Hypertension: Part 1 Flashcards
1
Q
Evidence based guidelines are…
A
Indispensable (necessary)
2
Q
What assist clinicians in providing the most effective care for clients?
A
Evidence based guidelines
3
Q
What does JNC stand for?
A
Joint National Committee
4
Q
How many JNC are there?
A
JNC 8
5
Q
What did the JNC 8 do?
A
Issued a highly anticipated guideline HTN
6
Q
When was the JNC 8 initially appointed?
A
2008
7
Q
Who appointed the JNC 8?
A
National Heart, Lung, & Blood Institute
8
Q
What event happened that prompted the JNC 8 and the American Society of Hypertension & the International Society of Hypertension to create their own guidelines?
A
The National Institutes of Health discontinued sponsorship of clinical recommendations
9
Q
What guideline did the JNC 8 create after the National Institutes of Health discontinued sponsorship of clinical recommendations?
A
Guideline on management of hypertension
10
Q
Where did the JNC 8 publish their guideline on management of hypertension?
A
Journal of the American Medical Association
11
Q
When did the JNC 8 publish their Guideline on management of hypertension in the Journal of the American Medical Association?
A
The same week that the American Society of Hypertension & the International Society of Hypertension released their guideline.
12
Q
Who did not endorse the JNC 8 Guideline on management of hypertension?
A
- American Heart Association
2. American College of Cardiology
13
Q
Who makes up the JNC 8?
A
panel members
14
Q
What study material is made based on these guidelines?
A
The two charts that we reviewed. SEE CHARTS.
15
Q
What do guidelines do for all practitioners?
A
- allow us to all provide the same care for out clients by basing our practice on the same guidelines.
- If in court we can say we made a decision based on guidelines
16
Q
What types of questions could a practitioner be asked in court that can be answered based on the guidelines?
A
- why did you do that?
- why did you put the patient on that medication?
- why did you order that diagnostic procedure?
- why did/didn’t you refer that patient?
17
Q
What answer does not hold up in court when asked these questions?
A
I thought it was a good idea…
18
Q
What is the most important preventable contributors to disease & death in the US?
A
HTN
19
Q
HTN leads to _1__, __2__, and __3__, __4__ and more when __5___ & __6___ occur.
A
- MI
- stroke
- RF
- Blindness
- not detected early
- treated appropriately
20
Q
What did the JNC 8 guideline on HTN cover?
A
- treatment thresholds
- goals
- medications
21
Q
What year were these updated guideline released?
A
2014
22
Q
What population does the JNC 8 guideline for HTN cover?
A
Adults
23
Q
What are the most current HTN guidelines?
A
2017 ACC/AHA&JNC-8
24
Q
How do the updated JNC 8 guidelines differ from the JNC 7 guidelines?
A
- more evidence-based
- use more “relaxed” thresholds for treatment
- attempt to simplify antihypertensive care
25
What is the official names of the updated HTN guideline created by the JNC 8?
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
26
Who should be most familiar with any changes in guidelines and why?
1. ACLS or CPR providers
| 2. Need to know what is best for patient
27
What does ASCVD stand for?
Atherosclerotic cardiovascular disease
28
Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease
1. to promote a healthy lifestyle throughout life
2. team-based care approach
3. Adults 40-75 yrs old & are being evaluated for CVD prevention should undergo 10-yr ASCVD risk estimation & have a clinician–client risk discussion before starting pharmacological therapy, such as anti HTN therapy, a statin, or ASA
4. healthy diet
5. physical activity
6. DMT2- metformin is 1st line therapy
7. assessed at every healthcare visit for tobacco use
8. Aspirin should be used infrequently in the routine primary prevention of ASCVD
9. Statin therapy is 1st line treatment for elevated LDL, DM, 40-70 yrs
10. Nonpharmacological interventions are recommended for all adults with elevated BP or HTN. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80.
29
What is VERY important to remember from the 10 take home messages for Primary Prevention of Cardiovascular Disease?
DMT2- metformin is 1st line therapy (oral)
30
When asking a patient about tobacco use what is important to keep in mind?
