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MSPA- Cardiology > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is optimal BP ?

A

<120/<80

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2
Q

What is normal BP ?

A

120-129/80-84

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3
Q

What is high normal BP ?

A

130-139/85-89

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4
Q

What is the BP in grade 01 HTN ?

A

140-159/90-99

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5
Q

What is the BP in grade 02 HTN ?

A

160-179/100-109

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6
Q

What is the BP in grade 03 HTN ?

A

greater than or equal to 180/ greater than or equal to 110

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7
Q

What is isolated systolic HTN?

A

≥ 140 / <90

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8
Q

What is isolated diastolic HTN ?

A

<140 /≥ 90

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9
Q

When should BP screening repeated in patients with optimal BP
( <120/80)?

A

Every 5 year.

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10
Q

When should BP screening repeated in patients with normal BP (120-129/80-84) ?

A

Repeat BP at least every 3 year.

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11
Q

When should BP screening repeated in patients with High normal BP (130-139/85-89) ?

A

Repeat BP at least annually + consider masked HNT ergo do HBPM and ABPM.

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12
Q

What should be the approach to clinical HTN (≥ 140 / <90)

A

Use repeated clinic visits or HBPM / ABPM to confirm the Dx.

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13
Q

What is the utility of Systematic Coronary Risk Evaluation (SCORE2 or SCORE2-OP)?

A

SCORE2 can be used to calculate 10-year risk of fatal & non-fatal CVD event in apparently healthy individuals ( age 40-69) and SCORE2-OP in people >70 years.

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14
Q

What are the parameters for calculating 10 year risk for fatal or non-fatal CVD in HTN patients ?

A
  • Gender
  • Age
  • Smoking
  • Systolic BP value
  • Non-HDL cholesterol level
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15
Q

What are the parameters of very high 10- year CVD risk classification ?

A

Anyone of the following:
* Hx of Clinical CVD events.
* Unequivocally documented CVD on imaging such as ≥ 50% stenosis on angio or US.
* T2DM with end organ damage.
* Sever CKD: eGFR< 30 ml/min.
* A calculated 10 year SCORE ≥ 10

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16
Q

What are the parameters of high 10- year CVD risk classification ?

A

Anyone of the following:
* Marked elevation of a single risk factor such as cholesterol >80 mMol/L or familial hypercholesterolimia or grade 3 HTN.
* T2DM
* Hypertensive LVH
* Moderate CKD: eGFR b/w 30-59/Ml/min.
* A calculated 10 year score of 5-10%

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17
Q

What are the parameters of moderate 10- year CVD risk classification ?

A
  • A calculated 10 year score of 1 to < 5%.
  • Grade 02 HTN
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18
Q

What are the parameters of Low 10- year CVD risk classification ?

A

A calculated 10 years score of <1%

19
Q

What is the initial management of high normal BP ?

A
  • life style change.
  • Consider drug Tx in very high risk patients with CVD especially CAD.
20
Q

What is the initial management of Grade 01 HTN?

A
  • life style advice.
  • Immediate drug therapy in high or very high risk patients with CVD, renal disease or HMOD.
  • After 3 to 6 months lifestyle intervention, if BP is not controlled drug therapy in moderate risk patients with CVD, renal disease or HMOD.
21
Q

What is the initial management of grade 02 and 03 HTN?

A

Life style advice + immediate drug therapy with an aim to control BP within 3 months.

22
Q

What should be the consideration for drug therapy in very high risk patients with high- normal SBP ( 130-140 mmHg)?

A
  • In patients b/w the age of 18 and 79 drug therapy should be considered, if they have HTN, T2DM, CKD, CVD, stroke/ TIA and their BP ≥ 140/ ≥90
  • In people ≥ 80 years the same risk factors with an SBP ≥ 160 should qualify for drug therapy.
23
Q

What are the parameters of lifestyle change in HTN management ?

A
  • Reduce dietary sodium to 2g/day
  • Reduce alcohol to 14 units/wk for men and 8 units/wk for women.
  • Adopt a healthy balanced diet.
    *Weight reduction in obese
  • Regular physical activity for 30min of moderate-intensity aerobic exercise 5-7/ week and Smoking cessation.
24
Q

What are the medical management steps in uncomplicated HTN?

A
  • Step-01: Initiate therapy with ACEI or ARB+ CCB or diuretic and consider mono therapy in low risk grade 01 HTN( <150mmHg) and in frail older patients >80 years.
  • Step02: ACEI or ARB + CCB + diuretics.
  • Step 03: If resistant HTN add spironolactone 25-50 mg OD or other diuretics or beta or alpha blockers.
  • Add beta blockers in any of these steps, if there are other co-morbidities and refer to a specialist centre for further evaluation.
25
Q

What is the medical management of HTN + CHD?

