Therapeutics of Hypertension

Question 1

what is a common cause of secondary hypert

Answer 1

sleep apnea

Question 2

which race/ethnicity is hypert higher in?

Answer 2

non-hispanic black adults

Question 3

T/F starting at 115/75, risk of CVD doubles ever 20/10 increase

Answer 3

true

Question 4

what is weight losses impact on SBP?

Answer 4

-5

Question 5

what is a heart-healthy diets impact on SBP?

Answer 5

-11

Question 6

what is sodium reductions impact on SBP?

Answer 6

-5-6

Question 7

what is potassium supplementations impact on SBP?

Answer 7

-4-5

Question 8

what is exercise’s impact on SBP?

Answer 8

-5-8

Question 9

how would drinking no more than 2 for men and 1 for women standard drinks per day impact SBP?

Answer 9

-4

Question 10

what does the ASCVD risk assessment tell us?
identify/interpret the score criteria

Answer 10

10 year risk of a cardiovascular complication
less than 5%: low risk
5-7.45%: borderline
7.5-20%: intermediate
over 20%: high risk

Question 11

according to the ADA, people with diabetes and hypertension should aim to target their blood pressure to be?

Answer 11

less than 130/80

Question 12

according to ACC/AHA guidelines, anyone with a comorbidity or over the age of 65 should aim to have a blood pressure of?

Answer 12

less than 130/80

Question 13

if pt has a BP of <130/80, what is the guideline?

Answer 13

no change, reassess in 1 year

Question 14

if pt has BP of 120-129/80, what is the guideline?

Answer 14

nonpharm therapy, reassess in 3-6 months

Question 15

if pt has BP of 130-139/80-89, what is the guideline?

Answer 15

if ASCVD less than 10%, nonpharm therapy and reassess in 3-6 months
if more than 10%, nonpharm therapy plus BP med and reassess in 1 month

Question 16

if pt has BP of 140/90, what is the guideline?

Answer 16

nonpharm therapy and BP med and reassess in 1 month

Question 17

what are the first line treatment for HTN?

Answer 17

thiazide diuretics, CCBs, and ACE-I/ARBs

Question 18

based on the reviewed study, which drug showed the best results for reducing SBP?

Answer 18

chlorthalidone

Question 19

based on the reviewed study, which drug showed the best results for reducing DBP?

Answer 19

Amlodipine

Question 20

based on the reviewed study, how did chlorthalidone, amlodipine, and lisinopril compare towards preventing a cardiac event?

Answer 20

they all had the same effect on outcome

Question 21

based on the reviewed study, what was the concluding drug of choice to treat HTN?

Answer 21

thiazide-diuretics

Question 22

what are the SEs of thiazide diuretics?

Answer 22

hyponatremia, hypomagnesemia, hypokalemia, hyperuricemia, hypercalcemia

Question 23

what should we monitor with pts taking thiazide diuretics?

Answer 23

BP, electrolytes, renal function

Question 24

if a pt has hypertension and CKD, which HPT drug would be most beneficial?

Answer 24

ACE-Is

Question 25

if a pt has hypertension and left ventricular dysfunction, which HPT would be most beneficial?

Answer 25

ACE-Is

Question 26

what are the SEs of ACE-Is?

Answer 26

hypotension, hyperkalemia, angioedema, increased serum creatinine, dry cough

Question 27

when are ACE-Is contraindicated as treatment for HPT?

Answer 27

pregnancy or bilateral renal artery stenosis

Question 28

what should we monitor for with pts using ACE-Is?

Answer 28

BP, renal function, and potassium

Question 29

why can ACE-Is potentially cause angioedema?

Answer 29

ACE-Is block degradation of bradykinin which increases as a result

Question 30

which ACE-Is are used once daily? (rest are 2+ more daily)

Answer 30

Fosinopril Lisinopril Perindopril

Question 31

The place in therapy and clinical benefits of ARBs is similar to ACE-Is. what is a SE ARBs don't cause that ACE-Is can?

Answer 31

cough

Question 32

what are SEs from Non-DHP CCBs?

Answer 32

bradycardia worsening HF (more with verapamil) hypotension constipation (more with verapamil)

Question 33

what are drug-drug interactions of Non-DHP CCBs?

Answer 33

may increase concentration of other Cyp3A4 substrates such as simvastatin and lovastatin

Question 34

Cardizem SR is given how often?

Answer 34

BID

Question 35

Cardizem CD is given how often?

Answer 35

QD

Question 36

Verapamil IR is given how often?

Answer 36

TID

Question 37

Verapamil SR/ER is given how often?

Answer 37

QD

Question 38

what place in therapy do we use aldosterone receptor antagonists?

Answer 38

add-on therapy for hypertension heart failure

Question 39

SEs of aldosterone receptor antagonists?

Answer 39

hyperkalemia gynecomastia (spironolactone) dizziness

Question 40

what adverse effect can hydralazine cause?

Answer 40

drug-induced lupus-like syndrome

Question 41

first line therapy for HPT is typically thiazide, CCB, ACE-I, or ARB. However, for pts with heart issues, what therapy is recommended?

Answer 41

Beta-blocker with an ACE-I or ARB

Question 42

how do you classify resistant hypert?

Answer 42

BP above goal using 3 diff drug classes including a diuretic

Question 43

which drugs can be given IV in hypertension emergencies?

Answer 43

nicardipine, sodium nitroprusside, nitroglycerine, hydralazine, esmolol, labetalol, enalapril, and phentolamine

Question 44

which drug is the treatment of choice for chronic HPT in pregnancy? what are alternative treatments?

Answer 44

methyldopa labetalol, CCBs, BBs (excluding atenolol)

Question 45

when do we treat children with HPT?

Answer 45

SBP and/or DBP greater than the 95th percentile for sex, age, and height on at least 3 occasions