Not just cigarettes! Can be chewing, vape, hookah, cigar, pipe, etc...
31
What not to ask when assessing if a patient uses tobacco? why?
Are you a smoker? (bc they could use in another way or have just quit yesterday)
32
When is aspirin used in cardiac treatment?
CAD or MI
33
Why is aspirin NOT used in primary prevention of ASCVD anymore?
1. lack of net benefit
| 2. can cause bleeding
34
How are the JNC 8 and the ANA/ACC guidelines similar? how are they different?
1. the numbers are the same
| 2. category names are different
35
What are the categories of HTN according to the JNC 8?
1. Normal
2. Prehypertension
3. HTN stage 1
4. HTN stage 2
5. Hypertensive crisis
36
What are the categories of HTN according to the ANA/ACC?
1. normal
2. elevated
3. stage 1
4. stage 2
5. hypertensive crisis
37
JNC 8 HTN category parameters
1. < 120 and < 80 (normal)
2. > 120 or > 80 (pre)
3. > 140 or > 90 (S1)
4. > 160 or > 100 (S2)
5. > 180 or > 110 (crisis)
38
What does the JNC suggest a person do when in hypertensive crisis?
Emergency care
39
AHA/ACC HTN category parameters
1. < 120 and < 80 (normal)
2. > 120 and < 80 (elevated)
3. > 130 or > 80 (S1)
4. > 140 or > 90 (S2)
5. > 180 and/or > 120 (crisis)
40
What does the AHA/ACC suggest a person do when in hypertensive crisis?
Consult doctor immediately
41
What are thiazides categorized as? How do they work?
1. Diuretics
| 2. rid your body of sodium and H2O
42
What does CCBs stand for?
Calcium Channel Blockers
43
What does ACEIs stand for?
Angiotensin Converting Enzyme Inhibitors
44
What does ARBs stand for?
Angiotensin Receptor Blocker
45
What drugs are recommended to be prescribed to the general non black population for HTN initially (JNC 8)?
1. Thiazides
2. CCBs
3. ACEIs
4. ARBs
46
What drugs are recommended to be prescribed to the general black population for HTN initially (JNC 8)?
1. Thiazides
| 2. CCBs
47
What drugs are recommended to be prescribed to CKD patients for HTN (JNC 8)?
1. ACEIs
| 2. ARBs
48
If initial treatment does not achieve BP goal by ___ , the treatment is changed.
one month
49
If initial treatment does not achieve BP goal__1__ or _2___ should be done.
1. up titrate current medication
| 2. add therapy
50
Which HTN medications should not be prescribed at the same time?
1. ACEIs and ARBs
| 2. HF clients
51
Are ACEIs and ARBs ever prescribed together?
Occasionally
52
When is it okay to be prescribed ACEIs and ARBs together?
In HF clients
53
Who would prescribe an ACEIs and ARBs together? Who would not?
A HF physician
54
Who would not prescribe an ACEIs and ARBs together?
NPs
55
Why would a heart failure physician prescribe an ACEI and ARB together?
ACEIs are one of the initial drugs used to treat heart failure
56
When would a heart failure patient NOT be prescribed an ACEI initially?
If the client is in fluid overload
57
If a heart failure patient is in fluid overload what medication is prescribed initially? (generic name and brand name)
furosemide (Lasix)
58
If a heart failure patient is NOT in fluid overload what medications would be prescribed initially?
1. ACEIs
| 2. Beta-blockers
59
If after initial treatment if an additional medication therapy is already added and BP goal is still not achieved what should be done?
Refer to a HTN specialist
60
What are examples of thiazides?
1. hydrochlorothiazide
| 2. chlorthalidone
61
What HTN medication is first line? Why?
1. thiazides
2. cheap
3. minimal side effects
4. old and well studied
62
Why would you initially start a general non black or CKD patient off on a ACEIs rather than an ARBs?
cheaper
63
What generation are ARBs?
second
64
What is the major side effect that happens with ACEIs? What should a prescriber do if a patient has this side effect? Why?
