Hypertension Flashcards
1
Q
Are age and sex useful factors to consider when predicting whether chest pain is musculoskeletal?
A
No
2
Q
What are the 4 best independent predictors that chest wall pain is likely the cause?
A
Absence of cough, stinging pain, pain that is reproducible on palpation, and localized muscle tension
3
Q
A normal troponin level at least ? Hours after the onset of chest pain in combination with normal or near normal ecg findings is a good prognostic sign.
A
At least 6hours
4
Q
What are the 4 most important predictors used to predict an acute myocardial infarction on an ecg?
A
New ST segment elevation greater than 1 mm, a new left bundle branch block, presence of a Q wave, Hyperacute T waves
5
Q
What are some key predictors of acute MI
A
Male sex, older than 60 years, pressure type pain, pain radiating to the arm, shoulder, neck, or jaw.
Pts with none or 1 of these finding had less than 1% risk of acute MI 
6
Q
Describe hypertensive emergency
A
Acutely elevated blood pressure, with a diastolic bp over 120 and objective signs of acute end organ dysfunction
7
Q
What blood pressure is considered hypertensive?
A
130/80 or higher in adults
8
Q
For patients with the central hypertension what is the cause?
A
There is no identifiable cause
9
Q
What are some causes of secondary hypertension?
A
Renal artery stenosis, endocrine abnormalities, adverse effect of drug, coartication of the aorta
10
Q
For black patients what are the two classes of medication recommended for hypertension?
A
Calcium channel blockers and thiazide diuretics
11
Q
If there is no evidence of acute end organ damage with a severely elevated blood pressure, what is the diagnosis?
A
Hypertensive urgency
12
Q
What diagnostic tool is used for identifying white coat hypertension?
A
Ambulatory 24 hour monitoring
13
Q
What is the most common cause of uncontrolled blood pressure? In pts on medication. 
A
Medication nonadherence
14
Q
What is the systolic and diastolic range for elevated blood pressure?
A
Systolic 120 to 129 MMHg,
diastolic lower than 80 MMHg 
15
Q
What is the systolic and diastolic range for stage one hypertension?
A
Systolic 130 to 139 MMHg,
diastolic 80-89 MMHg
16
Q
What is the systolic and diastolic range for stage two hypertension?
A
Systolic greater than 140,
diastolic 90 MMHg or higher
17
Q
What is Isolated diastolic hypertension?
A
Systolic lower than 130, and diastolic 80 MMHg or higher
18
Q
Blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medication with different mechanisms of action
What is this?
A
Resistant hypertension
19
Q
What is white coat hypertension?
A
It is blood pressure the significantly higher when measured in the medical office then we measured at home or via ambulatory blood pressure monitor in patient’s usual environment
20
Q
What is masked hypertension?
A
Normal blood pressure in office, abnormal blood pressure out of office in hypertensive range
21
Q
Nocturnal hypertension is prevalent in which race?
A
Black patients
22
Q
Name some symptoms that suggest acute end organ dysfunction caused by hypertensive emergency
A
Dyspnea, chest pain, severe headache, blurry vision, nausea vomiting, confusion, seizures, somnolence, focal neurological symptoms
23
Q
Symptoms that raise suspicion of secondary hypertension include:
Dyspnea caused by pulmonary edema suggests what?
A
Renal artery stenosis
24
Q
Symptoms that raise suspicion of secondary hypertension include:
Change in body habit is such as weight gain with truncal obesity, buffalo hump, moon facies, or purple straie suggest what?
A
Hypercortisolism
25
Symptoms that raise suspicion of secondary hypertension include:
Headache, flushing, palpitations, syncope or near syncope, visual disturbances, and excessive perspiration suggest what?
Pheochromocytoma
26
What 3 symptoms are common with elevated blood pressure but don’t suggest end organ dysfunction?
Nose bleeds, dizziness, mild headache
27
Name some drugs that can elevate blood pressure
Oral contraceptives, and NSAIDS, antidepressants, steroids, decongestants, cycloporin, tacrolimus, antiretrovirals
28
Abrupt discontinuation of clonidine can cause what?
