MHD: Hypertension

Question 1

Hypertension is defined as a blood pressure greater than:

Answer 1

Hypertension >/= 140/90

Question 2

A new patient in your clinic is found to have a BP of 145/90. Do they have hypertension?

Answer 2

No. Need 2 data points, repeat measure at future visit for diagnosis of hypertension

Question 3

What are the 3 stages of hypertension?

Answer 3

Prehypertension: syst = 120-139, diast = 80-89
Stage 1: 140-159, 90-99
Stage 2: >160, >100

Question 4

What ethnicity have the highest prevalence of hypertension in the US?

Answer 4

African americans > Caucasians > Mexican-americans

Question 5

How is hypertension associated with incidence of first heart attack and first stroke?

Answer 5

70% of people with first MI have hypertension

80% of people with first stroke have hypertension

Question 6

What is the recommended treatments for pre-hypertension?

Answer 6

Lifestyle modifications, no meds

Question 7

What is the difference between essential HTN and secondary HTN?

Answer 7

Essential HTN is idiopathic, caused by multifactorial processes (95% of all cases)
Secondary HTN has a identifiable systemic cause (5%) of cases (renal, endocrine, CV, neurological)

Question 8

What is white coat hypertension?

Answer 8

BP higher in the MD office than at home due to anxiety associated with the doctor visit

Question 9

What is malignant hypertension?

Answer 9

A BP > 200/120 with signs and symptoms

Encephalopathy, papilledema, hemorrhages, renal failure

Question 10

What is pseudohypertension?

Answer 10

Peripheral arteries with advanced atherosclerosis are unable to be compressed as normally, so higher cuff pressures are required

This presents as a falsely elevated BP reading

Question 11

How do systolic and diastolic pressures change with aging?

Answer 11

Systolic BP tends to rise, diastolic tends to fall

Question 12

What is resistant HTN?

Answer 12

when BP goals are not met even though patients are adhering to full doses, appropriate 3 drug regimens w/ diuretics
Could be due to primary cause, secondary HTN

Question 13

What is the difference between hypertensive urgency and hypertensive emergency?

Answer 13

Urgency is severe elevation in BP without acute end-organ damage
Emergency is severe elevation in BP with acute end organ damage, show signs and symptoms

Question 14

How is BP managed in hypertensive emergencies?

Answer 14

Immediate, but gradual lowering of BP (maximum rate 10-20%/hour)
Exception: dissecting aneurysm

Question 15

What is problematic about symptoms of hypertension?

Answer 15

Often silent, symptoms don’t begin until there is end organ damage

Question 16

How is blood pressure properly measured?

Answer 16

Patient seated in a chair (not the exam table) 
Arm at heart level
Performed on skin (not over clothes)
Proper cuff size
Deflate cuff 2-3 mmHg/sec

Question 17

What complications are associated with hypertension?

Answer 17

Cardiovascular disease has been associated with continuous, consistent HTN
Not an obvious cutoff value for BP

Question 18

What are the sequelae of hypertension?

Answer 18

Ischemic heart disease or heart failure
Stroke
Cardiac hypertrophy
Aortic dissection
End stage renal failure
Retinopathy

Hypertension is “SCARIE”

Question 19

What are the general treatments of hypertension?

Answer 19

Lifestyle modifications
Medications
Treating underlying condition, secondary cause

Question 20

What lifestyle modifications can improve hypertension?

Answer 20

Diet, exercise, weight loss, smoking cessation

Question 21

What are the antihypertensive drug classes?

Answer 21

Thiazide diuretics
ACE inhibitors
Angiotensin receptor blockers
Beta blockers
Calcium channel blockers

Question 22

Is monotherapy typically used for HTN?

Answer 22

No. 2/3 of patients will need multiple agents for proper management of hypertension

Question 23

What can be the causes of resistant hypertension?

Answer 23

Improper BP measurements
Excess sodium intake
Inadequate diuretic therapy
Inadequate medication dose or effectiveness
Excess alcohol intake

Question 24

What are the goals of treatment for HTN patients below 60 years old? How do they differ for patients above 60?

Answer 24

under 60yo: target BP below 140/90

over 60 yo: target BP below 150/90