HYPERTENSION

Question 1

two determinants of arterial pressure

Answer 1

Cardiac output and peripheral resistance

Question 2

Cardiac output is determined by

Answer 2

stroke volume and heart rate

Question 3

Peripheral resistance is determined by

Answer 3

functional and anatomic changes in small arteries (lumen diameter 100–400 μm) and arterioles

Question 4

the most common etiology of secondary hypertension

Answer 4

Primary renal disease

Question 5

Which is correctly matched:
A. α1 Receptors -elicit vasoconstriction
B. α2 Receptors - act as negative feedback controllers, inhibiting further norepinephrine release
C. β1 receptors - stimulates the rate and strength of cardiac contraction and consequently increases cardiac outpu
D. β2 receptors - relaxes vascular smooth muscle and results in vasodilation

Answer 5

ALL are correct

Question 6

TRUE OR FALSE: Acting primarily through angiotensin II type 1 receptors (AT1R) on cell membranes, angiotensin II is a potent pressor substance and is the primary trophic factor for the secretion of aldosterone by the adrenal zona glomerulosa

Answer 6

TRUE
* AT1R is believed to mediate most functions of angiotensin II, resulting in hypertension, cardiovascular remodeling, and endorgan damage.

Question 7

TRUE OR FALSE: The AT2R induces vasodilation, sodium excretion, and inhibition of cell growth and matrix formation.

Answer 7

TRUE
* The AT2R may improve vascular remodeling by stimulating smooth muscle cell apoptosis and contributes to the regulation of glomerular filtration rate.
* AT1R blockade induces an increase in AT2R activity

Question 8

TRUE OR FALSE: Among older individuals, systolic blood pressure and pulse pressure are more powerful predictors of cardiovascular disease than is diastolic blood pressure

Answer 8

TRUE

Question 9

Patients with elevated office blood pressures but have normal ambulatory readings

Answer 9

White coat hypertension

Question 10

normal office blood pressure and elevated out-of-office blood pressure

Answer 10

masked hypertension

*associated with a risk of cardiovascular disease and all-cause mortality twice that of normotensive individuals, with a risk range similar to that of patients with sustained hypertension.

Question 11

Stage 1 Hypertension is defined as

Answer 11

130-139 mmgHg sytolic pressure or 80-89 mmHg diastolic pressure

Question 12

Stage 2 Hypertension is defined as

Answer 12

> /= 140mmgHg systolic pressure or >90mmHg diastolic pressure

Question 13

TRUE OR FALSE: Centrally located body fat is a more important determinant of blood pressure elevation than is peripheral body fat.

Answer 13

TRUE

Question 14

A potentially curable form of hypertension due to an occlusive lesion of a renal artery

Answer 14

Renovascular hypertension

• Two groups of patients are at risk for this disorder:
  
  • older arteriosclerotic patients who have a plaque obstructing the renal artery, frequently at its origin
  • patients with fibromuscular dysplasia

Question 15

TRUE OR FALSE: The lesions of fibromuscular dysplasia are frequently bilateral and tend to affect more distal portions of the renal artery.

Answer 15

TRUE

Question 16

TRUE OR FALSE: Severe or refractory hypertension, recent loss of hypertension control or recent onset of moderately severe hypertension, carotid or femoral artery bruits, flash pulmonary edema, and unexplained deterioration of renal function or deterioration of renal function associated with an angiotensin-converting enzyme inhibitor (ACEI) should raise the possibility of renovascular hypertension

Answer 16

TRUE

Question 17

“gold standard” for evaluation and identification of renal artery lesions.

Answer 17

Contrast arteriography

Question 18

The most effective medical therapies for renovascular hypertension include

Answer 18

ACE inhibitor or an angiotensin II receptor blocker.

Question 19

TRUE OR FALSE: Primary aldosteronism should be considered in all patients with refractory hypertension

Answer 19

TRUE

• The age at the time of diagnosis is generally the third through fifth decade.
• sodium retention, hypertension, hypokalemia, low PRA, cardiovascular disease, and kidney damage.

