Term
| What qualifies someone as normal blood pressure? |
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Definition
<120/<80
Based on the average of 2 or more seated readings taken at each of 2 or more visits. |
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Term
| What qualifies someone as prehypertension? |
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Definition
120-139 / 80-89
Based on the average of 2 or more seated readings taken at each of 2 or more visits. |
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Term
| What qualifies someone as stage-1 hypertension? |
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Definition
140-159 / 90-99
Based on the average of 2 or more seated readings taken at each of 2 or more visits. |
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Term
| What qualifies someone as stage-2 hypertension? |
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Definition
>160/>100
Based on the average of 2 or more seated readings taken at each of 2 or more visits. |
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Term
| Define isolated systolic hypertension |
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Definition
| Systolic blood pressure 140 mm Hg or greater and diastolic blood pressure less than 90 mm Hg and staged appropriately (e.g., 170/78 mm Hg is defined as stage 2 isolated systolic hypertension). |
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Term
| What are the recommended follow up times based on blood pressure classification? |
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Definition
Normal- 2 years
Pre-hypertension- 1 year
Stage 1 HTN- 2 months
Stage 2 HTN- within 1 month or 1 week if >180/110 |
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Term
| List 9 Major risk factors for cardiovascular risk |
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Definition
1.Hypertension
2.Cigarette smoking
3.Obesity (body mass index 30 kg/m2)
4.Physical inactivity
5.Dyslipidemia
6.Diabetes mellitus
7.Microalbuminuria or estimated glomerular filtration rate <60 mL/min
8.Age (older than 55 for men, 65 for women)
9.Family history of premature CVD (men under age 55 or women under age 65) |
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Term
| List 9 key pieces of information to be obtained during a medical history for HTN |
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Definition
1. Blood pressure levels
2. History of heart or metabolic problems
3. Family history
4. Symptoms of secondary causes of hypertension
5. History of weight, physical activity, and tobacco use
6. Diet assessment
7. History of all drug use
8. Results of previous HTN therapy
9. Patient environmental/social factors (stress) |
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Term
| List three tests that must be obtained before initiating therapy of a hypertensive patient |
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Definition
1. Urinalysis (to assess target organ damage)
2. Blood chemistry (K, Na, Scr, glu, lipid profile)
3. Electrocardiogram- to assess for CVD and get baseline |
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Term
|
Definition
Heart rates below 60bpm
Beta blockers may be contraindicated |
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Term
| What is the goal of hypertension management? |
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Definition
To reduce cardiovascular and renal morbidity and mortality.
The primary focus should be on achieving the systolic blood pressure goal |
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Term
| What are the blood pressure goals for uncomplicated hypertension or diabetes? |
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Definition
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Term
| What are the blood pressure goals for renal disease, diabetes with proteinuria, CAD, or high CAD risk? |
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Definition
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Term
| What is the blood pressure goal for heart failure? |
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Definition
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Term
| List 6 lifestyle modifications for HTN prevention and management |
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Definition
1. Weight reduction
2. DASH diet
3. Sodium restriction
4. Physical activity
5. Moderation of alcohol consumption (<2 drinks a day for men, <1 for women)
6. Stop smoking |
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Term
| Describe a DASH (Dietary Approaches to Stop Hypertension) eating plan |
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Definition
| A diet rich in fruits, vegetables, and low-fat dairy products with reduced content of saturated and total fat. Maintain adequate intake of dietary potassium, calcium, and magnesium. |
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Term
| Under what conditions does AHA recommend beta blockers first line for hypertension? |
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Definition
| AHA reports that BB should still be used first line for compelling indications (angina, post MI, heart failure), but not first line for uncomplicated HTN due to “weak” data for cardioprotection. |
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Term
| What drug class is considered the best to prevent cardiovascular complications of HTN? |
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Definition
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Term
| What were the results of the ALLHAT (The Antihypertensive and Lipid Lowering to Prevent Heart Attack Trial)? |
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Definition
-Diuretics provide similar blood pressure lowering effects when compared to ACE inhibitor, CCB, or alpha blocker.
-All others more effective than alpha blockers at preventing heart failure
-Beta blockers were not tested |
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Term
| Other than drug class, what does the JNC-7 recommend in starting HTN therapy? |
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Definition
-Start with lowest possible dose
-Use a once-daily agent |
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Term
What drug class does JNC-7 recommend in starting HTN therapy?