Hypertension
29
Hypertension is more common in what sex (male or female) up to the age of 64 years
Males
30
Hypertension is more common in what sex (male or female) after the age of 65v
Females
31
To confirm hypertension how many encounters do you need using sphygmomanometry or automated blood pressure measurement?
At least 2 encounters
32
A cuff size that is too small can cause what type of blood pressure reading?
High blood pressure reading
33
Cuff size that is too big can cause what type of bp reading?
It can cause a low blood pressure reading
34
What is the correct way to take a blood pressure?
Have the patient seated with Feet flat on the floor, the legs and crossed, and back supported, a lot of patience to sit for 3 to 5 minutes without talking or moving around before recording blood pressure
35
For asymptomatic patients with acute rise in blood pressure such as hypertensive urgency what lab should be done?
Obtain creatinine level, there is no evidence to guide other testing recommendations in hypertensive urgency
36
What are some routine tests at the time of diagnosis for hypertension that should be done to assess for chronic end organ damage and modifiable cardiovascular risk factors?
Fasting blood glucose, hemoglobin A1c, serum chemistry (sodium, potassium, chloride, bun, creatinine) , fasting lipid, hct level, Ua with albumin 
37
For patients with stage one hypertension and an estimate a 10 year ASCVD risk score less than 10% what is the recommended treatment? What about the time for re-evaluation
They can be treated initially with lifestyle modifications alone with a repeat blood pressure evaluation within 3 to 6 months.
38
For black patients without heart failure or chronic kidney disease, including those with diabetes, what is the initial treatment? List two classes a medication
Thiazide diuretic and calcium channel blocker
39
For patients with chronic kidney disease, initial or add-on therapy should include one of what classes of medication?
ACEI or angiotensin receptor blocker (ARB)
40
Which two classes of antihypertensive medication should never be given together?
ACEI and ARBs
41
Beta blockers are not recommended for initial treatment of hypertension, except for what type of patients?
For patients with angina pectoris, arrhythmias, heart failure, or recent myocardial infarction
42
Which class of medication reduces the risk of stroke compared to ACEI and reduce risk of myocardial infarction compared to ARBs but increased risk of congestive heart failure as compared to both ace inhibitors and angiotensin receptor blocker’s
Calcium channel blockers
43
ACE inhibitors and a ARBs are associated with an increased risk of heart failure and stroke compared to what class of medication?
Thiazide diuretics
44
Amlodipine, diltiazem, nitrensipine are apart of what class of medication ?
Calcium channel blockers
45
What is the difference between metoprolol tartrate
| and metoprolol succinate?
Metoprolol succinate is extended release and metoprolol tartrate is immediate release 
46
 What is a aerobic activity recommendation for lifestyle modifications for hypertension?
At least 90 to 150 minutes per week
47
What is the optimal goal of sodium intake for lifestyle modification?
1500 mg a day
48
What is the alcohol limit for lifestyle modifications in men and women? For hypertension
Limit alcohol intake to two drinks per day or fewer for males, and one drink per day or fewer for females
49
What class does eplerenone belong to?
 Aldosterone antagonist
50
What is important to monitor for aldosterone antagonists?
Monitor serum potassium before starting therapy.
51
What class do these medications belong to? Doxazosin, prazosin, and terazosin
Alpha blockers
52
What medication belongs to centrally acting adrenergic agents?
Clonidine
53
What is the first line agent for treating hypertension in patients with diabetes and chronic kidney disease? What is the second line treatment?
First line is ace inhibitor
| Second line if ace inhibitor isn’t tolerated it’s an angiotensin receptor blocker (ARB)
54
What is important to monitor if a diabetic is on a thiazide diuretic?
Thiazide diuretics can cause hyperglycemia, consider increase monitoring of glucose levels
55
For patients with chronic kidney disease what is the target systolic blood pressure recommended to be at?
Lower than 120
56
For adult kidney transplant recipients what 2 classes of medication Can be used to treat their blood pressure?
Calcium channel blockers and angiotensin receptor blocker
57
Primary hypertension occurs mainly in children older than what age?
13 years
58
 For children ages 6 to 11 what is considered hypertensive?
If blood pressure is higher than 120/80 and children ages 6 to 11
59
For children ages 12 to 17, what is considered hypertensive?
