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Internal Medicine > HYPERTENSION > Flashcards

HYPERTENSION Flashcards

1
Q

What defines elevated BP and Stage 1 hypertension according to ACC/AHA?

A

Elevated BP: SBP 120-129 mmHg and DBP >80 mmHg; Stage 1 Hypertension: SBP 130-139 mmHg or DBP 80-89 mmHg.

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2
Q

What is blood pressure?

A

The force exerted by circulating blood against the artery walls.

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3
Q

What are primary risk factors for hypertension?

A

Smoking, obesity, inactivity, dyslipidemia, diabetes, microalbuminuria, age, family history of cardiovascular disease.

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4
Q

Which conditions increase CVD risk in hypertensive patients?

A

Hyperinsulinemia, impaired glucose tolerance, type 2 diabetes, insulin resistance, microalbuminuria, hypercoagulability, visceral obesity, dyslipidemia.

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5
Q

What were the findings of the Framingham Study on hypertension?

A

Higher DBP is linked to increased risks of stroke and MI, especially in combination with other risk factors.

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6
Q

Why is hypertension often called a “silent killer”?

A

It is usually asymptomatic until complications develop, necessitating lifelong management.

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7
Q

What is the JNC 7 classification of hypertension levels?

A

Normal: <120/<80 mmHg; Prehypertension: 120-139/80-89 mmHg; Stage 1: 140-159/90-99 mmHg; Stage 2: >160/>100 mmHg.

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8
Q

How should prehypertension be managed?

A

With lifestyle modifications, and possibly drug therapy if diabetes or kidney disease is present.

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9
Q

What is isolated systolic hypertension?

A

A condition where only SBP is elevated, often due to reduced aortic compliance with age, increasing CVD risk.

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10
Q

What are the two main types of hypertension?

A

Primary (essential) hypertension, with no identifiable cause, and secondary hypertension, due to underlying conditions.

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11
Q

What are common causes of secondary hypertension?

A

Renal disease, renovascular disease, mineralocorticoid excess, pheochromocytoma, sleep apnea, glucocorticoid excess, coarctation of the aorta, thyroid dysfunction.

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12
Q

What historical clues suggest secondary hypertension?

A

Early onset, severe or treatment-resistant HTN, episodic headache or palpitations, morbid obesity with daytime sleepiness.

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13
Q

What are signs of secondary hypertension on physical examination?

A

Pallor, edema, truncal obesity, abdominal bruit, and signs of conditions like Cushing’s syndrome or pheochromocytoma.

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14
Q

What symptoms are common in obstructive sleep apnea?

A

Daytime sleepiness, loud snoring, episodes of stopped breathing, gasping or choking, and difficulty concentrating.

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15
Q

What organs are commonly affected by hypertension?

A

The heart, brain, kidneys, and eyes, leading to left ventricular hypertrophy, stroke, chronic kidney disease, and retinopathy.

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16
Q

How does hypertension impact the nervous system?

A

It increases the risk of stroke, intracerebral hemorrhage, lacunar infarcts, cerebral atrophy, and dementia.

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17
Q

What is the purpose of patient evaluation in hypertension?

A

To assess lifestyle, cardiovascular risks, possible causes, and target organ damage.

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18
Q

What are the guidelines for accurate blood pressure measurement?

A

Regularly calibrate equipment, ensure patient is seated 15-20 minutes, use correct cuff size, avoid caffeine, smoking, and exercise before measurement.

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19
Q

What are the primary goals of treating hypertension?

A

Reduce BP to <140/90 mmHg in general, or <130/80 mmHg in patients with diabetes or kidney disease, to reduce cardiovascular and renal morbidity.

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20
Q

What are the main benefits of controlling hypertension?

A

Reduction in stroke risk by 35-40%, MI by 20-25%, and heart failure by over 50%.

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21
Q

What lifestyle modifications help manage hypertension?

A

DASH diet, physical activity, smoking cessation, portion control, reduced calorie beverage and food intake.

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22
Q

What are first-line medications for hypertension?

A

Thiazide diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers.

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23
Q

How do beta-blockers work in hypertension management?

A

They reduce heart rate and contractility, lowering BP by blocking adrenaline effects on the heart.

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24
Q

What is the function of ACE inhibitors in hypertension treatment?

A

They prevent angiotensin I from converting to angiotensin II, promoting vasodilation and reducing fluid retention.

25
Q

When are ARBs used in hypertension management?

A

ARBs are used when ACE inhibitors are not tolerated, as they block angiotensin II receptors and reduce BP without causing cough.

26
Q

How do calcium channel blockers aid in treating hypertension?

A

They block calcium entry into vascular smooth muscle, causing vasodilation and reducing BP.

27
Q

What are examples of second-line antihypertensive agents?

A

α1-sympatholytics, α2-sympathomimetics, direct vasodilators, and potassium-sparing diuretics.

28
Q

How do α1-sympatholytics help reduce BP?

