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Cardiology: Exam > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the two major exceptions when a single elevated blood pressure reading is sufficient to diagnose hypertension?

A
  • Obvious evidence of end-organ damage (HTN Emergency)
  • BP > 220/125
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2
Q

A 3 month delay in treatment of hypertension in high-risk patients is associated with how much of an increase in cardiovascular morbidity and mortality?

A

Twofold (2x)

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3
Q

What is considered a Normal blood pressure?

A

< 120/80

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4
Q

What is considered an Elevated blood pressure?

A

120 - 129/ < 80

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5
Q

What is considered Stage 1 HTN?

A

130-139/80-89

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6
Q

What is considered Stage 2 HTN?

A

≥ 140/90

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7
Q

Type of hypertension that results from multiple genetic and environmental factors with NO IDENTIFIABLE CAUSE.

A

Primary Essential Hypertension
(95% of patients)

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8
Q

When does Primary Essential Hypertension usually present in life?

A

25 - 50 years old

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9
Q

Type of hypertension that results from an identifiable specific cause.

A

Secondary Hypertension
(5% of patients)

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10
Q

What two types of patients should you suspect Secondary Hypertension in?

A
  • HTN develops at Young Age or > 50
  • Previously controlled HTN becomes refractory to treatment
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11
Q

Syndrome that is defined by:
- Upper Body Obesity
- Insulin Resistance
- Hypertriglyceridemia

A

Metabolic Syndrome

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12
Q

How many medications is Secondary Hypertension usually resistant to?

A

3 Meds
(at max doses)

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13
Q

What is the most common cause of Secondary Hypertension?

A

Renal Parenchymal Disease

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14
Q

What is the Screening Test for Renal Vascular Hypertension?

A

None

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15
Q

What is the definitive diagnostic test for Renal Vascular Hypertension?

A

Renal Arteriography

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16
Q

Is Renal Arteriography recommended as routine to adjunct to coronary studies?

A

No

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17
Q

Secondary Hypertension occurs in about 80% of patients with what syndrome?

A

Cushing Syndrome
(excess Glucocorticoid)

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18
Q

Evidence of Radial-Femoral delay should be sough in all younger patients with hypertension out of concern for what pathology?

A

Coarctation of the Aorta

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19
Q

What can be a cause of Secondary Hypertension in women?

A

Estrogen Use

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20
Q

When should you refer someone with Hypertension?

A

Severe
Resistant
Early Onset (Before 20)
Late Onset (After 50)

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21
Q

What are some complications of Untreated Hypertension?

A

Structural and Functional Changes
Thrombosis

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22
Q

When does morbidity and mortality related to HTN double in rate?

A

Every 6 mmHg increase in Diastolic BP

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23
Q

What is the most frequent symptoms of Mild to Moderate Primary Hypertension?

A

Headache

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24
Q

How long can Mild to Moderate Primary Hypertension be asymptomatic for?

A

Years

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25
Q

What are two urgent presentations of HTN?

A

Uncontrolled HTN
Hypertensive Emergencies

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26
Q

Symptoms of HTN Encephalopathy.

A

Headache
Somnolence
Vomiting

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27
Q

Symptoms of Posterior Reversible Encephalopathy Syndrome.

A

Headache
Seizures
Altered Consciousness
Disturbance of Vision

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28
Q

Focal neurologic deficits would indicate what?

A

Stroke

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29
Q

Symptoms of Left Ventricular After-load.

A

Angina
Dyspnea

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30
Q

Symptoms of Aortic Dissection or Rupture.

A

Severe Chest or Abdominal Pain

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31
Q

Hypertensive Retinopathy findings

A

Copper Wiring
AV Nicking
Cotton Wool Spots
Papilledma

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32
Q

Falsely elevated BP seen in older patients.

A

Osler Sign

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33
Q

Weight Loss with a target BMI of 18.5 - 24.9 can reduce blood pressure by how much?

A

5 - 20 mmHg per 10kg loss

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34
Q

DASH Diet can reduce blood pressure by how much?

