Hypertension

Question 1

K+ sparing diuretics

Answer 1

Spironolactone

Question 2

Ending for ace-inhibitors

Answer 2

…pril

eg lisinopril, enalapril, ramipril, quiropril

Question 3

Ending for angiotensin-II receptor blockers

Answer 3

…sartan

eg. losartan, valsartan, olmesartan

Question 4

Recommended diet to help lower BP

Answer 4

low sodium DASH diet

Question 5

Hypertension is a risk factor for… (name some conditions)

Answer 5

Stroke, MI, Vascular disease, Chronic kidney disease

Question 6

Normal BP

Answer 6

<120/<80 mmhg

Question 7

Elevated BP

Answer 7

120-129 / <80 mmhg

Question 8

Stage 1 hypertension

Answer 8

130-139 / 80-89 mmhg

Question 9

First step in managing HTN

Answer 9

Lifestyle modifications… low sodium (DASH diet), low alcohol, physical activity(30 min/day of aerobic exercise), smoking cessation (to reduce CV risk)

Question 10

Which antihypertensive agent may cause hyperkalemia and require monitoring of potassium

Answer 10

ACE Inhibitors

Especially in people with prior history of renal impairment, diabetes, simultaneous use of K-sparing diuretics and potassium supplements

Question 11

Side effect of thiazide

Answer 11

Mild hypokalemia, impaired glucose tolerance, increased serum lipids and increased renin secretion:

the side effects of the thiazide (mild hypokalemia) can be countered by either an ACE-I or an ARB (which can produce mild hyperkalemia).

Question 12

Minimum number of antihypertensive meds needed to reduce systolic BP by about 40mmHg

Answer 12

Each antihypertensive drug can, on average, reduce SBP by ~10 mm Hg. Many patients with more severe degrees of hypertension may require at least 3 drugs, plus lifestyle changes to achieve a target goal of lowering their systolic BP by 40 mm Hg (to achieve a systolic BP of <130 mm Hg). The math isn’t exact, but its a ball park estimate.

Question 13

First choice antihypertensive med for pt with history of either diabetes or kidney disease

Answer 13

Patients with a history of either diabetes or kidney disease should be given an ACE-I or an ARB to prevent the development of, or further progression of kidney disease.

Question 14

Thiazides produce mild hypoglycemia. T/F

Answer 14

False.
Thiazides are known to produce mild hyperglycemia. It is typically not of clinical consequence in non-diabetics, and can be minimized by correcting any associated hypokalemia

Question 15

Which antihypertensive drug would be best at preventing heart failure

Answer 15

The correct answer is a (thiazide) diuretic. Studies have shown that alpha blockers actually double the risk of heart failure compared with a diuretic, and both calcium channel blockers and ACE inhibitors are also inferior to a diuretic for preventing CHF.

Question 16

Antihypertensive drug that can be used during pregnancy?

Answer 16

Methyldopa has the best, most well established track record for safety as an antihypertensive drug in pregnancy

Propranolol (a non-selective β-blocker) has been associated with premature labor & neonatal apnea.

Question 17

ACE inhibitors and ARBs in pregnancy?

Answer 17

CONTRAINDICATED
Exposure to such drugs may result in a decrease in placental blood flow, which can result in oligohydramnois, renal failure, low birth weight, cardiovascular anomalies, spontaneous abortions, and other abnormalities.

Question 18

Concern about rapid drops in blood pressure?

Answer 18

concern about reductions in cerebral blood flow

Intravenous sodium nitroprusside one of the drugs of choice for rapid lowering of systolic BP to <120 mm Hg (within 20 minutes) in the setting of a dissecting aorta. Most other hypertensive emergencies do not call for such rapid changes in BP

Question 19

A definite contraindication for the use of ACE inhibitors and ARBs includes:

Answer 19

bilateral renal stenosis

Ang II is necessary for maintaining efferent arteriole resistance in this setting. Reducing Ang II levels, or Ang II effects, can reduce GFR and cause kidney failure in this setting.

Question 20

Mechanisms by which blood-pressure may be reduced:

Answer 20

reduced cardiac output
increased vagus nerve activity
decreased central sympathetic outflow
reduced angiotensin II levels

Question 21

peptidyl dipeptidase?

Answer 21

An ACE

Question 22

Define orthostatic hypertension

Answer 22

It is defined as a drop of systolic blood pressure by at least 20 mmHg or diastolic by 10 mmHg.

Question 23

Describe five physical findings in long-standing or severe hypertension.

Answer 23

Hypertensive retinopathy, which is observed as narrowed arterioles seen on funduscopic examination
Retinal hemorrhages and exudates along with swelling of the optic nerve head (papilledema)
Left ventricular hypertrophy, which can be detected by echocardiography or ECG, and cardiac enlargement, which can be detected on physical examination
Renal bruits from narrowing of the renal arteries
A blood pressure rise on standing sometimes occurs in essential hypertension presumably because of a hyperactive sympathetic response to the erect posture. This rise is usually absent in other forms of hypertension

Question 24

Name the known causes of hypertension.

Answer 24

Essential hypertension is the most common
Renal: renovascular (atherosclerosis or fibromuscular dysplasia) or parenchymal (chronic kidney disease, obstructive uropathy)
Endocrine: primary aldosteronism, Cushing syndrome, pheochromocytoma, adrenal enzyme deficiencies, hyperthyroidism, hyperparathyroidism, and acromegaly
Obesity and metabolic syndrome
Drug related: estrogen, androgens, corticosteroids, nonsteroidal anti-inflammatory drugs, cocaine, amphetamine, alcohol, decongestants, appetite suppressants, antidepressants, cyclosporine, and tacrolimus
Other: pre-eclampsia, coarctation of the aorta, sleep apnea, polycythemia, and increased intracranial pressure