A

They promote vasodilation by blocking α1-adrenergic receptors, which reduces vascular resistance.

29
Q

What is the mechanism of α2-sympathomimetics in hypertension?

A

They decrease norepinephrine release, reducing sympathetic nervous activity and lowering BP.

30
Q

What lifestyle changes does the JNC 8 recommend for hypertension?

A

Quit smoking, control blood glucose and lipids, DASH diet, reduce sodium, and regular physical activity.

31
Q

What complications can arise from untreated hypertension?

A

Congestive heart failure, myocardial infarction, renal failure, retinopathy, and cerebrovascular accidents (CVA).

32
Q

How does renovascular disease cause hypertension?

A

Narrowed renal arteries lead to renin release, which raises blood pressure.

33
Q

What is mineralocorticoid excess and how does it affect BP?

A

Excess mineralocorticoids cause sodium and water retention, leading to high blood pressure.

34
Q

What is pheochromocytoma and how does it affect BP?

A

A tumor in the adrenal gland producing catecholamines that increase heart rate and BP.

35
Q

What lab tests are used to diagnose secondary hypertension?

A

Tests include renal function, serum electrolytes, thyroid function, and hormonal assays for conditions like pheochromocytoma.

36
Q

What imaging studies are used for secondary hypertension?

A

Renal Doppler studies, CT angiography, echocardiography, MRI for adrenal or pituitary tumors.

37
Q

What are signs of renal parenchymal disease related to hypertension?

A

Increased creatinine, abnormal urinalysis, proteinuria, and hyperkalemia.

38
Q

How does hypertension affect the kidneys?

A

It can cause glomerular sclerosis, reduced GFR, and eventual end-stage renal disease.

39
Q

What are eye changes associated with hypertensive retinopathy?

A

Retinal hemorrhages, narrowed blood vessels, exudates, and in severe cases, papilledema.

40
Q

How does hypertension cause blood vessel damage?

A

It leads to endothelial injury and arteriosclerosis, increasing stiffness in the blood vessels.

41
Q

What symptoms might a hypertensive crisis present with?

A

Fatigue, decreased activity tolerance, dizziness, palpitations, angina, dyspnea.

42
Q

What is the significance of left ventricular hypertrophy (LVH) in hypertension?

A

LVH increases oxygen demand, which can lead to heart failure and increases risk of MI.

43
Q

What is the DASH diet?

A

A diet rich in fruits, vegetables, and low-fat dairy, which has been shown to lower blood pressure.

44
Q

How does physical activity affect blood pressure?

A

Regular aerobic exercise lowers BP and improves cardiovascular health.

45
Q

What are different types of diuretics used for hypertension?

A

Thiazides, loop diuretics, potassium-sparing diuretics, and carbonic anhydrase inhibitors.

46
Q

How do thiazide diuretics lower BP?

A

They promote salt and water excretion in the kidneys, reducing blood volume.

47
Q

What is the difference between cardioselective and non-selective beta-blockers?

A

Cardioselective beta-blockers primarily block β1 receptors in the heart, while non-selective beta-blockers affect both β1 and β2 receptors, impacting heart and lung function.

48
Q

What are common side effects of ACE inhibitors?

A

Cough, angioedema, and hyperkalemia.

49
Q

Why are ARBs a good alternative to ACE inhibitors?

A

ARBs block angiotensin II receptors without causing cough, making them suitable for patients intolerant to ACE inhibitors.

50
Q

What are the primary indications for calcium channel blockers?

A

Effective in elderly patients and those with isolated systolic hypertension.

51
Q

What are α1-sympatholytic agents, and when are they used?

A

They block α1 receptors to lower BP, used in resistant hypertension or cases with benign prostatic hyperplasia (BPH).

52
Q

What is white coat hypertension?

A

Elevated BP in clinical settings but normal BP at home, which still poses cardiovascular risk.

53
Q

What medications are used for resistant hypertension?

A

α2-agonists, direct vasodilators, and combination therapy with other classes.

54
Q

What are alcohol recommendations for hypertensive patients?

A

Limit alcohol to 2 drinks per day for men, 1 drink per day for women.

55
Q

How does smoking contribute to hypertension?

A

Smoking increases vascular stiffness, promotes plaque buildup, and raises BP through adrenaline release.

56
Q

How do NSAIDs affect blood pressure?

A

NSAIDs can raise BP by reducing sodium excretion and increasing fluid retention.

57
Q

How does dietary sodium affect blood pressure?

A

Reducing sodium intake can lower BP, particularly in salt-sensitive individuals.

58
Q

What are the JNC 8 BP goals for different populations?

A

General target: <140/90 mmHg; age >60 without comorbidities: <150/90 mmHg; with diabetes or CKD: <130/80 mmHg.

59
Q

What is the goal for BP management in diabetes or CKD patients?

A

BP target is <130/80 mmHg to reduce cardiovascular and renal complications.

Internal Medicine (5 decks)

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