Blood pressure greater than 130/85
60
Hypertension is diagnosis if systolic or diastolic blood pressure is at the 95th percentile or greater for age, sex, and height on at least how many separate occasions?
At least three separate occasions
61
What is initial treatment of high normal blood pressure for children?
Lifestyle modifications of altering diet, increasing exercise and controlling weight
62
What exam should be done to evaluate children with hypertension? List seven
Serum biochemistry, lipids, glucose urinalysis, Renal ultrasonography, echocardiogram, and retinal exam
63
How long should you wait before starting a child on medication for hypertension?
Six months
64
What is the goal blood pressure for children ages 13 or older that are on antihypertensive medication?
Below 120/80
65
What is the initial pharmacologic therapy for children with hypertension? List the three class the medication’s that you can give
Ace inhibitor , angiotensin receptor blocker, or calcium channel blocker
66
If a child is not control with monotherapy for hypertension what is the next step?
Refer to a pediatric hypertension specialist
67
Describe chronic pre-existing hypertension and pregnant patients
Blood pressure that is higher than 140/90 that predates the pregnancy or begins before the 20th week of gestation
68
Describe gestational hypertension
Blood pressure higher than 140/90 with the onset after 20 weeks of gestation in a previous normotensive woman, it last less than six weeks postpartum
69
What is preeclampsia?
The presence of hypertension with proteinuria and/or new onset of signs of end organ damage with onset after the 20th week of pregnancy
70
What are the maternal risk of hypertension in pregnancy? List 4
Placental abruption, stroke, multi organ failure, DIC
71
What are the fetal risks of hypertension in pregnancy? List 3
Intrauterine growth restriction, preterm birth, intrauterine death
72
What is the initial therapy for pregnant women with hypertension? List three medications
labetalol, Methyldopa, long acting to nifedipine
73
What is the second line agents used for a pregnant woman with hypertension?
List 3
Clonidine, hydralazine, and thiazide diuretics
74
What does the USPSTF and American College of obstetrics and gynecologist recommend for prevention of preeclampsia in patients at high-risk after 12 weeks of gestation?
They recommend low dose of aspirin 81 mg a day for prevention of preeclampsia and patients at high risk after 12 weeks of gestation
75
 How long should aspirin be taken in women that have preeclampsia?
Start at 12 to 28 gestation and continued til day of delivery
76
If a pregnant patient has a systolic blood pressure of 160 to 170 systolic and or a diastolic blood pressure of 105 to 110 what do they need?
They require immediate hospitalization and an urgent antihypertensive therapy, it is considered obstetrical emergency
77
What is the purpose of magnesium sulfate for patients who have preeclampsia? 
It is indicated for seizure prophylaxis
78
Adults with stage one hypertension who have a ASCVD score less than 10%, what is there treatment recommendation?
Non-pharmacological therapy and lifestyle modifications, reevaluate blood pressure again in 3 to 6 months
79
For adults with stage one hypertension who have an ASCVD score higher than 10%, what is the recommended treatment?
Treat with non-pharmacologic lifestyle modifications and antihypertensive drug therapy and reevaluate in one month
80
For adults with stage two hypertension, what is the recommended therapy?
Lifestyle modifications and antihypertensive drug therapy with two agents of different classes, evaluate again in one month
81
For adults initiating a new or adjusted drug regimen for hypertension, they should have a follow up for evaluation of how often in response to treatment until control is achieved?
Monthly intervals
82
For patients taking a ARBs or ace inhibitors what labs should be check?
Measure creatinine and potassium level before beginning therapy and 1-2 weeks after each dose increase
83
A patient with a potassium greater than 5.6 while on a Acei or arb means what?
It requires dose reduction or discontinuation
84
Diastolic blood pressure elevation is a primary predictor of risk in persons younger than what age?
Younger than 50
85
Systolic blood pressure is way more important predictor in person’s older than what age?
Older than 60 years
86
True or false hypertension is the most common cause of chronic kidney disease, conversely chronic kidney disease can lead to or exacerbate hypertension.
True
87
The US preventive service task force recommends screening for high blood pressure in all adults ages __ and older? 
Ages 18 and older
88
Adults age 40 and older and persons at increased risk for high blood pressure should be screened how often? For hypertension
Screen annually
89
For adults ages 18 to 39 with no increased risk for hypertension and with prior blood pressure readings within reference range what is the screening recommendation?
