Crr Week 7: Hypertension (Blair)

Front 1

What systolic/diastolic values classify hypertension?

Back 1

Systolic >140 and/or diastolic >90 mmHg

Front 2

Do prehypertension patients need to be treated?

What values classify prehypertension?

Back 2

No, but they should be warned that they have a higher risk of developing hypertenion.

Systolic 120 - 139 mmHg
Diastolic 80 - 89 mmHg

Front 3

Describe how systolic and diastolic pressures increase with age

Back 3

Both pressures tend to increase with age up to about 50 years old. After that, the diastolic pressure levels off or decreases while the systolic pressure continues to increase

Front 4

Before age 50, which pressure (systolic/ diastolic) is a greater risk factor for cardiovascular disease?

What about after age 50?

Back 4

Before age 50 --> diastolic

After age 50 --> systolic

Front 5

Are the majority of cases of hypertension caused by known or unknown factors? What sort of hypertension is this?

Back 5

Unknown cause (85-90%)
(termed primary hypertension)

Front 6

Hypertension due to an identifiable cause is termed..?

Back 6

Secondary hypertension (10 - 15% cases)

Front 7

List some problems that chronic hypertension can cause.

Back 7

1. Arteriosclerosis
2. Atherosclerosis
3. Increased risk of blood clots
4. Increased buildup of plaques
5. Vascular weakness
6. Vascular scarring
7. Tissue damage due to arterial narrowing and ischemia
8. Increased cardiovascular workload

Front 8

List some deleterious events that can result from hypertension.

Back 8

1. Stroke
2. Angina
3. Myocardial infarction
4. Heart failure
5. Renal failure
6. Peripheral artery disease
7. Blindness

Front 9

In addition to hypertension, what are some risk factors that enhance a patients likelihood of developing cardiovascular disease?

Back 9

1. High cholesterol
2. Low HDL
3. Smoking
4. Diabetes
5. Left ventricular hypertrophy

Front 10

What should the target blood pressure be for managing hypertension?

Back 10

BP < 140/90 mmHg
(with an emphasis on reducing systolic pressure)

Front 11

If a patient has hypertension along with atherosclerosis, diabetes, or renal disease, what should the target blood pressure be?

Back 11

130/80 mmHg

Front 12

If a patient has hypertension along with atherosclerosis, diabetes, or renal disease, what should the target blood pressure be?

Back 12

< 130/80 mmHg

Front 13

What is the first step in the management of hypertension?

Back 13

Trying to get patients to modify their lifestyles

Front 14

What is the first step in the management of hypertension?

Back 14

Trying to get patients to modify their lifestyles

Front 15

What is the best way for people with prehypertension to lower their blood pressure?

Back 15

Lifestyle modifications

Front 16

What is the best way for people with prehypertension to lower their blood pressure?

Back 16

Lifestyle modifications

Front 17

For reducing hypertension, patients should try to consume less than ______grams of sodium per day.

Back 17

2.4 grams
(100 mmol)

Front 18

For reducing hypertension, patients should try to consume less than ______grams of sodium per day.

Back 18

2.4 grams
(100 mmol)

Front 19

For lowering blood pressure, patients should limit their alcohol consumption to how many drinks per day?

Back 19

Males --> < 2 drinks/day
Females --> <1 drink/day

Front 20

For lowering blood pressure, patients should limit their alcohol consumption to how many drinks per day?

Back 20

Males --> < 2 drinks/day
Females --> <1 drink/day

Front 21

How does the body maintain a high blood pressure in primary hypertension?

Back 21

Both the baroreceptor reflex and the renin-angiotensin-aldosterone system seem to be reset to a higher level of blood pressure

Front 22

How does the body maintain a high blood pressure in primary hypertension?

Back 22

Both the baroreceptor reflex and the renin-angiotensin-aldosterone system seem to be reset to a higher level of blood pressure

Front 23

How does the body regulate acute changes in blood pressure?

Back 23

Baroreceptor reflex

Front 24

How does the body regulate acute changes in blood pressure?

Back 24

Baroreceptor reflex

Front 25

How does the body regulate chronic changes in blood pressure?

Back 25

Renal mechanisms
(renin-angiotensin-aldosterone system)

Front 26

How does the body regulate chronic changes in blood pressure?

Back 26

Renal mechanisms
(renin-angiotensin-aldosterone system)

Front 27

How does pheochromocytoma result in high blood pressure?

Back 27

Excessive release of epinephrine and norepinephrine produce vasoconstriction

Front 28

How does pheochromocytoma result in high blood pressure?

Back 28

Excessive release of epinephrine and norepinephrine produce vasoconstriction

Front 29

How does hyperaldosteronism result in high blood pressure?

Back 29

Excessive release of mineralcorticoids leads to salt and water retention

Front 30

How does hyperaldosteronism result in high blood pressure?

Back 30

Excessive release of mineralcorticoids leads to salt and water retention

Front 31

What is the primary limitation to the effectiveness of an antihypertensive drug?

Back 31

Compensatory responses that counteract the drug's effect

Front 32

In general, a patient with a blood pressure that is no more than ___/____ mmHg higher than the goal pressure of 140/80 mmHg can be adequately treated with a SINGLE antihypertensive drug.