Assume there are no compelling indications or contraindications in the patient. |
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Definition
A thiazide-type diuretic either alone or in combination with an ACE-I, ARB, BB, or CCB
Most patients will need two or more medications, but wait a month to assess effect before adjusting |
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Term
| What follow-up and monitoring recommendations are there once antihypertensive drug therapy is initiated? |
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Definition
-BP monitoring at monthly intervals until goal met
-Once BP at goal, 3-6 month intervals
-Potassium and Scr 1-2 a year until deemed stable |
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Term
| What are common side effects of thiazide and loop diuretics? |
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Definition
1. Short term ↑ cholesterol, glucose
2. ↓ K, Na, Cl, Mg
3. ↑ Scr, uric acid, and Ca |
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Term
| List the daily dosage of HCTZ and monitoring needed |
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Definition
daily dosing range: 12.5-50 mg (max effective dose is 25 mg)
dosing frequency: QD
monitoring: Chem-7 (sodium (Na+),
potassium (K+), chloride (Cl-), CO2, blood urea nitrogen (BUN), serum creatinine (SCr), and glucose), BP |
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Term
| List the daily dosage of furosemide and monitoring needed |
|
Definition
daily dosing range: 40-240 mg
dosing frequency: BID-TID
monitoring: Chem-7 (K+, SCr), BP |
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Term
| List the daily dosage of triamterene (a K-sparing diuretic) and monitoring needed |
|
Definition
daily dosing range: 25-100 mg
dosing frequency: QD
monitoring: Chem-7 (K+, SCr), BP |
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Term
| List the daily dosage of spironolactone and monitoring needed |
|
Definition
daily dosing range: 25-50 mg
dosing frequency: QD-BID
monitoring: Chem-7 (K+, SCr), BP, questions about adverse effects |
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Term
| List the daily dosage of aliskiren (a renin inhibitor), adverse effects, and monitoring needed |
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Definition
daily dosing range: 150-300 mg
dosing frequency: QD
adverse effects: angioedema, hyperkalemia (especially in diabetes treated with ACE-I), diarrhea, GI upset, dizziness
monitoring: Chem-7 (K+, SCr), BP, questions about adverse effects |
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Term
| List the daily dosage of reserpine (a peripheral adrenergic inhibitor), adverse effects, and monitoring needed |
|
Definition
daily dosing range: 0.05-0.25 mg
dosing frequency: QD
adverse effects: nasal congestion, sedation (depression and activation of peptic ulcer disease – uncommon at the recommended dosing range)
monitoring: BP, questions about adverse effects |
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Term
| List the daily dosage of clonidine (a central alpha-agonist), adverse effects, and monitoring needed |
|
Definition
daily dosing range: 0.2-1.2 mg
dosing frequency: BID-TID
adverse effects: sedation, dry mouth, lethargy, bradycardia, withdrawal rebound hypertension, impaired cognitive functioning in elderly patients
monitoring: BP, EKG, questions about adverse effects |
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Term
| List the daily dosage of doxazosin (an alpha blocker), adverse effects, and monitoring needed |
|
Definition
daily dosing range: 1-16 mg
dosing frequency: QD
adverse effects: postural hypotension, especially after the first dose and in the elderly or diabetic patient due to impaired autonomic nervous system function
monitoring: BP (sitting and standing), questions about adverse effects |
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Term
| List common side effects of beta-blockers |
|
Definition
bradycardia
bronchospasm – use is contraindicated in asthmatics and other lung diseases
heart failure (systolic dysfunction)
may mask insulin-induced hypoglycemia and delay recovery time ( more pronounced with non-specific beta-blockers)
impaired peripheral circulation – hard to quantify
insomnia
fatigue
impaired cognitive functioning in elderly patients
decreased exercise tolerance
sexual dysfunction (erectile dysfunction, impotence) |
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Term
| List the daily dosage of atenolol and monitoring needed |
|
Definition
daily dosing range: 25-100 mg
dosing frequency: QD
monitoring: BP, HR, EKG, questions about adverse effects |
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Term
| List the daily dosage of propanolol and monitoring needed |
|
Definition
daily dosing range: 40-480 mg
dosing frequency: BID
monitoring: BP, HR, EKG, questions about adverse effects |
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Term
| List the daily dosage of carvedilol and monitoring needed |
|
Definition
daily dosing range: 12.5-50 mg
dosing frequency: BID
adverse effects: postural hypotension, same as beta-blockers and alpha-blockers
monitoring: BP, EKG, questions about adverse effects |
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Term
| List the daily dosage of minoxidil (a direct vasodilator), side effects, and monitoring needed |
|
Definition
daily dosing range: 5-100mg
dosing frequency: QD
adverse effects: orthostatis hypotension (especially in older patients), headaches, fluid retention, tachycardia, hirsutism
monitoring: BP, questions about adverse effects, physical assessment |
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Term
| List the daily dosage of verapamil, side effects, and monitoring needed |
|
Definition
daily dosing range: 90-480 mg
dosing freqency: QD-BID
adverse effects: impaired cardiac conduction, bradycardia, worsening of systolic function in heart failure, constipation
monitoring: BP, HR, EKG, questions about adverse effects |
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Term
