Hypertension

Question 1

risk factors of hypertension

Answer 1

• smoking
• obesity
• poor diet
• stress
• sedentary lifestyle
• male gender

Question 2

clinical manifestation of hypertension

Answer 2

• fatigue
• dizziness
• headache
• palpitations
• dyspnea
• chest pain – angina

Question 3

causes of hypertension

Answer 3

• primary = unknown
• secondary = specific cause

Question 4

complications of hypertension

Answer 4

• atherosclerosis/CAD
• left ventricular hypertrophy
• heart failure
• stroke/TIA
• hypertensive encephalopathy
• peripheral vascular disease
• nephrosclerosis
• retinopathy/retinal hemorrhage

Question 5

labs and diagnostics for hypertension

Answer 5

• lipid panel
• urinalysis
• CBC
• BMP
• liver function
• EKG/ECG
• echocardiogram
• serum uric acid Ca/Mg
• TSH levels
• eye exams

Question 6

goals for hypertension

Answer 6

• achieve and maintain goal BP
• reduce CV risk factors and target organ disease
• lifestyle modifications = exercise, manage BP, manage cholesterol, decrease blood sugar, better diet, stop smoking
• lose weight – DASH eating plan, dietary sodium reduction, moderation of alcohol intake, physical activity
• avoid tobacco products
• management of risk factors
• activate SNS and stress hormones
• screen frequently for risk factors

Question 7

beta blockers

Answer 7

• decrease SNS stimulation
• work centrally on vasomotor center and peripherally to inhibit NE release
• block adrenergic receptors on blood vessels

Question 8

ACE inhibitors

Answer 8

• prevent conversion of angiotensin I to II
• reduce vasoconstriction and sodium and water retention

Question 9

A-II receptor blockers

Answer 9

prevent angiotensin II from binding to receptors in blood vessel walls

Question 10

Calcium Channel blockers

Answer 10

increase sodium excretion and cause arteriolar vasodilation by preventing the movement of extracellular Ca into cells

Question 11

Diuretics

Answer 11

reduce plasma volume

Question 12

Common side effects of hypertension

Answer 12

• orthostatic hypotension
• sexual problems
• dry mouth
• frequent voiding

Question 13

Resistant Hypertension

Answer 13

• failure to reach goal BP with appropriate therapy and drug regimen; increased risk of MI or stroke

Question 14

how to take accurate BP

Answer 14

• no caffeine, nicotine, or exercise 30 minutes prior
• rest quietly for 5 minutes prior
• proper size and location of cuff
• position arm at heart level
• use auscultatory method
• take BP in both arms and note difference

Question 15

orthostatic HTN

Answer 15

• BP and HR after supine for 5 minutes
• Assist to standing
• Measure BP and HR at 1 minute and 3 minutes of position change
• Normal: SBP decreased (less than 10 mmHg, DBP and HR increased slightly
• Abnormal:
• SBP decreased 20 mmHg or more
• DBP decreased 10 mmHg or more
• HR increased 20 beats or more
• Report of lightheaded or dizzy

Question 16

Reasons for poor adherence

Answer 16

• inadequate education
• low health literacy
• unpleasant side effects
• stop taking medication
• increased cost
• lack of insurance

Question 17

measures to enhance compliance

Answer 17

• individualize care plan
• active patient participation
• select affordable drugs
• involve caregivers/family
• combination drug
• patient teaching

Question 18

evaluate the effectiveness of treatment

Answer 18

• meet goal BP
• understand treatment plan
• reports minimal side effects of drug

Question 19

age-related physical changes contribute to HTN

Answer 19

• Loss of elasticity of artery
• Increased collagen and stiffness in myocardium
• Increased peripheral vascular resistance
• Decreased adrenergic receptors
• Blunted baroreceptor reflex
• Decreased renal function
• Decreased renin responds to Na/H20 depletion

Question 20

Hypertensive crisis

Answer 20

• SBP greater than 180 mmHg or DBP greater than 120 mmHg

Question 21

Hypertensive emergency

Answer 21

• target organ damage
• requires hospitalization
• severe problems:
  1. encephalopathy
  2. stroke
  3. MI
  4. renal failure
  5. retinopathy
  6. aortic aneurysm
  7. intracranial/subarachnoid hemorrhage

Question 21

Hypertensive emergency

Answer 21

• target organ damage
• requires hospitalization
• severe problems:
  1. encephalopathy
  2. stroke
  3. MI
  4. renal failure
  5. retinopathy
  6. aortic aneurysm
  7. intracranial/subarachnoid hemorrhage

Question 22

Hypertensive urgency

Answer 22

• no evidence of target organ disease
• hospitalization not required
• associated with chronic stable disorders = CHF, CVA, angina

Question 23

Clinical manifestations of hypertensive episodes

Answer 23

• hypertensive encephalopathy – nausea, seizures, confusion, trauma, retinal changes, vomiting
• renal insufficiency
• cardiac decomposition – chest pain, MI, pulmonary edema, dyspnea, unstable angina, heart failure
• aortic dissection – chest and back pain, reduced/absent pulses