A
  • Dual combination initial therapy with ACEI or ARB+ Beta blocker or CCB/ CCB + diuretic or beta blocker/ Beta-blocker + diuretic. mono therapy in low risk grade 01 HTN( <150mmHg) and in frail older patients >80 years.
  • Step 02: Triple combination of step 01. if the BP is > 130 and below 150 consider dual therapy as in step 01.
    *Step 03: If resistant HTN add spironolactone 25-50 mg OD or other diuretics or beta or alpha blockers.
26
Q

What is the medical management of HTN+ CKD?

A
  • Step 01: dual combo therapy ACEI or ARB + CCB / ACEI or ARB + diuretics or loop diuretics.
  • Add beta-blockers, if other indications at any step.
  • Step-02: triple combination of ACEI or ARB + CCB+ diuretic or loop diuretic.
  • Step 03 for resistant HTN triple therapy + spironolactone 25 to 50 mg / other drugs.
27
Q

When should renovascular disease to be probed in patients on medical management of CKD + HTN?

A

A raise in eGFR and creatinine is expected in CKD patients receiving BP lowering therapy with ACEI or ARB. However, if there is a raise in creatinine of >30% require evaluation for reno-vascular causes.

28
Q

What is the medical management of HF with reduced EF?

A

Step 01: ACEI or ARB + diuretic ( loop) + Beta blocker.
Step 02: ACEI or ARB + diuretic ( loop) + Beta blocker + Mineralocorticoid Receptor Antagonist ( MRA).

29
Q

What is the medical management of HTN + AFIB ?

A

Step 01dual combination: ACEI or ARB + B-blocker or non DHP CCB / B-blocker + CCB.
Step02 triple combination: ACEI or ARB + B-blocker + DHP CCB / diuretic or B-blocker + DHP CCB + diuretic.

30
Q

Why is routine combination of beta-blockers with Non- DHP CCB is contraindicated in the management of HTN + AFIB?

A

Verapamil or delitiazam along with beta blocker can cause significant bradycardia.

31
Q

What are the BP Tx targets in HTN and T2DM, CAD and CVD ?

A
  • age b/w 18 to 65 the target is 130/70 to 79 if tolerated. Never< 120.
  • age b/w 65 to 79 and in over 80 years, the target is 130 to 139/70 to 79 if tolerated.
32
Q

What are the BP Tx targets in CKD ?

A
  • Age b/w 18 to 65 the target is < 140 to 130/ 70 to 79.
  • Age > 65 the target is 130 to 139/ 70 to 79, if tolerated.
33
Q

What are the characteristics of patients presenting with secondary HTN ?

A
  • Patients < 40 presenting with grade II HTN or any grade of HTN in childhood.
  • Acute HTN in patients documented as chronically normotensive.
  • Tx resistant HTN
  • Grade 3 HTN or hypertensive emergency.
  • Presence of extensive HMOD
  • Clinical indication of endocrine disorders or CKD related HTN.
  • Symptoms or family Hx of Pheochromocytoma.
  • obstructive sleep apnea.
34
Q

What is hypertensive emergency ?

A

Severe(SBP > 180, DBP > 110), Grade 3 HTN assoc with acute HMOD with or without fundoscopic changes or neurologic changes.

35
Q

What is hypertensive urgency ?

A

Grade 3 HTN without HMOD.

36
Q

What are the work-ups in Hypertensive emergency ?

A
  • 12 lead ECG and cardiac troponin levels.
  • serum urea and electrolytes.
  • Albumin/ creatinine ratio and urine microscopy for RBC cast.
  • Pregnancy test.
  • CT-brain, if neurological deficit.
37
Q

What is the management of Hypertensive emergency?

A

*IV labetalol, nicardipine, or GTN depending on underlying cause & form of HOMD.
*Gradual vs rapid reduction in BP based on underlying cause & form of
HOMD.

38
Q

What is the management of Hypertensive urgency ?

A

Outpatient oral antihypertensives therapy with 3 agents and Close outpatient f/u.

39
Q

What is the definition of HTN related to pregnancy ?

A

*Mild = SBP > 140-159 AND/
OR DBP > 90-109
*Severe = > 160/110
5-10% of pregnancies complicated by HTN

40
Q

What are the maternal complications of HTN in pregnancy ?

A

*Placental abruption, Stroke, multi-organ failure and DIC.

41
Q

What are the fetal complications of HTN in pregnancy ?

A

Intrauterine growth retardation, Prematurity and Intrauterine death

42
Q

What is the only anti-hypertensive studied in pregnant women?

A

Methyldopa

43
Q

What is the management of HTN-pregnancy

A
  • Mild treat with Methyldopa and labetalol or CCB.
  • Avoid direct rennin inhibitors such as ACEI and ARB and diuretics ( non-reninn inhibition)
  • ~Exercise caution with beta blcokers.
  • severe HTN for close monitoring as mother at risk of pre-eclampsia and seizures.

MSPA- Cardiology (8 decks)

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