Hypertension

Question 1

Primary determinant of arterial pressure over the long term

Answer 1

Intravascular volume

Question 2

Modulator of BP on a minute-to-minute basis, i.e. postural changes, stress, changes in blood volume

Answer 2

Baroreceptor reflex arc

Question 3

NaCl-dependent hypertension

Answer 3

Increase in BP secondary to decreased renal Na excretion

Question 4

3 primary stimuli for renin secretion

Answer 4

1. Decreased NaCl transport in the thick ascending loop of Henle via macula densa mechanism
2. Decreased pressure or stretch within the renal afferent arteriole via baroreceptor mechanism
3. Sympathetic nervous system stimulation of renin-secreting cells via beta 1 receptors

Question 5

Effects of angiotensin II

Answer 5

1. Vasoconstriction
2. Release of catecholamines
3. Aldosterone secretion
4. Stimulates vascular smooth muscle cell and myocyte growth

Question 6

Most common cause of death in hypertensive patients

Answer 6

Heart disease

Question 7

Most accurate assessment of diastolic function

Answer 7

Cardiac catheterization

Question 8

Strongest risk factor for stroke

Answer 8

Hypertension

Question 9

Most common etiology of secondary hypertension

Answer 9

Primary renal disease

Question 10

Renal lesion in malignant hypertension

Answer 10

Fibrinoid necrosis of the afferent arterioles

Question 11

Circadian pattern of BP

Answer 11

Higher in early AM

Nighttime BP are 10-20% lower than daytime BP

Question 12

Criteria for diagnosis of hypertension based on home BP and/or 24h-ambulatory blood pressure measurements

Answer 12

Awake: >/= 135/85
Asleep: >/= 120/75

Question 13

_____ peripheral vascular resistance and _____ cardiac output in majority of patients with established hypertension

Answer 13

Increased peripheral vascular resistance and normal/decreased cardiac output

Question 14

Form of hypertension among high-renin patients

Answer 14

Vasoconstrictor form of hypertension

Question 15

Form of hypertension among low-renin patients

Answer 15

Volume-dependent form of hypertension

Question 16

Indicative of primary renal disease causing hypertension

Answer 16

Proteinuria > 1000mg/day and active urine sediment

Question 17

Gold standard for evaluation of renal artery stenosis

Answer 17

Contrast arteriography

Question 18

Simplest screening test for primary hyperaldosteronism

Answer 18

Measurement of serum potassium - hypertensive patients with unprovoked hypokalemia

Question 19

Useful screening test for primary hyperaldosteronism

Answer 19

Ratio of plasma aldosterone to plasma renin activity > 30:1 + plasma aldosterone concentration of >555pmol/l (>20ng/dl)

Question 20

Confirmatory test for primary hyperaldosteronism

Answer 20

Inability to suppress plasma aldosterone to <10ng/dl after IV infusion of 2L of isotonic saline over 4h

Question 21

Treatment for primary hyperaldosteronism

Answer 21

Low dose glucocorticoids, aldosterone antagonists

Question 22

Best screening test for Cushing’s syndrome

Answer 22

24h urine test for cortisol and creatinine

Low dose dexamethasone challenge

Question 23

Definitive treatment for pheochromocytoma

Answer 23

Surgical excision

Question 24

BP control medication for pheochromocytoma

Answer 24

Alpha blockers first then add beta blockers if persistent

Question 25

Confirmatory test for OSA

Answer 25

Polysomnography

Question 26

Most common congenital cardiovascular cause of hypertension

Answer 26

Coarctation of the aorta

Question 27

Form of hypertension in hyperthyroidism

Answer 27

Systolic hypertension

Question 28

Form of hypertension in hypothyroidism

Answer 28

Diastolic hypertension

Question 29

Indications for 24-hour ambulatory BP monitoring

Answer 29

1. Treatment resistance 2. Symptomatic hypotension 3. Autonomic failure 4. Episodic hypertension, possibly white coat hypertension

Question 30

First-line anithypertensives

Answer 30

Thiazide diuretics Inhibits NaCl pump causing sodium excretion Acts as vasodilators

Question 31

Younger patients are more responsive to what antihypertensives

Answer 31

Beta blockers and ACE-i

Question 32

Elderly patients are more responsive to what antihypertensives

Answer 32

Diuretics and CCBs

Question 33

High-renin hypertensive patients are more responsive to what antihypertensives

Answer 33

ACE-i and ARBs

Question 34

Low-renin / black hypertensive patients are more responsive to what antihypertensives

Answer 34

Diuretics and CCBs

Question 35

Resistant hypertension

Answer 35

BP persistently >140/90 on more than or equal to 3 antihypertensive agents including diuretic at full doses

Question 36

Osler maneuver

Answer 36

Palpable radial pulse despite occluded brachial artery by the cuff Done to diagnose pseudohypertension or inability to measure BP accurately in severely sclerotic arteries

Question 37

Goal BP if with hypertensive encephalopathy

Answer 37

Reduce MAP by = 25% or BP range of 160/100-110 within minutes to 2hrs

Question 38

Goal if with malignant hypertension but no encephalopathy

Answer 38

Decrease BP over hours using short-acting PO drugs

Question 39

Goal BP if with malignant hypertension and acute ischemic stroke

Answer 39

Treat if SBP > 220mmHg or DBP > 130mmHg

Question 40

Goal BP if with malignant hypertension and acute hemorrhagic stroke

Answer 40

Treat if SBP > 180mmHg or DBP > 130mmHg

Question 41

Goal BP if with malignant hypertension and acute ischemic stroke and is for thrombolysis

Answer 41

Lower SBP < 185mmHg and DBP < 110mmHg

Question 42

Goal BP if with malignant hypertension and acute subarachnoid hemorrhage

Answer 42

Cautious BP reduction if MAP >130mmHg

Question 43

JNC8 BP level to start meds

Answer 43

Age < 60, +/- DM, +/- CKD = 140/90mmHg Age >/= 60 = 150/90mmHg Can start with 2 agents if SBP >20mmHg or DBP >10mmHg above goal