Lecture 11 Hypertension

Question 1

HTN is defined as persistent systolic BP over _____ and/or diastolic over _____

Answer 1

140, 90

Question 2

HTN urgency is defined as systolic greater than _____ and or diastoloic greater than _____. with or without end organ damage?

Answer 2

180, 120;

without

Question 3

HTN emergency is defined as systolic greater than ____ and diastolic greater than _____. with or without end organ damage?

Answer 3

180, 120;

with

Question 4

most common cause of HTN?

Answer 4

idiopathic/primary/essential

Question 5

equation for MAP?

Answer 5

CO * TPR

Question 6

CO and TPR:
which is dependent on myocardial contractility and preload?
which is determined by tone of the arterioles?
which is typically elevated in patients with HTN?

Answer 6

CO,
TPR,
TPR

Question 7

3 instances that typically cause a release of renin:

1. _______ sensed by macula densa cells
2. _____ sensed by juxtaglomerular cells

where is it released from?

Answer 7

1. decreased Na delivery
2. decreased BP
3. increased sympathetic tone (via B1 receptors)

Juxta glomerular cells

Question 8

generally, the RAAS system causes a _____ in blood pressure via increased _____ activity and retention of ____ and _____

Answer 8

increase;
adrenergic
H2O, Na

Question 9

most patients have ____ levels of Renin

Answer 9

“inappropriately normal”

ie normal levels, but should not be normal due to high bp

Question 10

_____ nephron mass causes HTN

Answer 10

reduced

Question 11

secondary HTN: renal =
usual cause in males _____
classic cause in females _____

Answer 11

athersclerosis (renal stenosis)

fibromuscular dysplasia

Question 12

suspect ____ in patients with a triad of HTN, hypokalemia, and metabolic alkalosis

Answer 12

hyperaldosteronism

Question 13

a high ____ ratio suggest hyperaldosteronism

Answer 13

aldosterone:renin

Question 14

____ is important cause of HTN in children. what is a classic finding on physical exam

Answer 14

coarctation of the aorta;

HTN in arms, decreased bp in legs

Question 15

eye findings with severe HTN: 3

Answer 15

retinal hemorrhages, exudates, and papilledema

Question 16

HTN is based on an average of ____ or greater readings taken at ____ or greater office visits after initial screening visit

Answer 16

2, 2

Question 17

patients with increased ______ mass have a marked increased risk of CVD (Cardiovascular disease)

Answer 17

LV

Question 18

low risk patients (no diabetes, CKD, or organ damage) and are greater than ____ years old should be started with drugs at _____ over 90 mm Hg. patients younger than _____ years old should be started with drugs at _____ over 90

Answer 18

60, 150;

60, 140

Question 19

high risk patients include those with ____, ____ or organ damage. they should be started on drugs with a goal to get below ____ over 80

Answer 19

diabetes, CKD

130 (according to JCN 7)

Question 20

what is a DASH diet?

Answer 20

dietary approaches to stop HTN;

e.g. fruits/veggies, low fat

Question 21

what are the 2 most common/extensively used drug classes to treat HTN

Answer 21

thiazide diuretics, ACE inhibitors (or ARB)

Question 22

____ are especially indicated in patients with CAD, post MI, or LV dysfunction

Answer 22

beta blockers

Question 23

_____ are indicated in patients with prostatism

Answer 23

alpha blockers

Question 24

_____ improve survival in patients with increased cardiovascular risk by preventing LV remodeling

Answer 24

ACE inhibitors

Question 25

what drug, besides thiazides, seems to be indicated in black patients with HTN?

Answer 25

calcium channel blockers

Question 26

what drugs have been shown to improve outcomes in patients with kidney disease?

Answer 26

ACE inhibitors or ARBs