| List the daily dosage of diltiazem, side effects, and monitoring needed |
|
Definition
daily dosing range: 120-360 mg
dosing frequency: QD-BID
adverse effects: impaired cardiac conduction, bradycardia, worsening of systolic function in heart failure
monitoring: BP, HR, EKG, questions about adverse effects |
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Term
| List the daily dosage of amlodipine, side effects, and monitoring needed |
|
Definition
daily dosing range: 2.5-10mg
dosing frequency: QD
adverse effects: ankle edema, flushing, headache
monitoring: BP, questions about adverse effects, physical assessment |
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Term
| List the daily dosage of lisinopril, side effects, and monitoring needed |
|
Definition
daily dosing range: 5-40 mg
dosing frequency: QD
adverse effects: cough (in up to 25-30%), hyperkalemia (especially in diabetics and those with renal insufficiency), elevated SCr, angioedema (rare, but life-threatening), rash, loss of taste
monitoring: Chem-7 (K+, SCr), BP, questions about adverse effects, physical assessment |
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Term
| List the daily dosage of valsartan, side effects, and monitoring needed |
|
Definition
daily dosing range: 80-320 mg
dosing frequency: QD
adverse effects: hyperkalemia
monitoring: Chem-7 (K+, SCr), BP |
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Term
| What is the most common form of target organ damage associated with HTN? |
|
Definition
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Term
| What is the therapy of choice in someone with stable angina and HTN? |
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Definition
First drug of choice is a BB; alternatively, long-acting CCBs can be used.
Short-acting calcium antagonists should not be used because of the risk for myocardial ischemia or myocardial infarction. |
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Term
| What is the therapy of choice in someone with unstable angina/MI and HTN? |
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Definition
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Term
| What is the recommended treatment for a patient with asymptomatic heart failure? |
|
Definition
| ACE-Is and BBs are recommended. |
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Term
| What is the recommended treatment for a patient with symptomatic heart failure? |
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Definition
| In those with symptomatic ventricular dysfunction or end-stage heart disease, ACE-I, BB, ARB, and aldosterone antagonists are recommended with loop diuretics. |
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Term
| What is the recommended treatment for a diabetic with hypertension? |
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Definition
| Thiazide diuretics, BB, ACE-I, ARB, and CCB, are beneficial in reducing CVD and stroke incidence in patients with diabetes |
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Term
| What is the American Diabetes Association 2013 Clinical Practice Guidelines blood pressure goal? |
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Definition
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Term
| Define chronic kidney disease |
|
Definition
| either reduced excretory function with an estimated glomerular filtration rate (GFR) below 60 ml/min OR the presence of albuminuria |
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Term
| What is the drug treatment of choice for a patient with chronic kidney disease? |
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Definition
| ACE-I and ARBs, but loop diuretics may be needed in combination with advanced renal disease |
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Term
| What are the guidelines of treatment of HTN in a patient with a stroke? |
|
Definition
-Reduce BP gradually
-Control at 160/100 is appropriate until condition is stabilized or improved
-Combination of ACE-I and thiazide |
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Term
| What are treatment guidelines for African Americans with HTN? |
|
Definition
-Lifestyle modifications especially
-Diuretics should be agents of first choice |
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Term
| Define left ventricular hypertrophy as it relates to HTN |
|
Definition
LVH is a risk factor for CVD
It can be managed with all classes except direct vasodilators |
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Term
| How does HTN therapy change for elderly? |
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Definition
| Generally it doesn't change, but be aware to titrate and watch for orthostatic hypotension or cognitive functioning |
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Term
| How can thiazides and loop diuretics effect dyslipidemia? |
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Definition
In high doses, thiazide diuretics and loop diuretics can induce at least short-term increases in levels of total cholesterol, triglycerides, and LDL-cholesterol.
Low doses do not produce this |
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Term
| How can BBs, alpha blockers, and other HTN drugs effect dyslipidemia? |
|
Definition
Beta blockers may increase TG but reduce death anyway
Alpha-blockers can decrease cholesterol
All others are lipid neutral |
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Term
| What HTN drugs should be avoided in an asthmatic? |
|
Definition
| Beta-blockers, alpha-beta-blockers, and topical ophthalmic application of beta-blockers |
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Term
| How does gout affect HTN treatment? |
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Definition
| Diuretics should be avoided if possible, since they can increase uric acid (but this rarely causes an acute gout attack) |
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Term
| What are the preferred HTN drugs in pregnancy? |
|
Definition
| Methyldopa, BB, or vasodilators |
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