Hypertension

Question 1

HTN

HTN according to AHA

Answer 1

> = 130/80

Question 2

HTN

Normal BP ranges according to the AHA

Answer 2

<120/80

Question 3

HTN

high normal BP according to the AHA

Answer 3

120- 129/ <80

Question 4

HTN

HTN stages according to the AHA

Answer 4

• Stage 1= 130- 139/ 80- 89
• Stage 2= >=140/90

Question 5

HTN

Age specific BP targets

Answer 5

• <65 yrs = <130/80
• > = 65 yrs = <130/80

Question 6

HTN

If SBP and DBP are in two seperate categories,

Answer 6

classify under the higher BP category

Question 7

HTN

Isolated systolic HTN

Answer 7

Only SBP is high
>140/90
seen in the elderly

Question 8

HTN

Causes

Answer 8

• essential HTN- no secondary cause
• Secondary HTN

Question 9

HTN

Renal causes of HTN

Answer 9

All possible renal conditions can cause HTN
* Renal artery stenosis
* Diabetic nephropathy
* Chronic GN
* Adult PCKD
* Chronic glomerulo interstitial nephritis

Question 10

HTN

Renal artery stenosis

Answer 10

• Flash pulmonary edema
• Renal bruit on examination
• USS KUB- if one Kidney is smaller than the other kidney <1.5cm

Question 11

HTN

How can renal artery stenosis cause HTN

Answer 11

atrophied Kidney activate RAAS ( sodium retention. K excretion)

Question 12

HTN

Cause of renal artery stenosis in elderly and young

Answer 12

• elderly- atherosclerosis
• young- fibrodysplasia

Question 13

HTN

Endocrine causes of HTN

Answer 13

• Pheochromocytoma
• Primary hyperaldosteronism
• Cushings syndrome
• Thyroid disease
• Hyperparathyroidism
• Congenital adrenal hyperplasia
• Acromegaly

Question 14

HTN

Sx of pheochromocytoma

Answer 14

episodic sweating, headache, palpitations

Question 15

HTN

Pheochromocytoma is

Answer 15

an adrenaline, nor- adrenaline secreting tumor

Question 16

HTN

Primary hyperaldosteronism is

Answer 16

Conn syndrome

Question 17

HTN

K+ and Na 2+ levels in conn syndrome

Answer 17

Na2+ elevated
K+ reduced

Question 18

HTN

Cushings syndrome

Answer 18

Cortisol increased
Reduced K+

Question 19

HTN

Can both hyper and hypothyroidim cause HTN

Answer 19

YES
* Hyper usually cause systolic HTN
* Hypo usually cause diastolic HTN

Question 20

HTN

3 causes of HTN with reduced K+

Answer 20

• Renal artery stenosis
• Conn Syndrome
• Cushing’s syndrome

Question 21

HTN

CVS causes of HTN

Answer 21

• CoA

Question 22

HTN

Drugs that can cause HTN

Answer 22

• OCP
• Sympathomimetics (ecstasy pills, amphetamines)
• MAOI

Question 23

HTN

If the pt has DM and HTN

Answer 23

think about cushings

Question 24

HTN

What to always check for in a patient with a renal disease

Answer 24

BP

Question 25

# HTN Secondary HTN can occur when

Answer 25

* Young onset ( <30yrs w/o any risk factors or pre-pubertal children) * Rapidly developing HTN * Severe HTN refractory to Mx * Worsening of HTN in a previously well- controlled patient

Question 26

# HTN Risk factors of HTN

Answer 26

* CVD- IHD, stroke/ TIA, PVD, HF * CV risk factors- DM, dyslipidemia, smoking * Psychiatric disorders * Rheumatological disease * COPD * Other chronic Disease

Question 27

# HTN Sx

Answer 27

* usually ASx * Attacks of headache, sweating, palpitations * Epsitaxis * SOB

Question 28

# HTN Sx of malignant HTN

Answer 28

* Severe headache * Visual disturbance * fits * transient loss of consciousness

Question 29

# HTN Complications

Answer 29

* CVS- IHD, HF, PVD, LVH, arrhythmia * CNS- stroke, TIA * Renal - uremia * Hypertensive emergencies

Question 30

# HTN Hypertensive retinopathy

Answer 30

divided into grade 1 to 4

Question 31

# HTN Grade 1 hypertensive retinopathy

Answer 31

* Arteriolar thickening * tortuousity * increased reflectiveness **Arteries look like silver wires**

Question 32

# HTN Grade 2 hypertensive retinopathy

Answer 32

grade 1 + constriction of veins at arteriolar crossings ( arterio venous nippings)

Question 33

# HTN Grade 3 Hypertensive retinopathy

Answer 33

Grade 2 + Evidence of retinal ischemia ( flame shaped hemorrhages and cottin wool spots)

Question 34

# HTN Grade 4 Hypertensive retinopathy

Answer 34

Grade 3 + papilledema

Question 35

# HTN Malignant HTN

Answer 35

BP rises rapidly ( Severe HTN) **>180/110**

Question 36

# HTN Histo change in malignant HTN

Answer 36

**Fibrinoid necrosis of vessel wall**

Question 37

# HTN Untreated malignant HTN can cause

Answer 37

death from renal failure, HF, cerebral edema, hemorrhage w resultant hypertensive encephalopathy

Question 38

# HTN Ix

Answer 38

* To look for a cause 1. Renal- USS abd, RFT, Renal angio 2. Endocrine and metabolic- urinary VMA, CT scan 3. Primary hyperaldo- SE (hypokalemia) 4. Cushing Syndrome- Dexa suppression test 5. Thyroid function test 6. CVS- CoA, Xray, Echo * To look for complications 1. ECG- LVH 2. Echo- LVH 3. Renal- BU, SE, UFR, USS Abd

Question 39

# HTN Mx

Answer 39

* Lifestyle modifications * Assess CVS risk * Pharmacological Mx

Question 40

# HTN Lifestyle modification

Answer 40

* To all w BP >120/80 * DASH diet * salt reduction * exercise * reduce alcohol * stop smoking

Question 41

# HTN if any CVS disease exist they are classified under

Answer 41

high risk

Question 42

# HTN If no cardiovascular disease exists they are classified under

Answer 42

according to WHO/ ISH CV risk classification

Question 43

# HTN Who needs meds

Answer 43

* consider pts w high normal BP w very high Cardio vascular disease risk * Start for grade 1 w high Cardiovascular disease risk/ hypertensive organ damage/ CKD/ not controlled with lifestyle modifications for 3- 6 months * Start for all with grade 2 or 3 * Irrespective of co- morbidities >80yrs treatment threshold is 160/90

Question 44

# HTN When to start meds in pts >80 yrs

Answer 44

if BP >160/90

Question 45

# HTN Initial therapy

Answer 45

* ACEI + CCB OR * ACEI + diuretic **Start with a low dose and step up to full dose as necessary**

Question 46

# HTN When to consider monotherapy

Answer 46

**IF YES TO ANY** * Low risk grade 1 HTN * Patients >= 80 years * Pts with fraility

Question 47

# HTN Monotherapy

Answer 47

* ACEI/ ARB or * DHP-CCB or * Thiazide/ thiazide like diuretic

Question 48

# HTN When to consider dual low- dose combination

Answer 48

**NO TO ALL** * Low risk grade 1 HTN * Patients >= 80 years * Patients with fraility

Question 49

# HTN Dual low- dose combo

Answer 49

* ACEI/ ARB + DHP-CCB or * ACEI/ ARB + thiazide/ thiazide- like diuretic + DHP- CCB