1. cough
2. switch them to an ARBs
3. bc ARBs don't cause cough as a side effect
65
Should a provider start by prescribing thiazides or CCBs to the general black population?
They can start with either
66
What are the positives to each initial medication prescribed to the general black population?
1. thiazides: cheap
| 2. CCBs: studies on black men have have shown these clients have more resistant HTN (r/t genetic makeup)
67
In patients with CKD why would we start with ACEIs and ARBs? why not thiazides?
1. ACEIs and ARBs can be renal protective
| 2. Thiazides are harsh on kidneys
68
What does renal protective mean?
Supports kidney function
69
In CKD patients what lab values will be monitored?
1. BUN
| 2. Creatinine
70
What could occur in CKD clients prescribed HTN medications? Which ones run a higher risk of this?
1. electrolyte imbalance
| 2. Thiazides and CCBs
71
Which electrolyte should we be monitoring for imbalances in CKD patients prescribed HTN medications?
potassium
72
Is it possible for a patient to to have HTN that cannot be controlled? What causes this?
1. Yes
| 2. Certain conditions cause this
73
If a prescriber has tried to control a patients HTN without success what should they do?
Test for the conditions that cause HTN that cannot be controlled
1. Renal Artery Stenosis patients
2. Pheochromocytoma patients
74
Which conditions cause HTN that cannot be controlled?
1. Renal Artery Stenosis
| 2. Pheochromocytoma
75
What is Pheochromocytoma?
Tumor on the adrenal glands
76
As a NP, if you are unable to get a patients blood pressure under control what is important to do? Why?
1. Refer sooner than later
| 2. Avoid complications
77
Example Patient:
1. Diabetes: No
2. CKD: No
3. Age: 60+
4. Race: non black
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 150 and < 90
2. Thiazide, CCB, ACEI, ARB
3. alone OR in combo
78
Example Patient:
1. Diabetes: No
2. CKD: No
3. Age: 60+
4. Race: black
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 150 and < 90
2. Thiazide, CCB
3. alone OR in combo
79
Example Patient:
1. Diabetes: No
2. CKD: No
3. Age: < 60
4. Race: non black
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 140 and < 90
2. Thiazide, CCB, ACEI, ARB
3. alone OR in combo
80
Example Patient:
1. Diabetes: No
2. CKD: No
3. Age: < 60
4. Race: black
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 140 and < 90
2. Thiazide, CCB
3. alone OR in combo
81
Example Patient:
1. Diabetes: Yes
2. CKD: No
3. Age: any age
4. Race: non black
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 140 and < 90
2. Thiazide, CCB, ACEI, ARB
3. alone OR in combo
82
Example Patient:
1. Diabetes: No
2. CKD: Yes
3. Age: any age
4. Race: any race
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 140 and < 90
2. ACEI, ARB
3. alone OR with other drugs
83
Example Patient:
1. Diabetes: Yes
2. CKD: Yes
3. Age: any age
4. Race: any race
1. What should their BP goal be?
2. Which HTN medications could you prescribe?
3. Would you prescribe the medication alone, in combination, or with other drugs?
1. < 140 and < 90
2. ACEI, ARB
3. alone OR with other drugs
84
What does SPRINT study stand for?
Systolic Blood Pressure Intervention Trial
85
How many participants were included in the SPRINT study?
9,361
86
What factors were considered when choosing participants for the SPRINT study?
1. Age
2. BP
3. Number of cardiovascular disease risk factors
87
What were the SPRINT study's participant requirements:
1. Age
2. BP
3. Number of cardiovascular disease risk factors
1. 50+
2. systolic > 130
3. 1+
88
How many SPRINT study participants were 75+ ?
28%
89
How many SPRINT study participants had CKD?
28%
90
Who monitored the SPRINT study?
An independent Data & Safety Monitoring Board
91
What was the responsibility of the The SPRINT study's independent Data & Safety Monitoring Board?
To perform interim analyses of:
1. Study results
2. Adverse events
92
What was was the SPRINT study's independent Data & Safety Monitoring Board looking for when performing their responsibility?
