Secondary Hypertension

Question 1

What is the treatment of secondary HTN?

Answer 1

often interventional, including surgical correction of:
- renal artery stenosis
- adrenal adenoma
- pheochromocytoma

treat the underlying issue

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Question 2

When are ACE-I’s, ARBs, and direct renin inhibitors are not recommended to use for Secondary HTN intervention?

Answer 2

in bilateral renal artery stenosis
as they can accelerate renal failure

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Question 3

What certain disease processes require a combined pharmacologic and surgical approach?

Secondary HTN

Answer 3

Pheochromocytoma

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Question 4

What can Primary hyperaldosteronism can be treated with?

Answer 4

Aldosterone Antagonist
(Ex: Spironolactone)

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Question 5

What medications of Secondary HTN patients are instructed to be paused on the day of surgery?

Answer 5

ACE-I’s and Diuretics

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Question 6

Preop BP assessment is often complicated by ____ (white-coat HTN)

Assessing BP in a single moment in time does not give an ____ picture of overall BP trends

Current guidelines state that multiple elevated BP readings ____ are necessary for a diagnosis of HTN

Answer 6

• anxiety
• accurate
• over time

PCP have the pt trend their BP at home

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Question 7

When should surgery NOT be delayed for patients with elevated BP?

Answer 7

• in asymptomatic pt w/oother risk factors
• pt. experiencing extreme HTN or end-organ injury that could bereversed w/BP control

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Question 8

If BP elevated, a pressure on what side of the arm should be obtained?

Answer 8

contralateral side
(of first arm)

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Question 9

What is necessary to carefully review to gain an overall picture of CV health of Secondary HTN?

Answer 9

• clinic data
• homeBP’s
• thorough history

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Question 10

What symptoms suggests Pheochromocytoma is the cause of Secondary HTN?

Answer 10

• flushing
• sweating
• palpitations

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Question 11

What symptom suggests Renal Artery Stenosis is the cause of Secondary HTN?

Answer 11

Renal bruit

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Question 12

What symptom suggests Hyperaldosteronism is the cause of Secondary HTN?

Answer 12

hypokalemia

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Question 13

What is the risk of stopping Beta Blockers or Clonidine before surgery of pt’s with Secondary HTN?

Answer 13

can cause rebound effects

So, have patient take BBs or Clonidine before surgery

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Question 14

What is the risk of stopping Calcium Channel Blockers before surgery of pt’s with Secondary HTN?

Answer 14

increased perioperative cardiovascular events

So, have patient take CCBs before surgery

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Question 15

What are hypertensive pts prone to and why?

Answer 15

hemodynamic volatility

d/t physiologic factors along with the BP meds on-board

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Question 16

What can brief periods of hypotension cause on pts with organ damage from chronic HTN?

Answer 16

• acute kidney injury
• myocardial injury
• death

Clinicians need to consider acute intraoperative BP changes in the context of end-organ functional reserve

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