Screen every 3 to 5 years
90
Calcium intake of ___mg/day, slightly reduces go systolic and diastolic blood pressure normotensive people.
1000 mg a day
91
What is the blood pressure goal for adults over the age of 60?
Systolic pressure less than 150, diastolic blood pressure less than 90
92
For non-black patients that are older than 60 with no diabetes or chronic kidney disease, what is the first line medication?
Initiate Thiazide-type diuretic or an ace inhibitor or ARB or a calcium channel blocker alone or in combination.
93
For strategy A what is the recommendation?
Start one drug, titrate to the maximum dose, if not achieved then add second drug
94
For strategy B to dose antihypertensive drugs, what is the plan?
Start one drug and then add a second drug before achieving maximum dose of the initial drug, then titrate both drugs up to the max recommended dose of both to achieve goal, if no add third drug.
95
What is strategy C for dosing antihypertensive drugs?
Begin with two drugs at the same time, either as two separate pills or a single combination pill.
96
What strategy is recommended for patient with a systolic blood pressure greater than 160 and or a diastolic blood pressure greater than 100?
Strategy C , start two drugs at the same time
97
In the general population aged 60 yrs and older at what blood pressure should you initiate pharmacological treatment to lower BP?
What is the recommendation strength?
150/90
Grade A
98
in the general population of adults aged 60 or younger, what is the recommendation to treat diastolic blood pressure?
What is the recommendation strength?
Initiate pharmacological treatment to lower diastolic blood pressure that is greater than or equal to 90mmhg
Grade A—30-59 yrs; grade E—18-29yrs
99
In the general population younger than 60yrs, at what systolic blood pressure should pharmacological therapy be initiated at?
What is the recommendation grade?
Initiate pharm therapy at a systolic blood pressure of 140 or higher with goal of less than 140.
Grade E
100
In population aged 18 yrs or older with CKD what is the systolic and diastolic blood pressure recommendation to initiate pharmacological therapy ?
Begin treatment at systolic blood pressure greater than of equal to 140 MMHg and/or a Diasoltic blood pressure greater than or equal to 90mmhg
Grade E
101
What is the criteria for chronic kidney disease? EGFR and albuminuria
Estimated GFR less than 60 and people with albuminuria is defined as greater than 30mg of albumin/g of creatinine at any level of GFR
102
What is the blood pressure recommendation to initiate pharmacological therapy in patients with diabetes that are 18 years and older?
What’s the recommendation?
Initiate therapy at a systolic blood pressure greater than or equal to 140 and diastolic blood pressure greater than or Equal to 90
Expert opinion—grade E
103
 In non-black patients with or without diabetes what are the four classes of medication recommended to use to treat blood pressure?
What grade of recommendation?
Thiazide type diuretics
Ace inhibitors
ARBs
Calcium channel blockers
Grade B
104
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Which class of medication is more effective than the other in improving heart failure outcomes?
Between ace inhibitors and calcium channel blockers
```
Ace inhibitors are more effective
105
Why are beta blockers not used for initial treatment of hypertension?
Use of beta blockers resulted in a higher rate of primary composite outcomes of cardiovascular death, myocardial infarction, or stroke compared to an ARB.
106
Indapamide belongs to which class of medication?
Thiazide diuretics
107
Chlorthalidone belongs to what class of medication?
Thiazide diuretic
108
In the black population, including those with and without diabetes what is the recommendation grade for with diabetes and without?
Grade B for general black population with no diabetes (moderate)
Grade C for general black population with diabetes (weak)
109
In the black population, calcium channel blocker is preferred over ace inhibitors because?
Ace inhibitors we’re associated with higher rate of stroke and were less effective in reducing blood pressure
110
What is the pharm recommendation for people aged 18 or older with chronic kidney disease and hypertension for initial (or add on) therapy?
Grade recommendation?
To be on an ACE inhibitor or ARB to improve kidney outcomes, regardless of race or diabetes status
Grade B moderate
111
In a black patient with chronic kidney disease with proteinuria, what is the initial therapy?
Ace inhibitor or ARB
Because of the higher likelihood of progression to ESRD without use
