Hypertension

Question 1

Primary HTN

Answer 1

95% of all cases; onset usually less than 55 years of age

Question 2

Secondary HTN

Answer 2

5% of all cases; secondary to other known causes such as estrogen use, renal disease, pregnancy, endocrine disorders, renal artery stenosis (number one)

Question 3

Risk factors of HTN

Answer 3

Smoking
Obesity
Excessive alcohol intake
NSAIDs

Question 4

HTN signs/symptoms

Answer 4

Often none: “silent killer”
Elevated blood pressure
With severe hypertension: suboccipital pulsating headache, occurring early in the morning and resolving throughout the day
Epistaxes
Dizziness/lightheadedness
S4 related to left ventricular hypertrophy
Avery making
Tearing chest pain may indicate aortic dissection

Question 5

HTN lab/diagnostics

Answer 5

And uncomplicated hypertension, laboratory findings are usually normal.
Other test to rule out particular causes:
Renovascular disease studies
Chest x-ray of cardiomegaly is suspected
Plasma aldosterone level to rule out aldosteronism
A.m./ p.m. cortisol levels to rule out Cushing syndrome
UA, CBC, BMP, calcium, phosphorus, year Gassid, cholesterol, triglycerides
EKG
PA and lateral chest x-ray

Question 6

Normal BP

Answer 6

SBP < 120

DBP <80

Question 7

Elevated HTN

Answer 7

SBP 120-129 AND

DBP <80

Question 8

Stage 1 HTN

Answer 8

SBP 130-139 OR

80-89

Question 9

Stage 2 HTN

Answer 9

SBP >=140 or

DBP >= 90

Question 10

HTN Management

Non-pharmacologic

Answer 10

Restrict dietary sodium
Weight loss of overweight
– Riot
Exercise 30 minutes a day
Stress managing planning
Reduction or elimination of alcohol
Smoking cessation
Maintenance of adequate potassium, calcium, magnesium intake

Question 11

HTN management

Pharmacologic

Answer 11

Non-African-American
Thiazide diuretic
Ace inhibitors
ARB
CCB

African American
Thiazide diuretics
CCB

Diabetic
ACE Inhibitor or ARB

Adults greater than 18 with CKD
ACEI

Question 12

HTN other considerations

Answer 12

Treatment goal for initial treatment is one month; then one increase does; then would be adding a second drug
Continue to assess monthly until goal is reached
Do not use ace inhibitor and ARB together
Referred to hypertensive specialist if having difficulty reaching the goal
Goal of therapy: prescribe the least number of medication as possible at the lowest dosage to attain successful BP

Question 13

HTN special considerations

Answer 13

Neither age nor gender usually affects agent responsiveness
Thiazide type diuretics are usually recommended for first line treatment; may also protect against osteoporosis by reducing the amount of calcium misspelled in the urine
Ace inhibitors, adrenergic receptor blockers, and calcium channel blockers are also useful alone or in combination therapy

Question 14

Hypertensive urgency

Answer 14

> = 180/110

May or may not be associated with severe headache, shortness of breath, epistaxes, or severe anxiety

Management: Oral therapy such as clonidine, parental therapy is rarely required

Question 15

Hypertensive Emergency

Answer 15

> = 180/120

Requires immediate BP reduction to prevent or limit target organ damage

BP maybe lower than 180/120 with any of the following:
Malignant hypertension
Hypertensive encephalopathy
Intracranial hemorrhage
Unstable angina
Acute MI
Acute heart failure
Dissecting aortic aneurysm
Eclampsia

Question 16

Hypertensive Emergency Management

Answer 16

ICU

Nicardipine

For compelling conditions SBP should be reduce to less than 140 during the first hour and to <120 in aortic dissection

For adults without compelling conditions SBP should be reduced by no more than 25% within the first hour; then , if stable to 160/100 within the next 2-5 hours; and then cautiously to normal during the following 24-48 hours