hypertension - schreiber

Question 1

stage 2 HTN

Answer 1

systolic > 160

D: > 100

Question 2

in essential HTN you often have

Answer 2

both systolic and diastolic BP elevated

Question 3

who gets 2x more HTN than whites

Answer 3

Non hispanic blacks, 5-18x ESRD increased risk

Question 4

MAP =

Answer 4

SVR x CO

Question 5

most patients with hypertension have

Answer 5

INCREASED SVR

Question 6

what changes do NO and endothelin undergo in hypertensive patients?

Answer 6

reduced NO activity maybe due to oxidative stress and AT2

Elevated levels of endothelin

Question 7

why do hypertensive patients fail to excrete more Na to lower BP?

Answer 7

less nephrons

- activated SNS and RAAS

Question 8

2 reasons why increased BP leads to more vasoconstriction

Answer 8

organ perfusion -

Na/K atpase inhibitor to get rid of salt but vasoconstricts

Question 9

in sustained hypertension what does increased SVR lead to

Answer 9

structural vessel changes -

hypertrophy and hyaline arteriosclerosis

Question 10

secondary HTN can be due to

Answer 10

renal parenchymal disease
endocrine
drug - 
OSA
coarctation of aorta

Question 11

when do you suspect RAStenosis

Answer 11

• young patient with HTN
• old person with diastolic HTN
• refractory HTN

Question 12

3 clues for endocrine causes of secondary HTN

Answer 12

• hypokalemia
• headache, sweating, palpitations
• Cushinoid features

Question 13

coarctation of the aorta results in

Answer 13

hypertension in the arms

hypotension in the legs

Question 14

drugs that can cause secondary HTN

Answer 14

• licorice!
• cocaine
• EtOH
• NSAIDs, steroids, exogenous Epo

Question 15

every 20/10 increase in BP after 115/75

Answer 15

double risk for CV disease

Question 16

ACE inhibitors MOA

Answer 16

• vasodilate, natriuresis
• anti fibrotic
• antiproliferative
  (teratogenic)

Question 17

ACE inhibitors that result in acute renal failure have a drop in GFR of

Answer 17

> 30 %

Question 18

Side effects of ARBs

Answer 18

hyperkalemia

renal failure and teratogenic like ACEi

Question 19

which beta blockers have more CNS effects

Answer 19

lipid soluble ones - metoprolol and propranolol

Question 20

Side effects of dihydropiridines -

Answer 20

peripheral edema

flushing, headache

Question 21

major function of the DHP calcium channel blockers

Answer 21

arteriolar vasodilators

Question 22

Major mechanism of Non-DHP calcium channel blocker

Answer 22

• decreased HR and contractility

Question 23

Side effects of NON-DHP Ca channel blockers

Answer 23

• bradycardia
• heart block
• constipation

Question 24

to prevent hypokalemia what can you do

Answer 24

combine a thiazide with a K+ sparing diuretic

Question 25

side X of alpha drenergic blockers

Answer 25

• orthostatic hypotension

Question 26

For refractory hypertension what can you use?

Answer 26

• direct vasodilators like minoxidil and hydralazine

Question 27

which drug is good for use during pregnancy

Answer 27

methyldopa

Question 28

Over 60, african descent, what should you use as an antihypertensive?

Answer 28

CCB or Diuretic

younger patients use Ace and arb

Question 29

if you have angina, avoid using which anti hypertensive

Answer 29

hydralazine

Question 30

if you have bradycardia or severe PAD dont use

Answer 30

beta blocker
ditliazem
verapamil

Question 31

if you have gout avoid using

Answer 31

a diuretic

Question 32

useful fourth drug antihypertensive is

Answer 32

alpha blocker

Question 33

what should you avoid adding to a beta blocker?

Answer 33

diltiazem or verapamil

Question 34

factors that reduce the NNT

Answer 34

• higher baseline cV risk
• higher initial raised BP
• longer duration of treatment
• greater magnitude of BP drop
• statin/aspirin

Question 35

hypertensive encephalopathy is

Answer 35

diffuse brain dysfunction

Question 36

goal of therapy with hypertensive crisis

Answer 36

decrease MAP by 25%

Question 37

MAP-

Answer 37

diastolic + 1/3 pulse pressure