Hypertension

Question 1

most important cause of secondary hypertension

Answer 1

renal disease

Question 2

drugs that increase BP

Answer 2

amphetamines/ADHD drugs
cocaine
decongestants (pseudoephedrine/phenylephrine)
erythropoiesis-stimulating agents
immunosuppressants (cyclosporine)
NSAIDs
systemic steroids

excessive alcohol
appetite suppressants (phentermine)
caffeine
herbals (ma huang, licorice, yohimbine)
oral contraceptives
select oncology drugs (bevacizumab, TKIs)
antidepressants (TCAs, SNRIs, MAOis)

Question 3

BP monitoring Dos

Answer 3

go to restroom/empty bladder
sit in chair; both feed on floor; relax for 5 or more minutes
use correct cuff size
support arm and heart level
wait 1-2 min between readings
average 2 or more readings on two separate times in day

Question 4

BP monitoring Don’ts

Answer 4

talk
sit/lie down on examination table
drink caffeine, exercise, or smoke for 30 minutes before
use finger/writ monitor (less accurate)

Question 5

is self-monitoring or physician monitoring of BP preferred?

Answer 5

self

Question 6

ACC/AHA categories of BP in results

Answer 6

normal: SBP >120 and DBP <80
Stage 1 hypertension: SBP 130-139 or DBP 80-89
Stage 2 hypertension: SBP >=140 or DBP >=90

Question 7

lifestyle management

Answer 7

weight loss
diet (DASH)
dec sodium <1500
tobacco cessation

Question 8

natural products

Answer 8

fish oil
coenzyme Q10
L-glargine
garlic

Question 9

treatment principles (ACC/AHA)

Answer 9

emphasize lifestyle
once-daily preferred for med adherence
preferred for initial and/or titration of treatment: ACEI, ARBs, DHP CCBs, thiazide diuretics (not ACEI/ARBs together)

Question 10

when to start treatment

Answer 10

Stage 2 HTN
Stage 1 HTN and clinical CVD (stroke, HF, CAD); 10-year ASCVD risk >=10%; or does not meet BP goal after 6 months of lifestyle modifications

Question 11

BP goal

Answer 11

<130/80

Question 12

initial drug selection

Answer 12

non-black: thiazide, DHP CCB, ACEI/ARB
black: thiazide or DHP CCB
CKD: ACEI/ARB (for renal benefit)
diabetes w/ albuminuria: ACEI/ARB
diabetes w/ CAD: ACEI/ARB
start 2 first-line drugs in Stage 2 HTN when average SBP and DBP >20/10 above goal

Question 13

monitoring for hypertension guidelines

Answer 13

monitor every month and titrate meds if not at goal

Question 14

pregnancy and HTN

Answer 14

ACEIs, ARBs, and aliskiren (direct renin inhibitor): BBW for fetal toxicity; stop immediately

preeclampsia: after 20 weeks of pregnancy; elevated BP and proteinuria

if chronic HTN and BP >=160/105 = give drug treatment - labetalol and nifedipine ER recommended; methyldopa recommended but maybe less effective

Question 15

thiazide diuretics MOA

Answer 15

inhibit sodium reabsorption in DCT = excrete sodium, Cl-, water, K+

Question 16

chlorthalidone dosing

Answer 16

12.5-25 mg daily

Question 17

hydrochlorothiazide dosing

Answer 17

12.5-50 mg daily

Question 18

thiazide diuretics CI

Answer 18

HSN to sulfa

Question 19

thiazide diuretics side effects

Answer 19

dec K, Mg, Na
inc Ca, UA, LDL, TG, BG
photosensitivity
impotence

Question 20

thiazide diuretics monitoring

Answer 20

electrolytes
renal function

Question 21

thiazide diuretics notes

Answer 21

not effective with CrCl <30
take early in day to avoid nocturia
chlorothiazide: only one IV

Question 22

thiazide diuretics DI

Answer 22

NSAIDs: sodium and water retention = dec effectiveness of thiazide
lithium: thiazides dec renal clearance = inc lithium toxicity
do not use these with thiazides