Hypertension

Question 1

Definition of hypertension

Answer 1

as an office blood pressure (BP) of140/90 mm Hg or above, typically at least twice taken on 2 separate days.

Question 2

Among adult Filipinos, what device is recommended for
accurate blood pressure determination and
monitoring?

Answer 2

Validated automated oscillometric sphygmomanometer
(digital device) is recommended for in office or out of office
use

Question 3

when aneroid shygmomanometer is recommended

Answer 3

recommended for
special cases like the presence of arrhythmias or extremes
in BP levels.

Question 4

what are the blood pressure
thresholds for treatment and BP targets for the
prevention of cardiovascular disease

Answer 4

A therapeutic threshold of 140/90 mmHg to achieve a goal of
less than 130/80

Question 5

cornerstone for the
management of hypertension

Answer 5

lifestyle modification

Question 6

are the first line of antihypertensive
treatment and of course are synergistic to the effects of
antihypertensive medications

Answer 6

healthy lifestyle choices

Question 6

sodium limit of hypertensive patients

Answer 6

1500 mg/day

Question 7

The American Heart Association recommends that sodium
intake be limited ____ in people with prehypertension or hypertension

Answer 7

to 2300 mg/d (about roughly half a
teaspoon of table salt) in most healthy individuals
§ 1500 mg/d

Question 8

Significant weight loss of ___ of the baseline weight for
those who are overweight or obese

Answer 8

> 5%

Question 9

What are the preferred drugs for the treatment of
hypertension among adult Filipinos for prevention of
cardiovascular diseases?

Answer 9

angiotensin-converting enzyme (ACE) inhibitors or
o angiotensin-receptor blockers (ARBs)
o calcium channel blockers
o thiazide/thiazide-like diuretics

Question 10

what antihypertensive drugs are not recommended to be used
in combination.

Answer 10

ACE inhibitors & ARBs

Question 11

are suitable as initial therapy in hypertensive
patients with coronary artery disease, acute coronary
syndrome, high sympathetic drive and pregnant women

Answer 11

Beta blockers

Question 12

Beta blockers for those with congestive heart failure was
specified to be

Answer 12

bisoprolol, carvedilol, metoprolol succinate or
nebivolol.

Question 13

Among patients with BP >150/100 mm Hg (or >160/100 mm
Hg in the elderly), a combination of 2 agents

Answer 13

preferably
combination of a RAAS inhibitor (ARB/ACE-is) and CCB or
diuretic, should be given initially since it is unlikely that any
single agent would be sufficient to achieve the BP target

Question 14

Hpertension-mediated Organ Damage (HMOD):

Answer 14

o LVH (LVH with ECG)
o moderate-severe CKD (CKD; eGFR <60 ml/min/1.73m2)

Question 15

Significant Comorbid Diseases which increase
cardiovascular risk with the background of hypertension

Answer 15

• previous coronary heart disease (CHD)
• Heart Failure
• Stroke
• peripheral vascular disease
• atrial fibrillation
• CKD stage 3+

Question 16

Patients with hypertension who continue to be uncontrolled
on 3 drug combinations one of which is a diuretic are
considered to have

Answer 16

RESISTANT HYPERTENSION

Question 17

Among persons with diabetes, what is the threshold for
treatment of elevated blood pressure?

Answer 17

it is
recommended that drug therapy (along with lifestyle change)
be initiated at a blood pressure of > 140/90 mm Hg.
o the threshold for treatment continues to be 140/90 mm Hg.

Question 18

Among persons with diabetes and hypertension, what
are the blood pressure targets for prevention of
cardiovascular diseases (mortality and morbidity)?

Answer 18

A blood pressure target of <130/80 mm Hg is recommended
for most persons with diabetes mellitus and hypertension;
however, do not lower down the blood pressure below 120/70
due to an increased risk for adverse events.