Back 32

20/10 mmHg higher

*With an even higher BP, the patient will likely require two or more drugs

Front 33

Which drugs are typically recommended for treating Stage 1 hypertension?

Back 33

*Thiazide-type diuretics <-- First drug given to nearly all hypertensive patients

(May consider ACEI, ARB, BB, CCB, or combo)

Front 34

Which drugs are typically recommended for treating Stage 2 hypertension?

Back 34

Two-drug combination:
Thiazide diuretic and ACEI, or ARB, or BB, or CCB

Front 35

The clinical trials that have shown the greatest effect for thiazides used which type?

Back 35

Chlorthalidone

*Currently, the best evidence shows that Chlorthalidone is more effective than hydrochlorohiazide

Front 36

What type of side effects do thiazides have? Are these normally mild or severe?

Back 36

*Thiazides have relatively mild side-effects and are well-tolerated by most people

Possible side effects:
1. Hypokalemia
2. Erectile dysfunction
3. Diabetes
4. Uric acid accumulation (gout is rare)

Front 37

What is the primary side effect of long-acting Ca2+ channel blockers?

Back 37

Peripheral or pulmonary edema

(Nifedipine, amlodipine, felodipine)

Front 38

What are the major factors that limit the utility of ACE inhibitors for the treatment of hypertension?

Back 38

1. Dry cough
2. Angioedema
3. Hyperkalemia

(Captopril, Enalapril, Benzapril)

Front 39

Which drugs can be used if the dry cough with ACE inhibitors precludes their use?

What is another advantage of this group of drugs?

Back 39

Angiotensin receptor blocker (ARB)

*Also less angioedema

Front 40

Which combination of drugs has been found to reduce future cardiovascular risk better than the combination of benazepril and hydrochlorothiazide?

Back 40

ACE inhibitor (benazepril) and a Ca2+ channel blocker (amlodipine)

Front 41

Which combination of drugs is used not only to lower blood pressure, but also to reduce future cardiovascular events?

Back 41

ACE inhibitor + Ca2+-channel blocker

Front 42

An ACE inhibitor can be combined with a Ca2+-channel blocker to reduce what side-effect of the CCB?

Back 42

ACEI reduces the peripheral edema that may occur with the CCB.

Front 43

What sort of side effects and compensatory responses caused by thiazide diuretics can be curbed by drugs that inhibit the RAAS?

Back 43

RAAS inhibitors:

1. Limit the compensatory response (Na+/ water retention, vasoconstriction) to the diuretic
2. Reduce hypokalemia
3. Reduce glucose intolerance

Front 44

What are some examples of dihydropyridine Ca2+ channel blockers?

Back 44

1. Nifedipine
2. Nicardipine
3. Amlodipine
4. Felodipine

Front 45

Name 2 non-dihyrdopyridine Ca2+ channel blockers

Back 45

1. Verapamil
2. Diltiazem

Front 46

List 2 examples of INEFFECTIVE combinations of antihypertensive drugs.

Back 46

1. BB + RAAS inhibitors
2. BB + antiadrenergic drugs

Front 47

Beta blockers can be effectively paired with which other antihypertensive drugs?

Back 47

1. BB + thiazides
2. BB + dihydropyridine CCB

(*Do NOT pair with RAAS inhibitors)

Front 48

If a third drug is necessary to control hypertension, what should the 3 drug regimen include?

Back 48

1. Thiazide
2. CCB
3. RAAS inhibitor

Front 49

How is resistant hypertension defined?

Back 49

Failure to achieve goal BP in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic

Front 50

What are some causes of resistant hypertension?

Back 50

1. Improper BP measurement
2. Volume overload (inadequate diuretic, excess sodium intake, renal disease)
3. Drug-induced
4. Alcohol-induced
5. Obesity
6. Causes of secondary hypertension

Front 51

If a fourth drug is required due to resistant hypertension, which medications are recommended?

Back 51

1. Spironolactone (K+-sparing diuretic)
2. Direct vasodilator (hydralazine, minoxidil)
3. alpha-blocker (Doxazosin)

Front 52

Hypertensive emergencies occur when which two things happen?

Back 52

1. Blood pressure exceeds 180/120
2. Evidence of organ failure

Front 53

When treating a hypertensive emergency, how should you try to lower the blood pressure incrementally over time?

Back 53

1. Reduce MAP no more than 25% within minutes to an hour
2. Then reduce to 160/100-110 mmHg during the next 2 - 6 hours.

Front 54

List 3 medications that are used to treat hypertensive emergencies. Which is the most commonly used?

Back 54

1. Sodium nitroprusside <-- MOST COMMON
2. Diazoxide
3. Fenoldapam

*These are all direct vasodilators

Front 55

Alpha blockers are not recommended for treating most cases of hypertension, but an exception might be..?

Back 55

Men who have symptomatic benign prostatic hyperplasia

Front 56

What can be measured to test for high RAAS activity?

Back 56

plasma renin activity (PRA)

*If PRA is high, then RAAS inhibitors will likely be effective

Front 57

Give an example of how different races can respond to antithypertensive drugs in different ways.

Back 57

African Americans and Asians are more likely to have angioedema and dry cough in response to ACE inhibitors than whites