Primary and Secondary HTN

Question 0

Reducing sodium in the diet by 50% is the equivalent of what other intervention?

Answer 0

Tobacco cessation

Question 1

What is the cut off for “controlled” HTN?

Answer 1

<140/90

Question 2

Why is HTN a risk factor for other cardiovascular disease?

Answer 2

Accelerates atherosclerosis

Question 3

Patients with HTN often have other cardiovascular risk factors such as:

Answer 3

• obesity
• Type 2 diabetes
• hypercholesterolemia

Question 4

How much of a reduction in systolic BP is associated with reduced risk of MI and stroke in people under 60? Diastolic?

Answer 4

Systolic: 10-15 mm Hg
Diastolic: 5-6 mm Hg

Question 5

How many visits with BP of >/=160 systolic or >/=100 diastolic are required to diagnose HTN?

Answer 5

3 visits at least a week apart

Question 6

How many visits with a BP 140-160 mm Hg systolic and/or 90-100 mm Hg diastolic are required to diagnose HTN?

Answer 6

5

Question 7

What is the BP cut off for diagnosing HTN via ambulatory measurements?

Answer 7

> /=135 SBP and/or >/=85 DBP

Question 8

What are the target BP values for treatment in HTN patients with pre-existing diabetes chronic renal failure/disease?

Answer 8

<130/80 mm Hg

Question 9

How high does the BP have to be to be able to diagnose HTN on the second office visit even in the absence of target organ failure, diabetes or chronic renal failure/disease?

Answer 9

> /=180 SBP and/or >/= 110 DBP

Question 10

Which neural pathway regulates BP?

Answer 10

Sympathetic Nervous System

Question 11

What makes up the humoral pathway of BP regulation?

Answer 11

RAAS

Question 12

What is the MOA of angiotensin II?

Answer 12

Causes release of aldosterone from the adrenal cortex and directly causes vasoconstriction.

Question 13

About what percentage of HTN is laballed primary HTN?

Answer 13

90-95%

Question 14

What is the definition of primary HTN?

Answer 14

Diagnosed HTN without an obvious cause.

Question 15

Would genetic factors play a role in primary HTN?

Answer 15

Undoubtedly

Question 16

What are some of the theories presented in lecture on the cause of primary HTN?

Answer 16

• Mutations in genes coding for renal tubular sodium channels
• Enhanced response to circulating endogenous catecholamines
• Nature vs nuture

Question 17

When should suspect secondary HTN? (5)

Answer 17

• HTN occurs at the extremes of age with unexpected target organ damage
• Occurs abruptly
• Response to therapy is atypical
• Renal failure is present
• Hypokalemia or hyper calcemia is present

Question 18

What does the A in the ABCDE diagnostic aid stand for? (3)

Answer 18

• Accuracy
• Apnea
• Aldosteronism

Question 19

What does the B in the ABCDE diagnostic aid stand for? (2)

Answer 19

• Bruits

- Bad kidneys

Question 20

What does the C in the ABCDE diagnostic aid stand for? (3)

Answer 20

• Catecholamines eg: pheochromocytoma
• Coarctation of the aorta: upper limb HTN
• Cushing’s syndrome: pituitary adenoma causing increased cortisol release and by extension Na+/water retention

Question 21

What does the D in the ABCDE diagnostic aid stand for? (2)

Answer 21

• Diet: sodium >2300g/day

- Drugs (prescription and non-prescription)

Question 22

What does the E in the ABCDE diagnostic aid stand for? (2)

Answer 22

• Erythropoietin

- Endocrine disorders: hyper/hypothyroidism and hyperparathryoidism

Question 23

What are the four organs of target organ damage in HTN?

Answer 23

• Eyes
• Brain
• Kidneys
• Heart

Question 24

Describe the changes seen in Grade 1 hypertensive retinopathy.

Answer 24

Initially diffuse arterial spasm and narrowing, but fibrosis eventually leads to focal narrowing

Question 25

Describe the changes seen in Grade 2 hypertensive retinopathy.

Answer 25

Arteriole wall thickening where an artery crosses a vein causes compression of the vein (called arterio-venous nicking).

Question 26

Where do we look in the eye for changes due to hypertensive retinopathy?

Answer 26

Center of the retina called the fundus

Question 27

Do most patients with HTN report visual changes?

Answer 27

Nein

Question 28

How much would you have to reduce a patient’s BP by in order to reduce the incidence of stroke by 10%?

Answer 28

2-3 mm Hg

Question 29

Arterial HTN provides increased preload or afterload on the heart?

Answer 29

Afterload

Question 30

What is the physiologic response of the heart to chronic HTN? And what is this an independent risk factor for?

Answer 30

• Left ventricular hypertrophy

- Stroke, MI, sudden death

Question 31

What are the two top causes of renal disease?

Answer 31

1 is diabetes and #2 is HTN

Question 32

What process normally protects the renal microvasculature from high BP?

Answer 32

Autoregulation

Question 33

What is the process of rarefaction?

Answer 33

Decrease in flow of vascular beds due to increasing size of muscularis layer of arteries which results in a decrease of lumen size.

Question 34

What is the net effect of increased vascular resistance in the kidneys?

Answer 34

Irreversible parenchymal scarring (hypertensive nephrosclerosis)

Question 35

Functionally, what is the net result of hypertensive renal disease?

Answer 35

Disordered sodium, potassium, and water filtration, resorption and secretion. Also results in albuminuria which is an independent indicator of adverse CV events.

Question 36

About what BP is considered a hypertensive emergency?

Answer 36

~250 SBP and 140 DBP

Question 37

What are some clinical features of hypertensive encephalopathy?

Answer 37

Headache, vomiting, confusion, seizures and ultimately coma.

Question 38

What are common CV conditions commonly associated with a hypertensive emergency? (5)

Answer 38

• Hypertensive Encephalopathy
• Angina pectoris
• Congestive heart failure
• Aortic dissection
• Acute renal failure