Question 19

Among patients with CKD who are pre-dialysis, what is
the level of blood pressure to start pharmacotherapy to
prevent cardiovascular complications and renal
progression?

Answer 19

Patients with BP more than or equal to 140/90 mmHg should
have prompt initiation and timely titration of pharmacotherapy
to achieve blood pressure goals.

Question 20

Among patients with CKD who are pre-dialysis, what is
the target blood pressure to prevent cardiovascular
complications and renal progression?

Answer 20

For routine office blood pressure measurement, maintain a BP
target consistently less than 140 mmHg systolic and less than
90 mmHg diastolic in patients with low risk of cardiovascular
disease and CKD grade 4 and 5, or if with adverse effect on
intensive target of less than 130/80 mmHg

Question 21

Among patients with CKD, what is the level of blood
pressure to start initiation with two antihypertensive
drugs to prevent cardiovascular complications and
renal progression?

Answer 21

Patients with confirmed office-based blood pressure or more
than or equal to 160/100 mmHg should, in addition to lifestyle
modification, have prompt initiation and timely titration of two
drugs or a single-pill combination of drugs demonstrated to
reduce cardiovascular events.

Question 22

Among patients with CKD with albuminuria/proteinuria,
what is the anti-hypertensive of choice to prevent
cardiovascular complications and renal progression?

Answer 22

An ACE inhibitor or Angiotensin receptor blocker, at maximally
tolerated dose is the recommended first-line treatment for
hypertension in CKD patients with urinary albumin-tocreatinine
ratio more than or equal to 30 mg/g (or equivalent).

Question 23

If the patient is intolerant to both ACE inhibitor and angiotensin receptor blocker, ____may be used as first line treatment in this setting.

Answer 23

a non-dihydropyridine calciumchannel blocker (verapamil or diltiazem)

Question 24

Among patients with CKD with resistant hypertension, is the addition of mineralocorticoid receptor antagonist beneficial in reducing albuminuria and cardiovascular events?

Answer 24

CKD patients with resistant hypertension not meeting blood pressure targets on three classes of anti-hypertensive medications (including diuretic) should be considered for mineralocorticoid receptor antagonist therapy

Question 25

For adults with acute ischemic stroke (AIS) who are eligible for intravenous (IV) thrombolysis but not for mechanical thrombectomy, what is the threshold for pharmacological treatment and the target blood pressure (BP)?

Answer 25

It is recommended that the BP be maintained <185/110 mmHg prior to treatment and during infusion. * For the next 24 hours after treatment is given, the BP is recommended to be maintained <180/105 mmHg.

Question 26

For adults with AIS who are eligible for IV thrombolysis but not for mechanical thrombectomy, what are the pharmacologic agents of choice to reach the target BP?

Answer 26

Nicardipine 1- 5mg/hr. IV, titrated up by 2.5mg/hr. every 5-15 minutes, with maximum of 15mg/hr. * If available, labetalol 10 mg IV over 1-2 minutes followed by continuous IV infusion of 2-8 mg/min may also be used.

Question 27

For adults with AIS who are not eligible for IV thrombolysis or mechanical thrombectomy, what is the target BP and threshold for pharmacological treatment

Answer 27

it is recommended to maintain a target mean arterial pressure (MAP) of 110 to 130 mmHg. the threshold for urgent antihypertensive treatment is with severe hypertension of Systolic BP >220 mmHg or Diastolic BP >120 mmHg. If with severe hypertension, it might be reasonable to reduce the BP by 15% during the first 24 hours after the onset of stroke.

Question 28

For adults with AIS who are not eligible for IV thrombolysis or mechanical thrombectomy, what pharmacological agent may be used to achieve target BP, when needed?

Answer 28

use of IV nicardipine

Question 29

For adult patients with acute hypertensive parenchymal intracerebral hemorrhage (ICH), what is the threshold for BP lowering in the first few hours upon presentation at the emergency room?

Answer 29

For adult patients with acute ICH, the threshold for BP lowering is SBP ≥ 180 mmHg.

