Hypertension Directed Study

Question 1

Hypertension?

Answer 1

usual blood pressure of 140/90 mmHg or higher

Question 2

delay diagnosis and treatment?

Answer 2

asymptomatic

variability in bp

Question 3

cause non adherence?

Answer 3

pill burden, prescription drug costs, med side effects,insufficient time for patient education

Question 4

is age dependent rise in bp an essential part of human biology?

Answer 4

no, in less developed countries, bp remains low and does not rise with age

Question 5

People who develop hypertension before 50?

Answer 5

usually have combined systolic and diastolic hypertension

Question 6

people who develop hypertension after 50?

Answer 6

isolated systolic hypertension

Question 7

cause both systolic and diastolic?

Answer 7

main hemodynamic fault is vasoconstriction of resistance arterioles

Question 8

cause isolated systolic?

Answer 8

decrease distensionability of large conduit arteries, collagen replaces elastin in the lamina of the aorta

Question 9

under 50 yo more common in men or women?

Answer 9

men, more common in women after 50/ menopause

Question 10

primary hypertension?

Answer 10

single reversible cause of the elevated BP cannot be identified

however some things can be identified- habitual excessive calorie consumption, salt or alcohol

Question 11

secondary/ identifiable hypertension?

Answer 11

discrete mechanism can be identified

Question 12

BP of <80

Answer 12

Normal

Question 13

BP of 120-139/80-89

Answer 13

Prehypertension

Question 14

BP of 140-159/90-99

Answer 14

Stage 1 hypertension

Question 15

BP of >=160/>=100

Answer 15

Stage 2 hypertension

Question 16

How to obtain an accurate BP?

Answer 16

measured at least 2 after 5 min of patient seated, back supported, arm bare at heart level

tobacco/ caffeine avoided for at least 30 min prior

measured in both arms to exclude coarction of aorta

and after 5 min of standing to exclude postural fall, particularly in older persons and persons with dabetes or other conditions that predipose to autonomic insufficiency

Question 17

Home blood pressure monitoring?

Answer 17

help obtain a clear picture of person’s usual bp
2/3 readings should be taken in morning and a night for 1 week with a total of 12 readings being averaged before making clinical decisions

target treatment goal is 135/85

Question 18

Ambulatory blood pressure

Answer 18

provides automated measurements on bp during a 24 period while patients are engaged in their usual activities, including sleep

superior to office visit in predicting fatal/nonfatal MI and stroke

recommended daytime 135/85 and night time 120/70 and a 24 hr bp below 130/80

only way to detect hypertension during sleep

Question 19

lab testing for hypertension?

Answer 19

determination of blood electrolyte, fasting glucose,and serum creatinine levels, fasting lipid panel, hematocrit, spot urinalysis, resting 12 lead electrocardiogram

Question 20

most common cause of secondary hypertension?

Answer 20

chronic kidney disease

Question 21

mechanism for chronic kidney disease hypertension?

Answer 21

expanded plasma volume and peripheral vasoconstriction

Question 22

resistant hypertension?

Answer 22

high bp despite treatment

Question 23

why spot urine test for chronic kidney disease?

Answer 23

microalbuminuria (higher levels of albumninuria indicate more advanced kidney disease)
screen for GFR below 60 ml/min/1.73m2

Question 24

Renovascular hypertension?

Answer 24

2 mani cause of renal artery stenosis

aterosclerosis and fibromuscular dysplagia

Question 25

Diagnosis fibromuscular dysplagia?

Answer 25

string of beads on a CT scan in the midportion of a renal artery

Question 26

Most common cause of primary aldosteronism?

Answer 26

unilateral aldosterone producing adenoma and bilateral adrenal hyperplasia
hypokalemia