A

8 - 14 mmHg

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35
Q

Sodium intake < 100 mmol/day can decrease blood pressure by how much?

A

2 - 8 mmHg

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36
Q

Limiting alcohol intake to:
≤ 2 for Men
≤ 1 for Women
can reduce blood pressure by how much?

A

4 mmHg

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37
Q

Exercise can reduce blood pressure by how much?

A

5 - 10 mmHg

38
Q

Mindfulness can reduce blood pressure by how much?

A

5 mmHg

39
Q

Who should be treated with Anti-Hypertension medications?

A
  • All patients that will have a reduced Cardiovascular Risk from treatment
  • or -
    SBP > 140
    DBP > 90
40
Q

What are the Major Risk Factors of Cardiovascular Disease based on the AHA guidelines?

A

Hypertension
Smoking
Obesity
Inactivity
Dyslipidemia
Diabetes
Microalbuminuria or eGFR < 60
Age (Male 55+ or Female 65+)
Family History of premature CV Disease

41
Q

What two medications are used to reduce Cardiovascular Events from occurring?

A

Rosuvastatin
Aspirin

42
Q

What are the classes of Anti-Hypertensive medications?

A

ACE Inhibitors
Angiotensin (II) Receptor Blockers
Calcium Channel Blockers
Diuretics
Beta Blockers

43
Q

Class of medications that are commonly used as the initial medication for mild to moderate HTN. Both cardio- and renoprotective.

A

ACE Inhibitors

44
Q

Name two ACE Inhibitors

A

Lisinopril
Enalapril

45
Q

What are the indications for ACE Inhibitors?

A

HTN in Diabetes
Nephropathy
CHF
Post-MI

46
Q

Before starting a patient on ACE Inhibitors, what must you establish?

A

K⁺ and Creatinine Serum Levels
(repeat in 1-2 weeks after initiation)

47
Q

What is a contraindication for giving ACE Inhibitors?

A

Pregnancy

48
Q

What are some side effects of ACE Inhibitors?

A

First-Dose Hypotension
Hyperkalemia
Cough
Skin Rashes
Angioedema

49
Q

Name two Angiotensin (II) Receptor Blockers.

A

Losartan
Valsartan

50
Q

Patients that cannot tolerate which two medications should receive ARBs?

A

Beta-Blockers
ACE-Inhibitors
(don’t use in combo with ACE-I)

51
Q

What are some side effects of ARBs?

A

Hyperkalemia
Hypotension
Renal Insufficiency

52
Q

What is a contraindication for giving ARBs?

A

Pregnancy

53
Q

Class of medications that causes vasodilation.

A

Calcium Channel Blockers

54
Q

What are the two classes of Calcium Channel Blockers?

A

Dihydropyridines
Non-Dihydropyridines

55
Q

Class of Calcium Channel Blockers that have little to no effect on cardiac contractility.

A

Dihydropyridines
- Amlodipine
- Nifedipine
- Nicardipine

56
Q

Class of Calcium Channel Blockers that affect cardiac contractility and conduction.

A

Non-Dihydropyridines
- Diltiazem
- Verapamil

57
Q

What are the contraindications of Calcium Channel Blockers?

A

CHF
2ⁿᵈ + 3ʳᵈ AV Blocks

58
Q

What is the only Calcium Channel Blockers with established safety in patients with severe Heart Failure?

A

Amlodipine

59
Q

Diuretics that increase sodium and water excretion by preventing the reabsorption of Na⁺ and water at the distal diluting tubule.

A

Thiazide Diuretics

60
Q

What is an example of a Thiazide Diuretics?

A

Hydrochlorothiazide

61
Q

Diuretics that inhibit water transport across the Loop of Henle.

A

Loop Diuretics

62
Q

What electrolytes do Loop Diuretics affect?

A

Excretion of:
Water
Na
Cl
K

63
Q

What are some examples of Loop Diuretics?

