Primary Care - Hypertension

Front 1

what does the JNC do?

Back 1

issues guidelines etc re HTN

Front 2

definition of HTN

Back 2

systolic >140 or diastolic >90

Front 3

how many measurements for diagnosing HTN

Back 3

at least 2, one in each arm, on 2 or more visits

Front 4

for how long does patient need to be seated before measuring BP

Back 4

5

Front 5

should you ask about the following in a HTN interview: past HTN diagnosis and how long?

Back 5

yes

Front 6

should you ask about the following in a HTN interview: CHF symptoms

Back 6

yes

Front 7

should you ask about the following in a HTN interview: peripheral vascular disease

Back 7

yes

Front 8

should you ask about the following in a HTN interview: cancer history?

Back 8

no

Front 9

should you ask about the following in a HTN interview: diabetes

Back 9

yes

Front 10

should you ask about the following in a HTN interview: cardiovascular disease

Back 10

yes

Front 11

should you ask about the following in a HTN interview: cholesterol issues

Back 11

yes

Front 12

should you ask about the following in a HTN interview: glaucoma

Back 12

no

Front 13

should you ask about the following in a HTN interview: premature heart attack or stroke?

Back 13

yes

Front 14

should you ask about the following in a HTN interview: diabetes family history

Back 14

yes

Front 15

should you ask about the following in a HTN interview: hypercholesterolemia

Back 15

yes

Front 16

should you ask about the following in a HTN interview: colon cancer

Back 16

no

Front 17

should you ask about the following in a HTN interview: OTC and complementary meds

Back 17

yes

Front 18

should you ask about the following in a HTN interview: weight change

Back 18

yes

Front 19

should you ask about the following in a HTN interview: smoking history

Back 19

yes

Front 20

should you ask about the following in a HTN interview: diet history

Back 20

yes

Front 21

should you ask about the following in a HTN interview: psychosocial stressors

Back 21

yes

Front 22

should you assess the following on physical exam? 2 blood presure measurements 2 minutes apart on each arm

Back 22

yes

Front 23

should you assess the following on physical exam? BMI

Back 23

yes

Front 24

should you assess the following on physical exam? fundiscopic exam

Back 24

yes

Front 25

should you assess the following on physical exam? tympanic membranes

Back 25

no

Front 26

should you assess the following on physical exam? thyroid

Back 26

yes

Front 27

should you assess the following on physical exam? neck bruits

Back 27

yes

Front 28

should you assess the following on physical exam? PMI

Back 28

yes

Front 29

should you assess the following on physical exam? abdominal bruits

Back 29

yes

Front 30

should you assess the following on physical exam? hepatosplenomegaly

Back 30

yes

Front 31

should you assess the following on physical exam? genital exam

Back 31

yes

Front 32

should you assess the following on physical exam? peripheral vein assessment

Back 32

yes

Front 33

should you assess the following on physical exam? lower extremity edema

Back 33

yes

Front 34

should you assess the following on physical exam? neurological evaluation

Back 34

yes

Front 35

should you assess the following on physical exam? skin

Back 35

yes

Front 36

lifetime risk of getting HTN

Back 36

90%

Front 37

high BP increases risk of

Back 37

heart attack
CHF
stroke renal disease

Front 38

what % of arm circumference should the bladder of the cuff be?

Back 38

80%

Front 39

measurement for stage 2 HTN

Back 39

>160 or >100

Front 40

to evaluate essential HTN should you order? - EKG

Back 40

yes

Front 41

to evaluate essential HTN should you order? - TFTs

Back 41

no

Front 42

to evaluate essential HTN should you order? - hematocrit

Back 42

yes because anemia makes a CV event more likely

Front 43

to evaluate essential HTN should you order? - K, Cr, Ca, Cl, Na

Back 43

K, Cr, Ca (not CL or Na)

Front 44

to evaluate essential HTN should you order? - urinary albumin excretion or alb/crit ration

Back 44

yes

Front 45

what BMI increases CVD risk

Back 45

>=30

Front 46

CVD risk factors

Back 46

HTN
smoking
BMI over 30
physical inactivity
dyslipidemia
DM
Microalbuminuria or GFR <60
men >55, women >65
famHx of men under 55 or women under 65