Question 30

For adults who have a history of stroke, what is the target blood pressure level for secondary prevention?

Answer 30

less than or equal to 130/80 mmHg

Question 31

definition of preeclampsia

Answer 31

Systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure. 300 mg or more per 24 hour urine collection (or this amount extrapolated from a timed collection), or o Protein/creatinine ratio of 0.3 mg/dl or more or o Dipstick reading of 2+ (used only if other quantitative methods not available)

Question 32

in the absence of proteinuria, new onset hypertension with the new onset of any of the following( pre eclampsia)

Answer 32

Thrombocytopenia: Platelet count less than 100,000 x 109/L Renal insufficiency: Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease o Impaired liver function: Elevated blood concentrations of liver transaminases to twice normal concentration o Pulmonary edema o New-onset headache unresponsive to medication and not accounted for by alternative diagnoses or visual symptoms

Question 33

definition of eclampsia

Answer 33

New-onset tonic-clonic, focal, or multifocal seizures in the absence of other causative conditions such as epilepsy, cerebral arterial ischemia and infarction, intracranial hemorrhage, or drug use.

Question 34

Chronic Hypertension with Superimposed Preeclampsia- Chronic hypertension in association with preeclampsia

Answer 34

Others define it as worsening baseline hypertension accompanied by new-onset proteinuria or other findings supportive of preeclampsia

Question 35

Gestational Hypertension

Answer 35

Systolic blood pressure 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more, or both, on two occasions at least 4 hours apart after 20 weeks of gestation, in a woman with a previously normal blood pressure

Question 36

What blood pressure threshold is used to define hypertension in pregnancy?

Answer 36

Hypertension is diagnosed empirically when appropriately taken blood pressure is 140 mm Hg systolic or 90 mm Hg diastolic or above. Korotkoff phase V is used to define diastolic pressure.

Question 37

What antihypertensive agents can be used for urgent blood pressure control in pregnancy?

Answer 37

The first line of treatment is intravenous (IV) hydralazine and labetalol; intravenous nicardipine is also an option. * Extended release oral nifedipine also may be considered as a first line therapy, particularly when IV access is not available

Question 38

When do we treat hypertension during pregnancy?

Answer 38

Treatment of severe hypertension (blood pressure of>160/100mmHg) is always recommended as it prevents serious maternal and fetal complications to set in.

Question 39

What are the pharmacologic treatment options in the OPD management of hypertension in pregnancy?

Answer 39

The first line drugs are methyldopa, calcium channel blockers or beta blockers, and ACE-inhibitors and angiotensin-receptor blockers (ARBs) are generally not recommended.

Question 40

Among pediatric patients, what is the threshold for commencing pharmacologic treatment for Hypertension?

Answer 40

Children who remain hypertensive even after six (6) months of lifestyle modification strategies Presence of co-morbidities like chronic kidney disease (CKD) or diabetes mellitus (DM), or any evidence of target organ involvement (e.g. left ventricular hypertrophy).

Question 41

What are the preferred medications for hypertensive children?

Answer 41

Any of the following drugs may be used as initial treatment for children with hypertension: ACE inhibitors (Enalapril, Captopril), ARBs (Losartan, Valsartan), or calcium channel blockers (Amlodipine).

Question 42

For children with co-existing chronic kidney disease, proteinuria or diabetes mellitus, _____ recommended as the initial antihypertensive drug unless with absolute contraindications

Answer 42

an ACE-inhibitor or ARB

Question 43

An auscultatory device using ______ sphygmomanometer is recommended for children

Answer 43

an aneroid non-mercury

Question 44

limitation of alcohol in hypertensive patients

Answer 44

Alcohol intake should be limited to no more than 1 oz (30 mL) of ethanol, the equivalent of two drinks per day in most men and no more than 0.5 oz of ethanol (one drink) per day in women and lighter weight persons