Hypertension Flashcards
1
Q
acceptable increase in creatinine within first 2 months of aceinhibitor therapy
A
30%
2
Q
First line therapy: Acei
A
Htn with hf and systolic dysfunction type 1 dm and proteinuria mi or cad new af left ventricular dysfunction hd
3
Q
selectively antagonize Ang Ii at the AT1 receptor
A
ARB
4
Q
B receptor predominantly in heart adipose and brain tissue
A
B1
5
Q
B receptor in lung liver smooth muscle and skeletal muscle
A
B2
6
Q
B1 selective
A
Atenolol, Metoprolol, Bisoprolol, Acebutolol
7
Q
Nonselective + A blockade or other mechanism
A
Labetalol Carvedilol Nebivolol
8
Q
coexisting heart failure and htn
A
B blocker
9
Q
inhibit entry of calcium or its mobilization from intracellular stores, lower peripheral resistance
A
Calcium channel blockers
10
Q
Most potent vasodilator among ccb
A
dihydropyridines - amlodipine, nifedipine
11
Q
augment atrial natriuretic peptide release
A
ccb
12
Q
important tx option for renal transplant recipients - reduces initial graft nonfunction by attenuating ischemic and reperfusion injury, preserves long term renal function by protecting against cyclosporine nephrotoxicity
A
CCBs
13
Q
cause of edema in dihydropyridines
A
uncompensated precapillary vasodilation
14
Q
crosses the blood brain barrier and have a direct agonist effect in a2 adrenergic receptors in the midbrain and brainstem
A
central adrenergic agonist
15
Q
most common adverse effect of a agonist
A
dry mouth
16
Q
decrease peripheral vascular resistance, act directly on vascular smooth muscle
A
direct acting vasodilators
17
Q
direct vasodilator reserved for severe or intractable hypertension
A
minoxidil
18
Q
common adverse effect of minoxidil
A
hypertrichosis
19
Q
associated with development of sle (direct vasodilator)
A
hydralazine
20
Q
derivative of spironolactone that is approx 24x less potent in blocking mr than spironolactone
A
eplerenone
21
Q
Bp target < 60
A
< 140/90
22
Q
Bp target > 60 yo
A
< 150/90
23
Q
Ideal therapy for older patients
A
vasodilators - ace/arb + hctz, ccb
24
Q
optimal therapy in pregnant
A
a-methyldopa, hydralazine or bblocker
25
angina tx
Bblocker, nitrates, ccb
| reduce hr and induce vasodilation
26
Lvh htn tx
hctz acei ccb arb
avoid vasodilators
reduce sbp
27
systolic dysfunction htn tx pharma consideration
reduce afterload and preload
| acei, arb, hctz, bblocker, aldactone
28
diastolic dysfunction
improve myocardial compliance
bb, ccb, acei arb
avoid loop diuretics
29
MI
reduce heart rate, bb, acei
30
inability to reach desired bp goal despite the use of 3 optimally dosed drugs, one of which is a diuretic or need for four or more medications yo reach desired goal
Resistant htn
31
most common cause of resistant htn
non adherence
32
most potent parenteral vasodilator - dilates arteriolar resistance and venous capacitance vessels
sodium nitroprusside
33
degree of pressure gradient between aorta and poststenotic renal artery before measurable release of renin develops
10-20mmhg
34
critical lesions require how much of luminal obstruction before hemodynamic effects are detected
70-80%
35
Effects of angiotensin II
```
vasoconstriction
renal Na retention
aldosterone secretion
Vascular effects
Sns
myocardial effects
```
36
affects the intima or fibrous layers of the vessel wall, F, smoking, classically away from renal artery, string of bead appearance
fibromuscular disease, medial fibroplasia
37
most common cause of renovascular disease, at origin of artery
atherosclerosis
38
appear in the midportion of the vessel, strong predilection for the R renal artery
medial fibroplasia
39
syndromes associated with renovascular hypertension
1. Early or late onset htn
2. acceleration of treated essential htn
3. Deterioration of renal function in treater essential htn
4. Acute renal failure during treatment of hypertension
5. Flash pulmonary edema
6. Progressive renal failure
7. Refractory congestive cardiac failure
40
lateralizafion is defined as a ratio of more than ___ between the renin activity of the stenotic kidnet and the nonstenotic kidney
1.5
41
used to monitor after renal revascularizarion to monitor restenosis and target vessel patency
Doppler studies
42
gold standard for definition of vascular anatomy and stenotic lesions in kidney
Intra arterial angiography
43
resistive index that reflects intrinsic parenchymao and small vessel disease in the kidney that does not improve after revascularizarion
> 80
44
Most frequently reported complication after ptra and stenting
Minor - groin hematoma and puncture site trauma
45
Creatinine and size of kidneys which will unlikely benefit from surgical or endovascilar procedures
Crea > 3 cm, Small kidneys < 8 cm
46
Indications for revascularizarion
```
circulatory congestion
deteriorating kidney function
