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52 Cards in this Set
- Front
- Back
what is the most common contributory factor for morbidity and mortality from CVD, CVA, and renovascular disease
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essential hypertension
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if untreated, a 35 yo man with BP of 150/100 has his life expectancy reduced by...
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28 years
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individuals who are normotensive at age 55 have a __% lifetime risk for developing hypertension
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90%
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What percentage of individuals have inadequate control of their hypertension
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66%
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Name three populations where hypertension (HTN) is most prevalent
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men
elderly African-Americans |
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Has HTN related mortality increased or decreased significantly in the last two decades
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decreased significantly
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How often do HTN clusters with metabolic abnormalities of obesity, glucose intolerance, and dyslipidemia occur?
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less than 20% of the time
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what appears to be the common hormonal inciting event for HTN
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insulin resistance
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again BP =
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CO x PVR
= HRxpreload/afterload x contractility x PVR |
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What is salt sensitive BP related to (increased sodium intake increases BP)
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low renin BP (as opposed to high renin BP)
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what's the work up for HTN
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PE- fundi, carotids, thyroid, lungs, heart, abdomen, pulses, lower extremities
Lab- CBC, CHEM-7, calcium, lipid profile, U/A, 12 lead EKG |
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what is prehypertension (in terms of systolic pressure, diastolic)
when would you use drugs |
120-139 over
80-89 use drugs to treat BP to 130/80 for kidney disease and diabetes |
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what is hypertension stage 1?
what drugs to use? |
140-159 over
90-99 thiazide type diuretics consider ACEI, ARB, BB, CCB, or combo |
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what is hypertension stage 2?
what drugs regimen? |
>160 over
>100 two-drug combos |
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Name five classes of drugs acceptable for heart failure
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diuretic
beta blocker ACE inhibitor angiotensin receptor blocker aldosterone antagonist |
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Name three classes of drugs for post MI
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beta blocker
ACEI aldosterone antagonist |
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Name four classes of drugs for high coronary disease risk
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diuretic
beta blocker ACEI calcium channel blocker |
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Name five classes of drugs for diabetics
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diuretic
beta blocker ACEI angiotensin receptor blocker calcium channel blocker |
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name two classes of drugs for chronic kidney disease
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ACEI
angiotensin receptor blocker |
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name two classes of drugs for recurrent stroke prevention
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diuretic
ACEI |
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treatment goal for HTN is
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<140/90
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quantify the lifestyle modification shown to reduce blood pressure
weight reduction by... regular physical activity of... reduced alcohol intake to ... reduced dietary sodium to... |
weight 10 lbs or more
work out 30 minutes most days <1 oz ethanol per day <2.4 gm sodium per day |
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Name five components for the HTN treatment algorithm
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1. lifestyle modification
2. drug monotherapy 3. substitute new class of drug or add second drug 4. add third drug 5. begin with two drugs if BP stage 2 |
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this class of drug decreases PVR; is good with young athletes, in situations of mild renal failure, but drawbacks include cough, hyperkalemia, and precipitation of acute renal faiulre if used in HTN secondary to renal artery stenosis
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ACEI
(the "ils") |
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this class of drugs has a low incidence of side effects, no potentiation of bradykinin system, no cough, and may be helpful in young athletes, mild renal failure, CHF, DM, and renal disease
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angiotensin II receptor blockers (the "sartans")
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this class of drugs decreases heart rate and cardiac output; they are cadioprotective post MI and are also useful in migraine and angina patients because of this physiology; they may however aggravate asthma and CHF or cause impotence and depression
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beta blockers
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this class of drug has a PROVEN IMPACT ON MORBIDITY AND MORTALITY IN HYPERTENSION
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beta blockers
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this class of drugs decreases PVR, lowers heart rate and contractility; is useful in the elderly and patients with angina, or dyslipidemia; side-effects include constipation, AV block, and flushing or edema
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calcium channel blocker
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What did the Puget sound study show
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60% increase in MI for hypertensive patients on short acting dihydropyridines (nifedipine, amlodipine)--> long acting agents should be used instead
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this class of drugs is one of the original and still among the best for HTN; reduces extracellular fluid volume; works particularly well in African Americans and elderly; BEST DOCUMENTED REDUCTIONS IN MORBIDITY AND MORTALITY; disadvantages include lipidemia, hyperglycemia or gout, and can cause hypokalemia and impotence
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diuretics
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this class of drugs is useful in prostatic hypertrophy and dyslipidemia
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alpha-1-blockers
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this class of drugs is not first line but may have other advantages such as a weekly patch
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central alpha-2 agonists
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Name four common co-morbid ailments found in hypertensives
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arthritis
DM COPD CHF |
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what class would you give a type I diabetic
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ACEI
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what class would you give to patient with heart failure
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ACEI, diuretic
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what classes would you give with isolated systolic hypertension
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diuretic, calcium channel blocker
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what classes would you give for MI
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beta blocker
ACEI |
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___ has been virtually unsurpassed in preventing the CV complication of HTN but remains underutilized
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diuretics
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What is normal follow up for HTN
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initial follow up in 1-2 mo
then 3-6 mo if HTN well controlled |
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what is "step-down" care
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when BP is well controlled for 1 yr and the patient has no evidence of target organ damage, medication may be tapered and thn stopped if BPs remain below 130 over 85
follow should continue every 2 mo |
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in hypertensive emergency- which requires immediate control to prevent/reduce target organ damage- what drug is used for MI? for aortic dissection? for eclampsia?
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NTG for acute MI
esmolol in aortic dissection hydralazine in eclampsia |
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what is the goal of hypertensive emergency treatment
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reduce mean arterial pressure by 20-25% within minutes to 2 hours, then gradually to 160/100
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what drug is completely unacceptable in treating urgent hypertension
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short acting nifedipine- may precipitate acute MI or hypotension
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what is defined as inability to lower blood pressure despite maximal doses of 3 antihypertensive agents
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refractory hypertension
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what causes 43% of refractory hypertension
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sub-optimal therapy
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in persons older than 50, systolic pressure greater than ___ is much more important CVD risk factor than diastolic BP
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140
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risk of CVD beginning at 115/75 doubles with each increment of ___
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20/10 mmHg
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individuals with systolic BP of 120-139 or diastolic BP of 80-89 should be considered ___ and require ___
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pre-hypertensive;
health-promoting lifestyle modifications |
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___ should be used in drug treatment for most patients with uncomplicated HTN
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thiazide diuretics
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most patients with HTN will require ___ to achieve goal BP (<140/90, or <130/80 for patients with diabetes or chronic kidney disease)
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two or more antihypertensive drugs
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if blood pressure is ___ above goal BP, consideration should be given to initiating therapy with two agents, one of which usually should be a thiazide type diuretic
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>20/10 above goal
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the most effective therapy presecribed by the most careful clinician will control hypertension only if patients are ___
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motivated
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