Renal hypertension II

Question 1

what is seen on CXR in coarctation of the aorta?

Answer 1

notched ribs

Question 2

what are the signs and symptoms of coarctation of the aorta?

Answer 2

• history of HTN
• SOB on exertion
• arm / leg BP greater than 20 systolic difference
• delayed pulses

Question 3

how does a low sodium diet affect ACE / ARB therapy? why?

Answer 3

low sodium diet may make HTN more sensitive to treatment with ACE / ARB (increaes renin release and makes BP more angiotensin II dependent)

Question 4

what tests are used to diagnose pheochromocytoma (low and high suspicion)?

Answer 4

• low index: 24 hour urine metanephrines and catecholamines

- high index: plasma for fractionated metanephrines

Question 5

why do you not use a beta blocker first prior to pheo surgery?

Answer 5

unopposed alpha receptor stimulation

Question 6

how does hypothyroidism cause HTN?

Answer 6

• decrease CO
• increase PVR
• increases DIASTOLIC BP

Question 7

how does hyperthyroidism cause HTN?

Answer 7

• increase CO
• decreased vascular tone
• increased SYSTOLIC BP

Question 8

steps to diagnosis of HTN

Answer 8

• step 1: accuracy (must have elevated BP on at least an initial screen and then 2 or more repeat visits)
• step 2: classification
• step 3: CVD risk factors
• step 4: target organ damage
• step 5: identifiable causes

Question 9

how are steps 1, 2, and 3 done to assess for HTN?

Answer 9

• history
• physical
• ancillary studies

Question 10

BP goals are set based on what criteria?

Answer 10

• age
• diabetes
• kidney disease status

Question 11

goal BP for patients over 60 without DM / CKD

Answer 11

under 150/90

Question 12

goal BP for patient under 60 without DM / CKD

Answer 12

under 140/90

Question 13

goal BP for all ages WITH DM or CKD

Answer 13

under 140/90

Question 14

a trial of lifestyle modifications is given to patients with what BP?

Answer 14

under 160/100 with no evidence of target organ damage