A

Furosemide
Bumetanide

64
Q

What are some side effects of Loop Diuretics?

A

Ototoxicity
Do not use with Sulfa Allergy

65
Q

Diuretics that inhibit aldosterone mediate Na⁺ & Water absorption.

A

Potassium-Sparing Diuretics
(Mineralocorticoid Receptor Blockers)

66
Q

What is an example of a Potassium-Sparing Diuretic?

A

Spirinolactone

67
Q

Which diuretics are first-line for uncomplicated HTN?

A

Thiazide Diuretics

68
Q

Which diuretics are the strongest?

A

Loop Diuretics

69
Q

Which diuretics are the weakest?

A

Potassium-Sparing Diuretics

70
Q

What are some side effects of Potassium-Sparing Diuretics?

A

Hyperkalemia
Gynecomastia
(do not use in renal failure or hyponatremia)

71
Q

Which diuretics should be used with caution in Gout and Diabetes?

A

Thiazide Diuretics

72
Q

What are some side effects of Thiazide Diuretics?

A

Hyponatremia
Hypokalemia
Hypercalcemia
Hyperglycemia

73
Q

Cardioselective Beta Blockers.

A

Atenolol
Metoprolol
Esmolol

74
Q

Nonselective Beta Blockers.

A

Propranolol

75
Q

Alpha + Beta Blockers

A

Labetalol
Carvedilol

76
Q

What class of Beta Blockers are a good choice for people with lung issues?

A

Cardioselective

77
Q

What do Beta Blockers do?

A

Decrease Renin Release
↓Heart Rate + CO

78
Q

What can Beta Blockers be used to treat?

A

HTN
Angina
HF
MI
Migraines
Essentail Tremor

79
Q

Name some Alpha Blockers.

A

Prazosin
Terazosin
Doxazosin

80
Q

What are the First-Line hypertension medications for either:
Black Persons
Persons Age 55+

A

Calcium Channel Blockers
- or -
Thiazide Diuretics

81
Q

What are the First-Line hypertension medications for:
Persons Under 55

A

ACE-Inhibitor
ARB
Calcium Channel Blocker
Thiazide Diuretic

82
Q

What is the Second-Line hypertension medication for:
Persons Under 55

A

Vasodilating Beta-Blocker

83
Q

What are the Second-Line hypertension medications for:
Black Persons
Persons Age 55+

A

ARB
ACE-I
Vasodilating Beta Blockers

84
Q

What medications are used for all patients with Resistant HTN?

A

Aldosterone Receptor Blocker
(Spironolactone)

85
Q

What are some additional options for patients needing hypertension medication?

A

Central Alpha Agonist
Peripheral Alpha Antagonist

86
Q

What type of follow-up is recommended for Hypertensive patients?

A

Blood Lipids (Yearly)
EKG (Every 2 - 4 years)

87
Q

Failure to reach blood pressure control in patients who are adherent to full doses of an appropriate three-drug regimen (including a diuretic)

A

Resistant Hypertension

88
Q

Hypertension above what values is considered a Hypertensive Emergency?

A

> 180/120

89
Q

If you suspect End-Organ Injury due to Hypertension, what tests should you perform?

A

Blood Screening:
- Thrombotic Microangiopathy
- AKI
- Myocardial Damage

Urine Exam:
- Blood or Protein
- Substances of Abuse (Cocaine)

90
Q

What is the goal reduction rate when treating a Hypertensive Emergency?

A

No more than 25% in first hour
5-15% over the next 23 hours

91
Q

What are the two exceptions to treating Hypertensive Emergencies?

A

Stroke
- often falls spontaneously
- don’t treat unless BP exceeds 180-200
- Reduce by 10-15%

Aortic Dissection
- Keep under 120SBP and under 60HR all within 30 minutes

92
Q

In most situations, which medications can be used to best control blood pressure?

A

Calcium Channel Blockers + Beta Blockers
(Nicardipine + Labetalol or Esmolol)

Cardiology: Exam (5 decks)

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