HTN2

Question 1

what is the 3 steps of HTN treatment algorithm in JNC8

Answer 1

1. for adults over 18 with HTN
2. Implement lifestyle interventions
3. set BP goal and initiate meds based on age, diabetes and CKD

Question 2

what is the JNC8 BP definition of HTN

Answer 2

140/90

Question 3

what are some non-pharm therapies for lifestyle changes?

Answer 3

1 improve diet

2. reduce stressors
3. regular exercise
4. decrease intake of food/drugs that increase BP
5. smoking cessatoin

Question 4

what BP reduction recommendation involves a diet rich in fruits, vegetables, and lowfat dairy products

Answer 4

DASH diet

Question 5

what is the max amount of sodium intake in a day with a sodium reduction diet?
what is the preferred amount of sodium intake per day if possible

Answer 5

max in diet 2400 mg/ day

ideal = 1,500 mg/day

Question 6

the dash diet is estimated to decrease BP by how much

Answer 6

8-14 mmHg

Question 7

what reduction in SBP is estimated for every 10 kg of weight lost?

Answer 7

5-20

Question 8

what 5 drug classes used to be recommended to reduce BP?

what was dropped in JNC8 at first line

Answer 8

1. thiazide diuretics
2. CCBs
3. ACE inhibitors
4. ARBs
   - beta-blockers were removed as first line in JNC8

Question 9

what is treatment algorithm in JNC8 based on

Answer 9

1. age
2. diabetes (comorbidity)
3. CKD (comorbidity)

Question 10

what trial influenced guidelines of JNC8

Answer 10

Antihypertensive and Lipid Lowering tx to prevent Heart Attack Trial (ALLHAT)

Question 11

what was found to be drug of choice for first line therapy in ALLHAT?

Answer 11

Thiazide diuretics

Question 12

what are the 5 key trials JNC8 used for updates

Answer 12

1. hypertension detection and follow up program (HDFP)
2. Hypertension-Stroke Cooperative
3. Medical Research Council (MRC)
4. Australian National Blood Pressure (ANBP)
5. VA cooperative

Question 13

what DBP is inarguably considered cutoff for HTN?

Answer 13

less than 90

Question 14

If CKD or DM is present what does JNC8 give as a goal

Answer 14

140/90

Question 15

what is the goal BP for people over 60 without CKD and diabetes

Answer 15

150/90

Question 16

what is goal BP for people under 60 without CKD or DM

Answer 16

150/90

Question 17

why are black patients not recommended to have an ACEI or ARB

Answer 17

not as effective and increase risk of stroke

Question 18

If a black patient with CKD and DM has HTN what should they be treated with ?

Why?

Answer 18

ACEI or ARB (all races, black or white)

provided renal protective effect

Question 19

what are 3 dosing strategies per JNC8

Answer 19

1. max first medication before adding second
2. or add second med before reaching max dose with first
3. or start with 2 med classes separately or as fixed dose combo

Question 20

what are general rules for antiHTN dosing

Answer 20

1. reinforce med and lifestyle adherence
2. 1 month trial to reach goal before changing drug therapy
3. if adding new med, use it from a new class
4. avoid combined use of ACE and ARB

Question 21

if a patient has gout, what HTN treatment should not be used?

Answer 21

thiazides

Question 22

how many first line HTN treatment classes can be used at once

Answer 22

3, then considerer later-line drugs