Module 8/9 - Hypertension

Question 1

ACC/AHA BP Thresholds
Normal
Elevated
Stage 1
Stage 2

Answer 1

Normal: <120 / <80
Elevated: 120-129 / <80
Stage 1: 130-139 / 80-89
Stage 2: >140 / >80

Question 2

Threshold to Initiate Treatment for HTN

Answer 2

> 130/80
IF history of CVD or >10% ASCVD risk

> 140/90
IF no clinical CVD and >10% ASCVD risk

Question 3

Treatment Goals for HTN

Answer 3

< 130/80

Question 4

Treatment Algorithm for HTN

Answer 4

1 med for stage 1
(may try 3-6mo of health lifestyle changes for ASCVD risk < 10%)

2 meds for stage 2 with different mechanism of action

Question 5

Symptoms of HTN *

Answer 5

NONE - SILENT KILLER
- Headache
- Fatigue
- Dizziness
- Visual Changes
- Palpitations
- Epistaxis
- Flushing

Question 6

Target Organ Damage of HTN *

Answer 6

HTN is associated with a prothrombotic state, plt activation, endothelial dysfunction and altered angiogensis

Heart
- LV Hypertrophy
- Angina or MI
- HF

Brain
- Transient or Ischemic stroke
- Vascular Dementia

CKD
PAD
Retinopathy

(HTN is associated with a prothrombotic state. Platelet activation, endothelial dysfunction, and altered angiogenesis play an important part HTN organ damage)

Question 7

Primary HTN *

Answer 7

HTN is a complex multifactorial disorder
- genetics (~3%)
- environmental factors including diet, physical activity, alcohol

> overweight and obesity (direct relation)
sodium intake
potassium
physical fitness
alcohol

Question 8

Common Causes and Screening of Secondary HTN *

Answer 8

Renal parenchymal disease:
- renal ultrasound

Renovascular dx especially renal artery stenosis:
- renal duplex, MRA, abdominal CT

Primary aldosteronism:
- plasma aldosterone/renin ratio

Obstructive sleep apnea:
- berlin questionnaire, Epworth sleepiness score, overnight oximetry

Drug or alcohol-induced:
- urinary drug screen or response to withdrawal of suspected agent

Question 9

Pharm Treatment of HTN *

Answer 9

Non-Black (including those with DM)
- Thiazide diuretics (chlorthalidone preferred)
- CCBs
- ACE or ARB (especially in DM with albuminuria or CKD stage 3 or greater(

Black (including those with DM)
- Thiazide diuretic (chlorthalidone preferred) (first choice)
- CCBs

CKD (Black/Non)
- ACE or ARB

(amlodipine, -PINES, dilt, verapamil)

Question 10

ACE vs ARB *

Answer 10

• Use more ARBs instead of ACEs
• Evidence is changing through elimination of risk factors
• ARBs rarely cause cough or angioedema

Contraindication
- HTN or Diabetic Kidney Disease with microalbuminuria: ACE or ARB
- HF/CAD/MI: ACE
- Angioedema with ACE: Can use ARB if not severe reaction

Question 11

case studies within pp