Front 47

components of metabolic syndrome

Back 47

htn
obesity
dyslipidemia
DM

Front 48

heart evidence of HTN end organ damage

Back 48

LVH (2nd best prognosticator of death)
angina or prior MI
prior cath
CHF

Front 49

target organ damage indicators outside of heart

Back 49

stroke/tia
CKD
PAD
retinopathy

Front 50

secondary HTN cuases

Back 50

sleep apnea
drug induced
CKD
primary aldosteronism
renovascular disease
chronic steroid therapy
pheo
coartcation of aorta
thyroid/parathyroid disease

Front 51

initial drug therapy for prehypertension

Back 51

non indicated unless compelling indications (CKD, DM if over 130/80)

Front 52

initial drug therapy for Stage 1 HTN

Back 52

thiazide

Front 53

initial drug therapy for stage 2 HTN

Back 53

two drug cobo, usually thiazide and ACEI or
ARB, BB, CCB

Front 54

BP reduction from? - weight reduction

Back 54

5-20 per 10 Kg

Front 55

BP reduction from? - DASH plan

Back 55

8-14

Front 56

BP reduction from? - sodium restriction

Back 56

2-8

Front 57

BP reduction from? - physical activity

Back 57

4-9

Front 58

BP reduction from? - moderation of alcohol

Back 58

2-4

Front 59

normal BMI

Back 59

18.5-24.9

Front 60

what's in DASH diet

Back 60

fruits
vegies
lowfat dairy
reducted saturated and total fat

Front 61

what is meant by physical activity

Back 61

30 minutes aerobic most day sof week

Front 62

moderate alcohol consumption:

Back 62

2 or fewer drinks per day for men, 1 for women or light men

Front 63

what are compelling indications for starting drug therapy for stage 1 HTN at 130/80

Back 63

CHF
post MI
high CAD risk
DM
CKD
recurrent stroke prevention

Front 64

drugs for HTN in CHF

Back 64

thiazides
bb
acei
arb
aldo ant

Front 65

drugs for HTN in post MI

Back 65

bb
acei
aldo ant

Front 66

drug therapy for HTN in high CAD risk

Back 66

thiazide
bb
acei
ccb

Front 67

drug therapy for HTN in dM

Back 67

thiazide
bb
acei
arb
CCb

Front 68

drug therapy for HTN in CDK

Back 68

ACEI
ARB

Front 69

drug therapy for HTN in recurrent stroke

Back 69

thiazide
ACEI

Front 70

which HTN meds reduce afterload

Back 70

ACEI
ARBs

Front 71

which HTN meds reduce morbidity and mortality in CHF but should not be titrated to higher levels

Back 71

aldosterone antagonists

Front 72

do beta blockers mask hypoglycemia in diabetics?

Back 72

no -- and they are excellent reducers of morbidity and mortality

Front 73

after what age do you really need to care about BP goal

Back 73

50

Front 74

when do you add additional agents in attaining BP control

Back 74

when you max out on the first one

Front 75

which is better BID or daily rx

Back 75

daily, because it usually gvies more constant coverage

Front 76

why does smoking interfere with BP treatment

Back 76

nicotine increases blood pressure

Front 77

what needs to be monitored for patients in BP tx

Back 77

K and creatinine 1-2 times per year
follow-up visits every month until goal reached, 3-6 months therafter

no rules, but periodic checking of fasting chol, fasting glucose and microalbumin might be helpful

Front 78

definition of resistant hypertenison

Back 78

failure on a three drug regimen wthat includes a diuretic

Front 79

what are bad BP meds for pregnant women

Back 79

ACEIs, ARBs

Front 80

what HTN med reaction are AAs more vulnerable to?

Back 80

angiodema

Front 81

what meds are AAs less responsive to

Back 81

monotherapy with
BB
ACEI
ARBs

Front 82

what group has lowest rate of BP control

Back 82

elderly

Front 83

do older patients get same BP med dosing?

Back 83

yes, but usually start out lower