Hypertension

Question 1

What are the criteria for a “high risk patient” as defined by HTN Canada?

Answer 1

50+ yo with SBP 130-180 and one or more of the following:
1. CVD
2. CKD
3. 10 yr risk 15+%
4. Age 75+

Question 2

What is the BP target for high risk patient?

Answer 2

Initiate therapy if SBP 130+
Target SBP <120

Question 3

CI to intensive BP management

Answer 3

1. Unwilling/unable to adhere
2. Standing SBP <110
3. Inability to measure SBP accurately
4. Known secondary causes of HTN

*Limited or no evidence for institutionalized elderly individuals

Question 4

First line anti-HTN options (3)

Answer 4

1. ACEi/ARB
2. Thiazide
3. Long acting CCB

*BB not first line if 60+

Question 5

SPRINT Trial high risk criteria

Answer 5

1. Cardiovascular disease (non stroke)
2. CKD (GFR 20-<60)
3. 10 year risk 15% or more
4. Age 75+

Question 6

Why would BB not work in older adult with systolic hypertension?

Answer 6

Decreased beta-adrenergic responsiveness of the myocardium with age
Increased vascular stiffness results in inc SBP and decline in DBP as driver of HTN (this is not targeted by BB)

Question 7

Intensifying anti HTN meds in hospital

Answer 7

Intensification of BP management during admission for non cardiac condition didn’t improve cardiac events or BP control at 1 year and associated with inc risk of readmission or serious AE in 30 days

Question 8

SPRINT MIND results

Answer 8

Intensive BP control (<120) significantly reduced risk of MCI and combined rate of MCI or probable dementia

Question 9

JAMA 2023 Anti HTN and risk of dementia

Answer 9

Untreated HTN associated with greater risk of all cause dementia in late life vs. treated HTN
Those treated had no greater risk than healthy controls