Hypertension / Hypotension

Question 1

What is the accepted change in creatinine with ACE/ARB use?

Answer 1

« 30%

Question 2

What is the result of increase in increment of 20/10 mmHg of BP?

Answer 2

​risk of dying from CVA or CAD at all ages –> doubles

Question 3

What risk factor is responsible for an increased population burden of HFpEF?

Answer 3

Hypertension

Question 4

What BP defines hypertensive crisis?

Answer 4

> 180 / 120 mmHg

and

evidence of end-organ damage

Question 5

What are treatments of choice in hypertensive emergency?

Answer 5

Question 6

What is the recommended reduction in BP in hypertensive emergency (in the absence of a high risk condition)?

Answer 6

• 1st hour –> Reduce BP by max 25%
• 2-6 hours –> 160 / 110 mmHg
• next 24-48 hours –> normal

Question 7

What is the recommended BP reduction strategy?

• hypertensive emergency
• aortic dissection, severe preeclampsia/eclampsia, Pheochromocytoma crisis

Answer 7

• Preeclampsia/eclampsia, Pheochromocytoma
  
  • 1st hour –> Reduce SBP to < 140 mmHg
• Aortic dissection
  
  • 1st hour –> Reduce SBP to < 120 mmHg

Question 8

Define resistant hypertension

Answer 8

• persistent HTN despite the use of:
  
  • three antihypertensive agents at or near maximal dose
    
    • of different classes
    • at least one is a diuretic
  • ► 1 month
    
    • to allow to take effect

Question 9

Define stages of hypertension

Answer 9

• Normal = < 120 / 80
• Stage 1 = 130 - 139 / 80 - 89
• Stage 2 = ► 140 / ► 90

Question 10

What is the recommendation for proceedig with ABPM or HBPM to differentiate?

• white coat hypertension
• HTN

Answer 10

• For patients not on drug therapy?
  
  • BP > 130 / 80 but < 160 / 100 after 3 months of lifestyle modifications

Question 11

What is the cutoff for HTN in a 24-hour ambulatory BP monitor?

Answer 11

125 / 85 mmHg

Question 12

Define primary aldosteronism

Answer 12

• secondary hypertension cause
• due to aldosterone-secreting:
  
  • adrenal adenoma
  • adrenal hyperplasia
• Labs:
  
  • metabolic alkalosis
  • low potassium
  • hypertension
• Diagnosis:
  
  • aldosterone / renin ► 20
    
    • with aldosterone ► 12
  • aldosterone / renin ► 70
    
    • with aldosterone ► 15
    • and renin « 1
• Treatment
  
  • spironolactone or
  • eplerenone

Question 13

Describe the relationship between HTN and CV disease

Answer 13

Log-Linear relationship

• SBP 20 mmHg and DBP 10 mmHg –>
  
  • each associated with a doubling in the risk of death from stroke heart disease or other vascular disease

Question 14

Describe differences in the following parameters between 80 year old and 20 year old?

• SBP
• DBP
• Aortic Pulse Wave Velocity
• Endothelial NO release

Answer 14

• SBP –> Increase
• DBP –> Decrease
• Aortic Pulse Wave Velocity –> Increase
  
  • ​increased pulse pressure due to decreased aortic distensibility and
  • increased arteriolar resistance
• Endothelial NO release –> Decrease

Question 15

Define orthostatic hypotension secondary to autonomic dysfunction

Answer 15

• brief initial rise in HR with standing –>
• sustained fall in SBP ( > 20 mmHg) and DBP ( > 10 mmHg)
• without a compensatory rise in HR

Question 16

Describe an adequate HR and BP to diagnose orthostatic hypotension secondary to autonomic dysfunction?

• BP 130 / 80
• HR 80

Answer 16

SBP < 110 / DBP < 60

and

HR « 105 bpm (fail to increase by > 10-25 bpm)

Question 17

Describe the findings and diagnosis:

• 67 year old female s/p LHC with MVCAD and revascularization with LCx stenting who develops acute SOB 4 hours post-PCI requiring intubation
• VS: HR 110 bpm, RR 14, BP 100 / 65
• PE: heart sounds are distant, no mrumurs audible. Extremities cool
• CXR: right sided fluffy opacities, normal heart size
• EKG: lateral Q waves, flipped T waves in inferior leads
• RHC / PA catheter:
  
  • RA 11
  • RV: 53/10
  • PA: 55/35
  • PCWP: 40; “difficult to wedge”
  • CI: 1.85
  • CO: 3.9
  • PA sat: 45%

Answer 17

Papillary muscle rupture / Cardiogenic shock secondary to acute MR

• Right sided pulmonary edema
  
  • lateral papillary muscle rupture –> MR jet directed toward R pulmonary veins