Hypertension

Question 1

bp classification

Answer 1

normal 160, >100

Question 2

renal art stenosis

indication for intervention

Answer 2

5-10% htn pts
prox 2 cm: atherosclerosis older individuals
fmd distal 2/3
inter indicated if: severe bilat dz, unilat dz solitary kidney

Question 3

coarctation:
%
association
intervention indication

Answer 3

6-8% of congenital defects
2x more in males
associated bicuspid aov (30-40%) pda, vsd, as and intracerebral aneurysm
interv iv peak-peak grad >20mmhg-

Question 4

pheochromocytoma:
characterisitics
triad
% with nl bp
location, diagnositic studies

Answer 4

cat secreting tumor- chromaffin cells of adrenal medulla, 4th -5th decade, men~women
episodic headache, sweat, tachy
50% essential htn, 15% nl bp- 10% malignant, 10%mulitple
24 hr urine cat

Question 5

pheochromocytoma
confusing meds
rx meds

Answer 5

increase levels of cats: tca, levodopa, amphetamine, buspirone, clonidine withdrawal, adrenergic agonists (sinus meds)
meds for surg:
irrev alpha blockade phenoxybenzamine 7-10 day prior followed by b blockade: do not start first- phentolamine for emergent

Question 6

hyperaldosteronism:
characteristics
dx

Answer 6

elevated bp due to vol expansion
renin suppressed by either bilat adrenal hyperplasia or secreting tumor
PRA: very low PAC plasma aldo concentration
PAC/PRA usually 4-10, primary aldo 30-50

Question 7

hypertension dx

Answer 7

3 separate occasions

Question 8

general cad prevention htn goals

risk goals

Answer 8

risk dm, renal insuff
if < 140/90 gen pop lifestyle modification
if risk then meds

Question 9

ALLHAT study:

Answer 9

antiHypertensive And Lipid Lowering treatmtent to prevent Heart Attack Trial
diuretic vs newer agents for high risk patients
doxacin increased mortality
diuretics trend better

Question 10

SHEP trial

Answer 10

Systolic Hypertension in Elderly Program
1991
>60 yrs mean 71 yrs
decreased cva, decreased chf

Question 11

LIFE trial

Answer 11

Losartan Intervention For Endpoint reduction
losartan vs atenolol
losartan less composite endpoint

Question 12

lipid soluble beta blockers

Answer 12

atenolol and nadolol least lipid soluble

Question 13

Effects on Renin Angiotensin system
diuretic 
ace inhib
arb
direct renin inhib

Answer 13

diuretic increase pra, ang 1, ang 2
ace increase pra, ang 2, decrease ang 2
arb increases pra, ang1, ang 2
dri decreases pra, ang1 and ang 2

Question 14

Hypertension in Pregnancy:
preelampsia- eclampsia definition
preexisting hypertension definition
preeclampia superimposed on preexisting htn
gestational hypertension

Answer 14

preeclampsia/eclampsia- new onset htn and proteinuria after 20 wks in normotensive- protein > 0.3 gm/24 hr
prexist. htn: >140/90 predates preg before 20 wks gestation
preeclampisia on htn: worsening htn with new proteinuria prior htn
gest htn: elevated bp after 20 wks with no proteinuria

Question 15

Rationale for treating bp in pregancy

Answer 15

stroke prevention
bedrest best
consider pharm rx if sbp<160/105 with target 130-150/80-100
no nitroprusside, no ace- rx labetolol, aldomet, hydralazine, sustained release nifedipine

Question 16

hypertensive breast feeding

Answer 16

b blockers and ccb enter milk, but compat with lactation

avoid atenolol, acebutolol