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PHRM 844 > Therapeutics of HTN pt. 1 > Flashcards

Therapeutics of HTN pt. 1 Flashcards

1
Q

what is essential htn

A

elevated arterial blood pressure with an unknown etiology

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2
Q

what is secondary htn

A

elevated arterial blood pressure due to concurrent medical conditions or medications

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3
Q

what is isolated systolic htn

A

systolic BP values are elevated and diastolic BP values are not

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4
Q

what is resistant htn

A

failure to attain BP goal while adherent to a regimen that includes at least 3 agents at max dose (including a diuretic) or when 4 or more agents are needed

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5
Q

what is orthostatic hypotension

A

a systolic BP decrease of >20 mmHg, a diastolic BP decrease of >10 mmHg within three minutes of positional change, and/or increase in HR >20 bpm

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6
Q

what are essential htn pathophysiology

A

humoral abnormalities
neuronal mechanisms
vascular endothelial mechanisms
peripheral autoregulation defects
electrolyte disturbances

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7
Q

what are the modifiable htn risk factors

A

high sodium intake
obesity
low potassium intake
excess alcohol intake

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8
Q

what are the non-modifiable htn risk factors

A

age
ethnicity
genetic predisposition
gender

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9
Q

what can cause secondary htn

A

CKD
renovascular disease
primary aldosteronism
OSA
drug-induced
food/substances
pheochromocytoma
cushing’s syndrome/chronic steroid use
thyroid or parathyroid disease
aortic coarctation

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10
Q

what substances can increase BP

A

illicit drugs
caffeine
nicotine
decongestants
amphetamines
antidepressants
atypical antipsychotics
immunosuppressants
OCs
NSAIDs
systemic steroids
oncology agents

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11
Q

what is the in office BP measurement

A

two readings, 5 minutes apart, and sitting in a chair. take measurement in opposite arm to confirm reading

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12
Q

what is ambulatory BP monitoring indicated for

A

indicated for white coat, masked htn, nighttime BP dipping

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13
Q

what is home BP monitoring indicated for

A

indicated for evaluation of white coat, masked htn, and response to therapy

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14
Q

what is normotensive BP pattern

A

no htn in healthcare setting
no htn in home/AMB setting

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15
Q

what is sustained htn BP pattern

A

htn in healthcare setting
htn in home/AMB setting

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16
Q

what is masked htn pattern

A

no htn in healthcare setting
htn in home/AMB setting

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17
Q

what is white coat htn pattern

A

htn in healthcare setting
no htn in home/AMB setting

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18
Q

what are the pros of HBPM and ABPM

A

confirm diagnosis
aide in med titration
identify white coat and masked htn
better predictor of long term cv outcomes

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19
Q

what are the cons of HBPM and ABPM considerations

A

user error
equipment cost
will insurance cover?

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20
Q

what is normal BP

A

<120 AND <80

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21
Q

what is elevated BP

A

120-129 AND <80

22
Q

what is htn stage 1

A

130-139 OR 80-89

23
Q

what is htn stage 2

A

> =140 OR >=90

24
Q

what is the ACC/AHA recommendation for normal BP

A

healthy lifestyle changes
reassess in 1 year

25
Q

what is the ACC/AHA recommendation for elevated BP

A

non-pharm tx
reassess in 3-6 months

26
Q

what is the ACC/AHA recommendation for htn stage 1

A
27
Q

what is the ACC/AHA recommendation for htn stage 2

A
28
Q

how often should pts at BP goal follow up

A

q3-6 months

29
Q

what is the BP threshold for tx initiation for clinical CVD or 10yr ASCVD risk >= 10%

A

> = 130/80

30
Q

what is the BP threshold for tx initiation for no clinical CVD or 10yr ASCVD risk <10%

A

> =140/90

31
Q

what is the BP threshold for tx initiation for older persons (>=65yo)

A

systolic BP >=130

32
Q

what is the BP threshold for tx initiation for pt with stable ischemic heart disease

A

> = 130/80

33
Q

what is the BP threshold for tx initiation for pt with secondary stroke prevention

A

> =140/90

34
Q

what are the goals of htn tx

A

decrease morbidity/mortality by:
reaching BP targets
select agent with proven CV benefit

35
Q

what is the ACC/AHA and ADA BP goal

A

<130/80

36
Q

what is the ACC/AHA BP goal for elderly

A

<140/90

37
Q

what is the KDIGO BP goal

A

SBP <120 for adults with elevated BP and CKD, if tolerated

38
Q

what is SPRINT trial’s subject population

A

pts without diabetes or prior stroke

39
Q

what is SPRINT trial’s outcome

A

reduced death in intensive group
average of 2.8 meds needed to achieve systolic <120
increased risk of hypotension, electrolyte imbalances, AKI

40
Q

what is ACCORD trial’s subject population

A

pts with T2DM, age 40-79, CVD or multiple CVD risk factors

41
Q

what is ACCORD trial’s outcome

A

reduced risk of stroke by 41%
increased risk of AEs

42
Q

what is weight loss impact on SBP

A

-5 mmHg

43
Q

what is DASH diet impact on SBP

A

-11 mmHg

44
Q

what is decreased sodium intake impact on SBP

A

-5 to 6 mmHg

45
Q

what is enhanced potassium intake impact on SBP

A

-4 to 5 mmHg

46
Q

what is physical activity impact on SBP

A

-4 to 8 mmHg

47
Q

what is moderate alcohol intake impact on SBP

A

-4 mmHg

48
Q

what does the DASH diet recommend

A

veggies and fruits
whole grains
fat free or low fat dairy products
fish, poultry, beans
nuts, vegetable oil
foods rich in K, Ca, Mg, fiber, protein, low Na

49
Q

what foods do DASH diet restrict

A

foods high in sat fats
sweets
sugar sweetened beverages

50
Q

what are htn pharm tx

A

ACEi
ARBs
CCB
direct renin inhibitors
Beta blockers
diuretics
alpha 1 blockers
central alpha 2 agonists
vasodilators

PHRM 844 (13 decks)

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