4

Cardiac Output

Answer 4

CO = HR X SV
influenced by:
- HR, inotropic state, neural, humoral
- renal volume control: Renin-angiotensin, aldosterone, atrial natriuretic factor

Question 5

Systemic vascular resistance

Answer 5

influenced by: BV diameter and blood viscosity

humoral vasoconstrictors

• angiotensin
• catecholamines

symNS

• alpha-Adrenergic receptors (constrictor)
• Beta-Adrenergic receptors (dilators)

Local regulation

• vasodilators: prostaglandins, EDRF
• vasoconstrictors: endothelin

Question 6

What is prehypertension

Answer 6

sysBP 130-139

diaBP 85-89

Question 7

Types of HTN

Answer 7

ISOLATED SYSTOLIC HTN

• occurs in elderly (>65)
• affects women more than men
• increased sysBP only

PRIMARY HTN
- unknown etiology

SECONDARY HTN

Question 8

Explain primary HTN

Answer 8

• 90-95% of all cases
• d/t interaction of genes X environment
• higher incidence in African and Hispanic
• affects men more than women; reversed after age 50

Question 9

Modifiable risk factors of HTN

Answer 9

sedentary lifestyle
tobacco use
dyslipidemia 
diet
abdominal obesity 
dysglycemia 
stress

Question 10

Non-modifiable risk factors of HTN

Answer 10

gender - male + post-menopausal women

age - risk increases after age of 55

family Hx of premature cvd

Question 11

Clinical manifestations of HTN

Answer 11

“silent killer” - no S/S until severe

target organ damage - related to vascular changes

• microvascular + macrovascular changes
• brain - stroke, hemorrhage, encephalopathy
• eye - retinopathy
• heart - CAD, MI, heart failure, LV hypertrophy
• kidney - chronic kidney failure

Question 12

Secondary manifestations of HTN

Answer 12

decreased activity tolerance
fatigue and/or dizziness
dyspnea
palpitations and/or angina

Question 13

Diagnostic testing for HTN

Answer 13

tests done to rule out secondary causes and to assess the extent of risk factors

BLOOD WORK

• glucose levels
• lipid profiles
• WBC count

URINALYSIS
- a protein in urine (increased albumin = glomerular membrane damage)

ECG
- ischemic changes

Question 14

Collaborative Care for HTN includes:

Answer 14

Risk stratification
Lifestyle changes
Medications

Question 15

High-risk pt profile for HTN

Answer 15

CVD
CKD
age > 75
estimated 10 year global cardiovascular risk > 15%

Question 16

Lifestyle modifications for HTN

Answer 16

TREATMENT OF HTN FOCUSES ON REDUCING THE RISK FACTORS

smoking cessation
DASH diet 
reduced-sodium intake
exercise 30-60 mins 4-7X/week
weight reduction
limit alcohol 
stress management

Question 17

What is the first line of treatment for adults w/ HTN w/o any co-morbidities

Answer 17

Health behaviour management should always be first

Drugs used next (usually single pill + lifestyle modifications)

Ace inhibitors and ARB have the same action and result –> NEVER GIVE TOGETHER

THIAZIDE diuretics
Very effective as a first-line treatment

B-blockers
Used to be first-line; not anymore

Question 18

Goals for planning for HTN

Answer 18

• achieve + maintain target BP
• understand and implement a therapeutic plan
• minimal or no unpleasant adverse effects
• confident inability to manage and cope w/ condition