Question 20

In patients with an elevated PA/PRA ratio, the diagnosis of primary aldosteronism can be confirmed by demonstrating failure to suppress PA to any one of four suppression tests:

Answer 20

Oral sodium loading
Saline infusion
Fludrocortisone
Captopril

Question 21

The most accurate means of differentiating unilateral from bilateral forms of primary aldosteronism

Answer 21

Bilateral adrenal venous sampling

• Major difference in the aldosterone/cortisol ratio is indicative of unilateral disease
• An ipsilateral/contralateral aldosterone ratio >4, with symmetric ACTH-stimulated cortisol levels, is indicative of unilateral aldosterone production.

Question 22

TRUE OR FALSE: The ratio of plasma aldosterone (PA) to PRA (PA/PRA) is a useful screening test that is obtained in ambulatory patients in the morning.

Answer 22

TRUE

• A ratio >30:1 in conjunction with a PA concentration >555 pmol/L (>20 ng/dL) reportedly has a sensitivity of 90% and a specificity of 91% for an aldosterone-producing adenoma

Question 23

definitive treatment of pheochromocytoma

Answer 23

Surgical excision

• Clinical manifestations, including hypertension, are primarily related to increased circulating catecholamines
• Laboratory testing consists of measuring catecholamines in either urine or plasma, e.g., 24-h urine fractionated metanephrine excretion or plasma-free metanephrines under standardized conditions.

Question 24

The most common congenital cardiovascular cause of hypertension

Answer 24

Coarctation of the aorta

* Physical findings include diminished and delayed femoral pulses and a systolic pressure gradient between the right arm and the legs

Question 25

Basic laboratory test for the initial evaluation of hypertension

Answer 25

UA, Albumin excretion, BUN and Crea (compute for eGFR)
Na, K, Calcium and TSH
FBS, Total Cholesterol, HDL, and LDL, Triglycerides
CBC, ECG

Question 26

Lowering systolic blood pressure by _____ and diastolic blood pressure by _____ confers relative risk reductions of 35–40% for stroke and 12–16% for CHD within 5 years of the initiation of treatment.

Answer 26

10–12 mmHg
5–6 mmHg

Question 27

Recommended dietary salt restriction as part of the lifestyle modifications to manage hypertension

Answer 27

<6 grams per day

Question 28

Modertation of consumption of alcohol is defined as how many drinks in men and women respectively?

Answer 28

</=2drinks/day in men and </=1drink/day in women

Question 29

Possible exception to therapeutic target of <130/80mmHg

Answer 29

1. Patients more than 80 years of age
2. Patients previously untreated for hypertension who experience ischemic stroke or TIA and have BP <140/90
3. Acute therapy of most hypertensive urgencies and emergencies

Question 30

Blood pressure goal for patients with hypertension

Answer 30

<130/80mmHg

Question 31

Which mechanism of action is correctly matched:

A. Thiazides - inhibit the Na+/Cl– pump in the distal convoluted tubule
B. Potassium-sparing diuretics, - inhibit ENaC in the distal nephron
C. Loop diuretics - target the Na+-K+-2Cl– cotransporter in the thick ascending limb of the loop of Henle
D. All of the above

Answer 31

ALL OF THE ABOVE

Question 32

What is the SPRINT trial?

Answer 32

Intensive blood pressure control (systolic blood pressure <120 mmHg) reduced the risk of cardiovascular events and mortality by 25% compared with less intensive control (systolic blood pressure 135–139 mmHg).

Question 33

Patients with blood pressures persistently >140/90 mmHg despite taking three or more antihypertensive agents, including a diuretic.

Answer 33

Resistant hypertension

• In the absence of a specific identifiable cause, mineralocorticoid receptor antagonists, especially spironolactone, have been demonstrated to be the most effective add-on drugs for the treatment of resistant hypertension.

Question 34

In patients with a hypertensive urgency, except for those with acute aortic dissections or hemorrhagic strokes, blood pressure is generally gradually lowered over 24 h to ____% of the initial value

Answer 34

~25%

Question 35

In patients with encephalopathy, the initial goal of therapy is to reduce mean arterial blood pressure by no more than ____% within minutes to 2 hours or to a blood pressure in the range of ___ mmHg.

Answer 35

25%, 160/100–110 mmHg