Hypertension (Exam IV) Flashcards
Which ethnicity is most affected by hypertension?
Sex?
- African Americans
- No thank you (jk its women)
Hypertension is defined as sustained systolic BP > ______ mmHg.
130
Hypertension is defined as sustained diastolic BP > ______ mmHg.
80
Isolated systolic hypertension is defined as systolic BP greater than ______ and diastolic BP less than ______ mmHg.
130
80
Isolated diastolic hypertension is defined as systolic BP less than ______ and diastolic BP greater than ______ mmHg.
130
80
Differentiate stage 1 and stage 2 hypertension.
Stage 1:
- sBP of 130 - 139
- dBP of 80 - 89
Stage 2:
- sBP ≥ 140
- dBP ≥ 90
What is the cause of Primary (essential) HTN?
Etiology unclear
What factors contribute to primary HTN?
- SNS activity
- Dyregulation of RAAS
- Deficient endogenous vasodilators
Increased and dysregulated renin release results in elevated levels of what two effector molecules of the RAAs?
Angiotensin II → Aldosterone
(thus ↑ H₂O/ Na⁺ = HTN)
Angiotensin I is cleaved into angiotensin II by _______.
chymase
Reduced efficacy of ACE-inhibitors is seen in _______.
females
Where are vasodilatory substances produced?
Vascular endothelium
What vasoactive substances are produced by the vascular endothelium?
- NO (dilatory)
- Endothelin (constrictive)
Aside from nitric oxide, what other vasodilators should be known?
- ANP
- BNP
- C-type NP
- Urodilatin
Vasodilators? needs work.
What are the results of oxidative stress on the vasculature?
- Impaired endothelial function
- Disruption of NP release and/or receptor response
What are ARNI’s?
Angiotensin Receptor Neprilysin Inhibitors (Sacubitril)
What are ARNI drugs more useful for compared to standard treatment with ACE inhibitors?
Slowing progression of heart failure
What is the benefit of using sacubitril/valsartan?
ARNI/ARB combo (Entresto):
- Promotes vasodilatory effects of NPs (natriuretic peptides)
- Reduction of vasostricting/pro-inflammatory effects of endothelin 1 and Ang II.
How is secondary hypertension different from primary hypertension?
- Secondary HTN has a correctable casue
- Age-dependent (possibly)
- Drug-induced (possibly)
What herbal supplements often contribute to hypertension?
Ephedra
Ginseng
Ma Huang
What age group comprises 75-80% of secondary hypertension cases?
Children (0 - 12yo)
What is the most common cause(s) of secondary hypertension in children aged 0 - 12 ?
- Renal Parenchymal Disease
- Coarctation of the Aorta
What are the major consequences of chronic hypertension?
- Arterial vasculature remodeling
- Endothelial dysfunction
- End-organ damage
What categorizes Resistant Hypertension?
HTN despite ≥ 3 anti-HTN drugs of differing classes
What categorizes Controlled Resistant Hypertension?
HTN controlled with ≥ 4 drugs.
What categorizes Refractory Hypertension?
Uncontrolled HTN despite ≥ 5 drugs
What are some possible alternative causes of Refractory Hypertension?
- Drug intolerance
- Pseudo-resistant HTN (underlying pathology like pheochromocytoma)
What drug classes would be used for a non-black hypertensive patient?
- ACEi
- ARBs
- CCBs
- Thiazide diuretics
What drug classes would be used for a black hypertensive patient?
No history of HF or CKD
- CCBs
- Thiazide diuretics
What drugs would be utilized for HTN in a CKD patient?
- ACEi
- ARBs
What drugs are first-line antihypertensive therapies?
- Diuretics
- CCBs
- ACEi
- ARBs
When would β-blockers be utilized for hypertension?
- If CAD or tachydysrhythmias are present
- As multi-drug therapy for resistant HTN
What drug class needs to be avoided in patients with Heart failure w/ reduced EF?
CCBs
What drug class needs to be avoided in patients with history of angioedema?
ACE-Inhibitors and ARBs
What non-selective β blocker is preferred for HFrEF?
Carvedilol
When are aldosterone antagonists (spironolactone) preferred?
- Patients with primary aldosteronism
- Patients with resistant hypertension
What anti-hypertensives have to be avoided in pregnant patients?
- ACE-Inhibitors
- ARBs
At what blood pressure measurements is immediate intervention warranted for pregnancy-induced hypertension?
- Systolic > 160 mmHg
- Diastolic > 110 mmHg
What drug is firstline treatment for peripartum hypertension?
Labetalol
What anti-hypertensive medications needs to be discontinued prior to surgery?
ACE-inhibitors & ARBs
