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CV > Hypertension > Flashcards

Hypertension Flashcards

1
Q

Risk factors for hypertension

A 
age
family history
tobacco use
excessive alcohol use
low SES
obesity
high sodium diet
sedentary lifestyle
psychosocial stress
intrauterine abnormalities
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2
Q

Describe changes in blood pressure that occur with aging

A
  • systolic pressure increases with age

- diastolic increases until age in 50s then decreases

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3
Q

Lifetime risk of hypertension is about __% for adults that are non-hypertensive at age 55 and live to be 80-85 years old

A

90%

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4
Q

Until age 45, do men or women have higher prevalence of hypertension?

A

Men

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5
Q

After age 65, to men or women have a higher prevalence of hypertension

A

Women

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6
Q

Hypertension is defined based on the level of pressure associated with what outcome?

A

Doubling of long term cardiovascular risk

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7
Q

True or false: pre-hypertension is not associated with increased risk of future cardiovascular disease

A

False, pre-hypertension is associated with higher CV risk as compared to individuals with normal blood pressure
Also greater risk of chronic kidney disease with even mildly elevated blood pressure

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8
Q

Blood pressure of 145/92 would be categorized as stage ___ hypertension

A

Stage I

Normal: 160/>100

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9
Q

List secondary causes of hypertension

A 
sleep apnea
chronic renal disease
primary aldosteronism
renovascular disease
drug related causes
pheochromocytoma
coarctation of the aorta
thyroid disease
parathyroid disease
Cushing's syndrome
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10
Q

In which group is hypertension more prevalent: African Americans or non-Hispanic whites?

A

African Americans

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11
Q

In the US, which ethnic group has lowest rates of controlled hypertension?

A

Mexican Americans

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12
Q

In the US, which ethnic group has highest age adjusted hypertension related mortality rate?

A

Puerto Rican Americans

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13
Q

Beginning with a baseline of 115/75, the risk of cardiovascular disease event doubles with each incremental rise of ____ mg systolic and ___ mg diastolic

A

20 mm Hg systolic/ 10 mm Hg diastolic

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14
Q

What is considered the fundamental defect in primary hypertension?

A

Control/ regulation of blood pressure (by way of regulation of resistance in blood vessels)

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15
Q

Describe short-term, intermediate, and long-term mechanisms that respond to elevated blood pressure

A

short-term: cardiovascular reflexes (baroreceptors, chemoreceptors)
intermediate: capillary fluid shifts, vascular compliance, hormones
long-term: kidneys regulate volume

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16
Q

Persistent hypertension develops in response to an increase in __________ or ____________

A

cardiac output

systemic vascular resistance

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17
Q

Mean arterial pressure is a function of:

A
  • the rate at which the heart pumps blood into large arteries
  • the rate at which blood flows out of large arteries into smaller arteries
  • arterial wall compliance
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18
Q

MAP=

A

MAP = DBP + 1/3(SBP – DBP)

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19
Q

SVR=

A

SVR = (MAP – CVP)/CO

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20
Q

Describe the link between obesity and hypertension

A
  • insulin has direct action on kidney to stimulate sodium retention
  • leptin, produced by white adipose, correlates with increased blood pressure
  • RAAS is abnormally activated in obesity
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21
Q

Describe the link between dietary sodium intake and hypertension

A 
Promotes:
Renal sodium retention
Extracellular-fluid volume expansion
Vascular smooth-muscle cell contraction
Increased systemic vascular resistance
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22
Q

List some populations that are more likely to be sodium sensitive

A

elderly, Afro-Caribbean race, DM type 2, familial genetic influence, obesity, use of NSAIDs

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23
Q

Describe effects of the SNS that are linked to the development of hypertension

A

vasoconstriction, tachycardia, renin release, vascular remodeling, and renal sodium retention

24
Q

SNS activity is increased with age, weight, and ______

A

Systemic vascular resistance

25
Q

Younger patients with hypertension tend to have higher circulating levels of __________, augmented SNS activity, and heightened vascular reactivity

A

catecholamines

26
Q

What converts circulating angiotensinogen to angiotensin I

A

Renin

27
Q

What converts angiotensin I to angiotensin II

A

ACE

28
Q

The AT1 receptor is _______ type, and its activation causes:

A

G protein coupled

causes: vasoconstriction, increased blood pressure, cardiac hypertrophy, smooth muscle proliferation

29
Q

List some major complications of hypertension

A

increased afterload–> heart failure, myocardial ischemia and infarction
arterial damage–> atherosclerosis –> aneurysm, stroke, nephrosclerosis/ renal failure, retinopathy

30
Q

List three conditions that cause production of renin to be activated

A
  1. decreased delivery of sodium to macula ensa
  2. decreased renal perfusion
  3. renal stimulation by SNS
31
Q

In addition to converting Ang I to Ang II, ACE also ________________

A

Degrades bradykinin (causes vasoconstriction, blood pressure elevation)

32
Q

Angiotensin II stimulates release of ________

A

aldosterone

33
Q

List some effects of aldosterone

A
  1. increase sodium and water reabsorption
  2. mediates renal vascular remodeling
  3. contributes to endothelial dysfunction
  4. stimulates inflammatory response
34
Q

The ultimate public health goal of anti-hyeprtensive therapy is to do what?

