Hypertension Mid Term Flashcards
What is the difference between primary and secondary hypertension?
Primary hypertension has no identifiable cause and develops gradually over many years. Secondary hypertension is caused by an underlying condition such as renal disease, endocrine disorders, or medication use.
How is hypertension diagnosed?
Hypertension is diagnosed based on repeated blood pressure readings of ≥140/90 mmHg on at least two occasions.
What is masked hypertension?
Masked hypertension is a condition where a patient’s BP is normal in a clinical setting but elevated outside the clinic, leading to underdiagnosis and increased cardiovascular risk.
What is white coat hypertension?
White coat hypertension is a condition where a patient’s BP is elevated in a clinical setting but normal in daily life, often due to anxiety during medical visits.
What are the first-line drugs used for hypertension?
- Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone)
- ACE inhibitors (e.g., enalapril, lisinopril)
- ARBs (e.g., losartan, valsartan)
- Calcium channel blockers (e.g., amlodipine, diltiazem)
At what level of BP shall you consider combination therapy for hypertension?
Combination therapy is recommended for patients with BP ≥140/90 mmHg and strongly advised for patients with BP ≥160/100 mmHg.
What are the risk factors for increased risk of cardiovascular disease in addition to hypertension?
- Diabetes mellitus
- Dyslipidemia
- Smoking
- Obesity
- Sedentary lifestyle
- Family history of cardiovascular disease
- Age (men >55 years, women >65 years)
- Chronic kidney disease (CKD)
- Psychological stress
Patients who are Black tend to respond minimally to which antihypertensive agent?
Black patients tend to have a reduced response to ACE inhibitors and ARBs when used as monotherapy.
What is the initial drug of choice for a patient with a history of stroke or TIA?
ACE inhibitors or ARBs.
What is the initial drug of choice for stable ischemic heart disease?
Beta-blockers or ACE inhibitors.
What is the initial drug of choice for patients with CKD?
ACE inhibitors or ARBs.
What is the initial drug of choice for patients with diabetes?
ACE inhibitors or ARBs.
What are the symptoms associated with hypertensive urgency?
- Severe headache
- Shortness of breath
- Anxiety
- Epistaxis (nosebleeds)
What are the symptoms associated with hypertensive emergency?
- Chest pain
- Shortness of breath
- Neurological deficits (e.g., confusion, blurred vision, seizures)
- Acute kidney injury (reduced urine output)
Define hypertensive urgency.
Hypertensive urgency is a severe elevation in BP (≥180/120 mmHg) without acute target organ damage.
Define hypertensive emergency.
Hypertensive emergency is a severe elevation in BP (≥180/120 mmHg) with evidence of acute target organ damage.
What is resistant hypertension?
Resistant hypertension is hypertension that remains uncontrolled despite the use of three antihypertensive agents, including a diuretic.
What lifestyle modifications can improve BP control?
- Weight loss
- Dietary changes (DASH diet)
- Sodium reduction
- Increased physical activity
What role do aldosterone antagonists play in hypertension management?
Spironolactone and eplerenone are useful in resistant hypertension and heart failure.
What is pseudohypertension?
Pseudohypertension is falsely elevated BP due to vascular stiffness, common in elderly patients.
What are the four drugs that increase the risk of hypertensive crisis?
- NSAIDs
- Cocaine and amphetamines
- MAO inhibitors
- Oral contraceptives
What other factors can increase the risk of hypertensive crisis?
- Non-adherence to antihypertensive medications
- Excessive alcohol or sodium intake
- Acute kidney injury
- Pheochromocytoma
- Autonomic dysreflexia (in spinal cord injury patients)
What organs are most susceptible to damage by excessively elevated blood pressure?
- Brain (stroke, hypertensive encephalopathy)
- Heart (myocardial infarction, heart failure)
- Kidneys (chronic kidney disease, acute kidney injury)
- Eyes (hypertensive retinopathy)
What laboratory tests are commonly used to identify target organ damage?
- ECG (to assess left ventricular hypertrophy, ischemia)
- Echocardiogram (to evaluate cardiac function)
- Serum creatinine and eGFR (to assess kidney function)
- Urinalysis (to check for proteinuria or hematuria)
- Fundoscopic exam (to detect hypertensive retinopathy)
- Brain imaging (if neurological symptoms are present)