Any indication that one treatment group’s results were superior to the other group
93
Did the SPRINT study's
independent Data & Safety Monitoring Board find any indication that one treatment group’s results were superior to the other groups?
If so, WHEN were indications identified and WHAT were they?
1. Yes
2. Before the study was planned to be completed
3. Indications that participants being treated for target systolic BP of < 120 had better health outcomes
94
The SPRINT study's
independent Data & Safety Monitoring Board found that the subjects treated for target systolic BP of < 120 had what outcomes?
Reduced:
1. cardiovascular events
2. overall risk of death
95
Were the SPRINT study's independent Data & Safety Monitoring Board's findings clear?
Yes, very clear
96
What did independent Data & Safety Monitoring Board advise to happen to the SPRINT study after identifying their findings?
That the study be stopped early
97
The independent Data & Safety Monitoring Board advised on how to proceed with The SPRINT study once their findings were identified. Why were these recommendations made?
So participants in the groups NOT being treated for target systolic BP of < 120 could be treated using new info and avoid complications
98
Did the SPRINT study accept the recommendations on how to proceed with the study based on the findings identified by the independent Data & Safety Monitoring Board?
Yes
99
The SPRINT study determined that __1__ systolic BP resulted in reduced __2__ and reduced__3___.
1. lower
2. cardiovascular events
3. overall risk of death
100
The SPRINT study determined that lowering the systolic BP to the target of < 120 reduced cardiovascular event occurrence by how much?
25%
101
Did The SPRINT study determine that lowering the systolic BP to the target of < 120 reduced cardiovascular event occurrence in participants with CKD?
Yes
102
Did The SPRINT study determine that lowering the systolic BP to the target of < 120 reduced overall risk of death in participants who had CKD?
Yes
103
The SPRINT study's findings helped to form what?
2017 AHA & ACC high BP clinical guidelines
104
Once The SPRINT study was completed and its findings were published did any follow up research occur?
If so/not, what was done?
1. Yes
| 2. A new study was formed
105
The study that was formed based on The SPRINT study's findings was referred to as ____.
The SPRINT MIND trial
106
The SPRINT MIND trial used _____ derived from The SPRINT study to form its hypothesis.
preliminary results
107
The SPRINT MIND trial hypothesized that:
Adults with increased risk for __1__ but without __2___ treated to a systolic BP target less than __3___ as compared to __4__ MAY reduce the risk of ___5___, and ___6___.
1. CVD
2. DM
3. 120
4. 140
5. MCI
6. Dementia
108
What does MCI stand for?
mild cognitive impairment
109
When was The SPRINT MIND trial's hypothesis presented?
June 25, 2018
110
What was The SPRINT MIND trial's hypothesis presented at?
The Alzheimer's Association International Conference
111
Where was The SPRINT MIND trial's hypothesis presented?
Chicago
112
The SPRINT MIND trial's findings concluded that:
Among ambulatory adults with ___1___, treating to an systolic BP goal of less than 120 vs. 140 __2__ [did/did not] result in a significant reduction in the risk of ___3____.
1. HTN
2. did not
3. probable dementia
113
How were the findings of the SPRINT MIND trial presented?
They were published
114
When were the findings of the SPRINT MIND trial presented?
Jan. 28, 2019
115
Where were the findings of the SPRINT MIND trial presented?
The Journal of the American Medical Association
116
Once The SPRINT MIND trial was completed and its findings were published did any follow up research occur?
If so/not, what was done?
1. No
| 2. A new hypothesis was created based on The SPRINT MIND trial's findings
117
As a follow to the The SPRINT MIND trial it was up hypothesized that:
Due to __1___ and ___2__ the study may have been __3___ for this __4___.
1. early study termination
2. fewer than expected cases of dementia
3. underpowered
4. endpoint
118
The hypothesis created following The SPRINT MIND trial's conclusion could be used for what?
Follow up research in future studies
119
What information could be found using the hypothesis created following The SPRINT MIND trial's conclusion?
It could prove the The SPRINT MIND trial's hypothesis is actually significant or it is not.
120
What is important to do as a practitioner/prescriber to get the best results for your clients?
Keep up to date on new study findings.