A

decrease CV and renal morbidity and mortality

35
Q

List some key lifestyle modifications and their relative contribution to lowering systolic blood pressure

A 
Weight reduction (5-20mm Hg)
DASH diet (8-14 mm Hg)
Reduce dietary sodium (2-8 mm Hg)
Physical activity (4-9 mm Hg)
Moderation of EtOH consumption (2-4 mm Hg)
Smoking cessation (3.5 mm Hg)
36
Q

Describe components of the DASH diet

A

Low in cholesterol and saturated fat
Emphasis on fruits, vegetables, low fat dairy
Reduce red meat, sugar

37
Q

Most dietary sodium comes from:

A

Restaurant and processed foods

38
Q

Weight loss of as little as ____ lbs reduced blood pressure and prevents hypertension in overweight adults.

A

10 lbs- CV benefits occur before a patient’s target weight

39
Q

If there is a difference of >15mm Hg systolic pressure when measuring blood pressure in both arms, follow up should include an evaluation for…

A

Sublcavian stenosis (lower blood pressure on the affected side)

40
Q

Normal hemodynamic response when transitioning from supine to standing

A
  • decrease of 5-10 mm Hg systolic pressure
  • increase of 5-10 mm Hg diastolic pressure
  • increase of 10-20 bpm heart rate
41
Q

Diagnosis of orthostatic hypotension

A
  • decrease of > 20 mm Hg systolic pressure
  • decrease of > 10 mm Hg diastolic pressure
  • symptoms of cerebral hypoperfusion
42
Q

What is the recommended follow up for a patient with normal blood pressure

A

Recheck in 2 years

43
Q

What is the recommended follow up for a patient with inital blood pressure suggesting pre-hypertension

A

Recheck in 1 year

44
Q

What is the recommended follow up for a patient with inital blood pressure suggesting stage I hypertension

A

confirm within 2 months

45
Q

What is the recommended follow up for a patient with inital blood pressure suggesting stage II hypertension

A

evaluate or refer within 1 month

If >180/110 evaluate and treat within 1 week

46
Q

24 hour ambulatory blood pressure monitoring is used to rule out

A
  • white coat hypertension
  • masked hypertension
  • nocturnal hypertension
47
Q

List some causes of falsely elevated blood pressure readings (pseudohypertension)

A 
cuff too small
talking or active listening
back unsupported/ feet not on floor/ legs crossed
full bladder
recent smoking, exercise
arm not supported
48
Q

List three initial objectives for evaluation of a patient newly diagnosed with hypertension

A
  • identify secondary causes of hypertension
  • identify other CV risk factors
  • assess for target organ damage
49
Q

List components of the physical exam for evaluation of hypertension

A

check bp in both arms
check orthostatic blood pressure
CV exam (palpate precordium, auscultate)
vascular exam (pulses, auscultate for bruits)
thyroid exam
abdominal exam for masses, aortic pulsation
lower extremity exam for edema
evaluate optic fundi for vascular changes

50
Q

What labs should be ordered for evaluation of hypertension

A 
urinalysis
blood glucose
hematocrit
serum potassium
serum calcium
serum creatinine
TSH
fasting lipid pannel
GFR
ECG
51
Q

What is the treatment goal (blood pressure) for patients with hypertension

A

140/90

if older than 80 years, goal is 150/90

52
Q

What is the FDA black box warning for all drugs that inhibit steps in the RAAS system, and why?

A
  • Do not use ACE-inhibitors, angiotensin receptor blockers, or renin inhibitors in pregnant women or women planning on becoming pregnant
  • Angiotensin II is necessary for normal fetal kidney development
53
Q

What is intrinsic sympathomimetic activity, and what drug used to treat hypertension shows sympathomimetic activity?

A

Pindolol causes weak B adrenergic activation because it is a partial agonist at B receptors, not a pure antagonist. This drug will decrease the resting heart rate and cardiac output less effectively than drugs without ISA but it does prevent the effect of catecholamine stimulation on the heard during exercise and stress

54
Q

Define resistant hypertension

A

BP ≥140/90 mmHg while on 3 different BP medication classes (incl. diuretic)

or on 4 antihypertensive drug classes regardless of blood pressure

55
Q

List criteria for diagnosis of resistant hypertension

A

Exclude pseudo-resistance
Identify and reverse contributing factors
Discontinue/minimize interfering substances
Screen for secondary causes

56
Q

What are some factors that affect patient adherence

A

Misunderstanding of condition or need for treatment
Absence of symptoms
Adverse effects of medications
Cost and simplicity of medication regimen
Cost of follow-up visits
Perceived lack of involvement in care plan

CV (7 decks)

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