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Hypertension Flashcards

1
Q

Hypertension is defined as sustained systolic BP >_ mmHg

A

130

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2
Q

Hypertension is defined as sustained diastolic BP >_ mmHg

A

80

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3
Q

Isolated systolic HTN is defined as systolic BP greater than _ and diastolic BP less than _

A

130
80

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4
Q

Isolated diastolic HTN is defined as systolic BP less than _ and diastolic BP greater than _

A

130
80

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5
Q

What is the difference between Stage I and Stage II HTN

A

Stage I:
SBP 130-139
DBP 80-89

Stage II
SBP >140
DBP >90

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6
Q

What is defined as normal blood pressure?

A

SBP < 120
DBP < 80

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7
Q

What is defined as elevated blood pressure?

A

SBP 120-129
DBP < 80

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8
Q

Which population is most affected by HTN?

A

African Americans (40%)

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9
Q

HTN is a risk factor for what three conditions?

A

Cardiovascular disease
Stroke
Renal disease

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10
Q

What causes Primary (Essential) HTN?

A

Etiology is unclear

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11
Q

What contributes to Primary (Essential) HTN?

A

SNS activity
Dysregulation of RAAS
Deficiency in endogenous vasodilators

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12
Q

What genetic and lifestyle risk factors contribute to HTN?

A

Obesity
ETOH
Tobacco

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13
Q

What five conditions contribute to Secondary HTN in middle-aged adults?

A

Hyperaldosteronism
Thyroid dysfunction
OSA
Cushing’s disease
Pheochromocytoma

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14
Q

What are some causes of Secondary HTN in children?

A

Renal parenchymal disease
Coarctation of the aorta

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15
Q

What age group has the highest percentage of HTN?

A

Children (70-85%)

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16
Q

Describe Resistant HTN

A

BP above goal despite 3+ anti-HTN drugs at max dose
(CCB, ACI-I or ARB + diuretic)

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17
Q

Describe Controlled Resistant HTN

A

Controlled BP requiring 4+ medications

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18
Q

Described Refractory HTN

A

Uncontrolled BP on 5+ drugs

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19
Q

What is Pseudo-resistant HTN?

A

Intolerance to medications
Resulting in BP inaccuracies or med noncompliance
(White coat syndrome)

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20
Q

For every _ kg of weight loss we can expect a _ mmHg drop in blood pressure

A

1
1

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21
Q

What consequences come with Chronic HTN?

A

Remodeling of small & large arteries
Endothelial dysfunction
Irreversible end-organ damage

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22
Q

What 4 drug classes are effective in treating HTN in Non-black patients?

A

ACE-I’s
ARBs
CCBs
Thiazide diuretics

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23
Q

What drug classes are effective in black patients w/o HF or CKD initially?

A

CCBs
Thiazide diuretics

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24
Q

What two drug classes are effective in patients with CKD?

A

ACE-I’s
ARBs

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25
Q

Beta-blockers are reserved for patients with ___

A

CAD or tachydysrhythmias

26
Q

Treatment for Secondary HTN is usually __

A

Interventional (Surgical)

27
Q

What three conditions attribute to Secondary HTN?

A

Renal artery stenosis
Adrenal adenoma
Pheochromocytoma

28
Q

ACE-I, ARBs, and Direct Renin inhibitors are contraindicated with what condition?

A

Bilateral renal artery stenosis

29
Q

Primary aldosteronism is usually treated with what drug?

A

Spironolactone

30
Q

What medications should be held the night before or on the day of surgery?

A

ACE-I’s
ARBs
Diuretics

31
Q

Stopping Beta-blockers or Clonidine can have what effect before surgery?

A

Rebound effect

32
Q

Stopping CCBs can have what effect before surgery?

A

Increased perioperative cardiovascular events

33
Q

What anti-HTNisve should be avoided in pregnant patients?

A

ACE-I’s
ARBs

34
Q

At what blood pressure measurements is immediate intervention warranted for pregnancy-induced hypertension?

A

SBP >160 mmHg
DBP >110 mmHg

35
Q

What drug is first line for peripartum HTN?

36
Q

What drug is the gold standard for rapid arterial dilation?

A

Sodium Nitroprusside

37
Q

What new 3rd gen CCB has begun being used more often for its short DOA?

A

Clevidipine

38
Q

What other CCB is used in BP management during surgery?

A

Nicardipine

39
Q

Pulmonary HTN is defined as a mPAP of __ mmHg

40
Q

What two signs are noted with Pulmonary HTN?

A

Accentuated S2 & S4 sounds (gallop)
LE swelling

41
Q

Precapillary PH is defined as a PVR of __ without an __ in LAP or PAWP

A

> 3.0 WU
increase

42
Q

Isolated Postcapillary PH is defined as a PAWP __ with a __ PVR

A

> 15 mmHg
normal

43
Q

Combined Pre and Postcapillary PH is defined as a PAWP __ and a PVR __

A

> 15 mmHg
3.0 WU

44
Q

High flow PH occurs without a __ in PAWP or PVR

A

elevation
(caused by pulmonary shunt or high CO)

45
Q

What diagnostic procedure is required to diagnose Pulmonary HTN and PAH?

A

Right Heart Cath

46
Q

What is the formula for PVR?

A

(mPAP-PAWP)/CO

47
Q

Mild PH is defined as

A

mPAP 20-30 mmHg

48
Q

Moderate PH is defined as

A

mPAP 31-40 mmHg

49
Q

Severe PH is defined as

A

mPAP >40 mmHg

50
Q

What risk factors are there for idiopathic PAH?

A

Trick question.
It has none

51
Q

PAH leads to sustained __ and the remodeling process leads to __ of small __

A

vasoconstriction
pathologic distortion
pulmonary arteries

52
Q

What drug class is used as initial treatment for PAH?

53
Q

What three classes of pulmonary vasodilators are used for PAH?

A

Prostanoids
Endothelin receptor antagonists
Nitric oxide/guanylyl cyclase pathway meds

54
Q

Prostanoids mimic __ to produce vasodilation while __ platelet aggregation

A

Prostacyclin
Inhibiting

55
Q

What medications are classified as prostanoids?

A

Epoprostenol (IV)
Iloprost (inhaled)
Treprostinil (SQ, IV, INH, PO)
Beraprost (PO)

56
Q

What is the only prostanoid that has been shown to reduce mortality?

A

Epoprostenol

57
Q

What other class of medications can be used for PAH and Pulmonary HTN?

A

PDE 5 inhibitors

58
Q

What initial signs are present with PAH?

A

Nonspecific fatigue
Dyspnea
Cough

59
Q

What signs are present with advanced PAH?

A

Angina or syncope during exercise

60
Q

What six signs can be present on physical exam for PAH?

A

Parasternal lift
Accentuated S2, S3, and or S4
JVD
Peripheral edema
Hepatomegaly
Ascites

61
Q

Interventions that affect what three factors must be considered prior to surgery for PAH patients?

A

RV preload
Afterload
Oxygen supply/demand

62
Q

What five factors can affect RV afterload?

A

PEEP
Hypoventilation
Hypercarbia
Acidosis
Atelectasis

Physical Assessment (3 decks)

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