bilateral high grade ras
solitary functioning kidney
uncontrolled hypertension
```
47
Screening in primary hyperaldosteronism
Plasma aldosterone concentration to renin activity: ARR of 30
48
False positives Arr
K and Na loading, bb, nsaid, ckd
49
False negative primary hyperaldosteronism
HypoK, diuretics, acei, arb, ccb
50
confirmatory tests for Pa
Saline loading
oral Na loading
fludricortisone
Captopril challenge
51
+ saline loading test
plasma aldosterone > 10 ng/ml (2L in 4h)
52
+ oral sodium loading test
urinary aldosterone > 12-14 mcg/day (6g/day for 3-5 days)
53
+ fludrocortisone suppression test after 0.1 mg of fludrocortisone every 6 hrs for 4 days
+ if upright plasma aldo > 6 ng/dL and renin/cortisol low
54
+ captopril challenge test after 20-25 mg
+ plasma aldosterone elevated and unchanged after 1 amd 2h
55
initial study in subtype testing of pa
adrenal ct
56
small hypodense nodule (2 cm in diameter)
Aldosterone producing adenoma
57
normal adrenals or nodular changes
Idiopathic hyperaldosteronism
58
> 4 cm, heterogenous, indistinct margins, hemorrhage and necrosis
Aldosterone producing adrenal ca
59
medical management for GRA
low dose dexa/pred
60
11B-hydroxysteroid dehydrogenase deficiency
licorice
61
htn hypoK inappropriate kaliuresis with low aldosterone and renin
liddle syndrome
62
headache, sweating, hypertension in paroxysms
Pheochromocytoma
63
tx of pheochromocytoma
alpha blocker - phentolaminr or phenoxybenzamine
64
screening for acromegaly
Insulin like growth factors
65
tx for aortic dissection
bblocker plus nitroprusside
| 120 mmhg in 20 mins
66
phenomenon where a mild increase in blood pressure results in a concomitant increase in Na excretion
Pressure natriuresis
67
factor produced by adipocytes found to impair nitric oxide synthesis and enhances endothelin 1 production favoring the devt ko htn in obesity
resistin
68
when decreased causes insulin resistance, decreased induction of enos, increased sympathetic activity
adiponectin
69
When increased heightens sns
leptin
70
causes Na retention causing increased bp
angiotensinogen
71
isolated office htn, high bp in the office and normal bp in the out of office environment
White coat htn
72
normal bp in the office, increased outside
masked htn
73
difficult to control bp with 3 optimally dose drugs one of which is a diuretic, need for 4 or more medications
resistant htn
74
orthostatic hypotension is defined as a drop of more than how many mmhg in BP after 3 mins of standing
20/10
75
labile htn and hypotensive symptoms
home bp monitoring
76
gold standard when patients have home bp values that are borderline
abpm
77
monitor orthosatic htn
home bp
78
supine htn and average levels of bp
abpm
79
autosomal dominant disorder with htn, met alk, low aldo and low renin, increased bp with aldactone intake
hypertension brachydactyly syndrome
80
hypokalemia, met acid with normal renal fxn, htn
gordon syndrome
81
hypok, met alk, low plasma aldosterone and renin, enac mutation
liddle syndrome
82
hypok met alk low plasma and aldosterone, mutation in 11B hydroxysteroid dehydrogenase type 2
Apparent mineralocorticoid excess
83
Mutation in MR, hypok and met alk, low aldosterone and renin, increased bp due to pregnancy or aldactone intake
Geller syndrome
84
mutationnof hypertension brachydactily syndrome
phosphodiasterasr E3a
85
short fingers, stature; brainstem compression from
| vascular tortuosity in the posterior fossa
htn brachydactyly syndrome
86
patients who lack normal BP dip of 20% during sleep
sleep bp that falls by less than 10% compared with awake levels
nondippers
87
cut off of high renin
6.5 ng/mL/hr
88
medication of choice high levels of renin
acei, arbs, renin inhibitors, bblockers
89
Low levels of renin tx of choice
diuretics, aldosterone antagonists, ccbs or a blockers
90
when to work up for secondary htn
htn younger than 30 with no family hx of htn
> 55 yo with new onset htn, worsening of bp control, recurrent flash pulmo edema, abdominal bruit, inc of more than 30% after raas blocker
91
treatment of primary hyperaldosteronism
verapamil, hydralazine, peripheral a adrenoreceptor antagonists
92
cut off size to consider adrenal adenocarcinoma
> 4 cm
93
diffuse hyperplasia of aldosterone producing cells within adrenal cortex
idiopathic hyperaldosteronism
94
enlarged limbs of one or both adrenal glands > 10 mm thick
Unilateral adrenal hyperplasia
95
Management for acute aortic dissection
sbp < 120 within 20 mins
| Bblocker and vasodilator
96
bp target for htn with hemorrhage
10-15% reduction over 1-2 hrs
97
bp target for major hematuria or kidney injury
0-25% reduction in map over 1-12 h
98
Bp target for hypertensive enceph
25% over 2-3 h
99
bp target for acute head injury
0-35% reduction over 2-3h with nitroprusside
