Hypertension

Question 1

what does he have?
48 yr old Bronco football fan

30% above ideal body weight
2 beers/day (12 not 64 oz); chair to TV for exercise; fast food( not ‘sprouts and grasses’)- no more than 4 times/week

50 pk/yrs of cigarettes

Mother and Father died in their early 50’s of CVD

BP 160-170/85-95 mmHg over 3 weeks

HOW WOULD YOU TREAT HIM?

Answer 1

primary or essential hypertension

drugs and lifestyle modifications BOTH

Question 2

prevalence of HTN in US

Answer 2

50-60 million people

Question 3

life time risk of developing HTN

Answer 3

people normotensive at 55 have 90% lifetime risk for developing HTN

Question 4

why is it bad if 60 million people are hypertensive

Answer 4

starting at 115/75, CVD (stroke, HF, MI) risk doubles with each increment of 20/10

Question 5

which is more important

systolic vs. diastolic BP

Answer 5

> 50 y/o, SBP more important than DBP

Question 6

which is more difficult to control

systolic vs diastolic BP

Answer 6

systolic BP

Question 7

equation for MAP

Answer 7

MAP = CO x SVR

Question 8

Guyton Hypotehsis of Essential hypertension
1) defect in …

2) incr in ..
3) incr in ..
4) autoreg incr in ..
5) incr in …

Answer 8

IN KIDNEY
1) Primary defect in renal Sodium Excretion

2) Increase in Plasma Volume
3) Increase in Cardiac Output, incr perfusion

4) Autoregulatory Increase in Systemic
Vascular Resistance so organs not overperfus

5) Increase in BP (and afterload-mediated normalization of CO)

Question 9

cellular hypothesis of essential HTN

Answer 9

in VSMC
1) Na transport inhib thru Na/K ATpase
so elev cell Na

2) decr Na/Ca exchange due to high Na inside so incr cell Ca
3) incr in SVR
4) incr BP

Question 10

JNC 7 BP classification
normal 
pre HTN
stage 1 
stage 2

Answer 10

normal = 120/80
prehypertension = 120-139/80-89
Stage 1 HTN = 140-159/90-99
Stage 2 HTN = 160/100

Question 11

BP 120-140, % risk of getting HTN

Answer 11

30-50% risk of

getting HTN within 4 yrs

Question 12

a

Answer 12

a

Question 13

a

Answer 13

a

Question 14

a

Answer 14

a

Question 15

BP measurement technique
1) ambulatory BP monitoring

2) self measurement

Answer 15

for “white coat” HTN
absence of 10-20% BP decr during sleep –> incr CVD risk

2) self measurement = info on response to therapy and adherence to therapy and eval for white coat HTN

Question 16

3 objectives for eval patient with HTN

Answer 16

1. Assess lifestyle and identify other CV risk factors or concomitant disorders that affects prognosis and guides treatment.
2. Reveal identifiable causes of high BP.
3. Assess the presence or absence of target organ damage and CVD.

Question 17

CVD risk factors

Answer 17

1) HTN
2) obesity
3) dyslipidemia
4) diabetes mellitus
5) microalbuminuria or estimated GFR

Question 18

causes of HTN

Answer 18

• sleep apnea
• Drug-induced or related causes
• Chronic kidney disease
• Primary aldosteronism
• Renovascular disease
• Chronic steroid therapy and Cushing’s syndrome
• Pheochromocytoma
• Coarctation of the aorta
• Thyroid or parathyroid disease

Question 19

target organ damage

Heart

Answer 19

1) LVH
2) angina or prior MI
3) prior coronary revasc
4) HF

Question 20

target organ damage

brain

Answer 20

stroke or transient ischemic attack

incr risk of dementia with TIA’s

Question 21

target organ damage

kidney

Answer 21

CKD
periph artery disease
retinopathy

Question 22

Lab tests for HTN

Answer 22

1) ECG
2) UA
3) blood glucose and HCT
4) serum K, creatinine or GFR, Ca
5) lipid profile with HDL, LDL, triglycerides
6) urinary albumin excretion or albumin/creatinine ratio

Question 23

in stage 1 HTN (SBP 140-160) and additional CVD risk factors, a sustained 12 mmHg reduction in SBP over 10 yrs will …

Answer 23

prevent 1 death per 11

Question 24

goal of therapy

Answer 24

1) treat to BP 50 y/o

Question 25

lifestyle mods

Answer 25

1) weight decr
2) DASH
3) decr sodium
4) phys activity
5) moderate alcohol consumption

Question 26

algorithm for treating HTN

Answer 26

1) lifestyle mods

2) if not reach

Question 27

types of compelling indications

Answer 27

CKD

Question 28

Comparing drugs vs. lifestyle which is more likely to reduce BP and prevent CVD

Answer 28

drugs are better than lifestyle modification for CVD modification

Question 29

regardless men or women, CVD or not, all data looks ____

Answer 29

about the same

Question 30

Lifestyle modifications for which class of HTN

Answer 30

preHTN

stage 1
stage 2

Question 31

order of best lifestyle intervention to lower CVD risk

Answer 31

1) STOP SMOKING
2) lose weight (diet or exercise)

change jobs does nothing
alcohol good for women
dietary salt not effective

Question 32

treatment for stage 1 HTN

Answer 32

1) lifestyle mod
2) thiazide for most or ACEI,
ARB, BB, CCB,

Question 33

treatment for stage 2 HTN

Answer 33

1) lifestyle mod
2) thiazide + ACEI,
ARB, BB, CCB, or combination.

Question 34

goal of therapy for HTN

Answer 34

1) decr CVD/renal morbidity

2) treat to BP

Question 35

JNC 8
in patients > 60 y/o initiate and treat to BP ___

in patients

Question 36

HTN is a ____ problem

Answer 36

provider-related