Hypertension

Question 1

Prevalence of HTN in US

Answer 1

• 50-60 million people
• 50% of 60-70 yo
• 65% of 70-80 yo
• 70% of 80+
• normotensive ppl @ age 55 have 90% risk of developing HTN

Question 2

CVD risk associated with HTN

Answer 2

• Starting @ 115/75, CVD risk doubles w/each increase of 20/10 mmHG
• positive linear association between systolic BP and ischemic HD mortality
  
  • more important risk factor in persons > 50 yo (vs. diastolic)

Question 3

Essential HTN pathogenesis (2 theories)

Answer 3

• MAP = CO x SVR
• Theory 1: defect in renal sodium excretion => increased plasma volume => increased CO => autoregulatory increase in SVR => increase in BP
• Theory 2: Na+ transport inhibitor inhibits Na+/K+/ATPase => increases cell Na+, cell can’t extrude Ca2+ via NCX => increases cell Ca2+ => VSMC contraction => increase in SVR/BP

Question 4

Elements of lifestyle modification tx for HTN

Answer 4

• Weight reduction
  
  • 5-20 mmHg/10kg weight loss
• DASH eating plan
  
  • 8-14 mmHg reduction
• Dietary sodium reduction
  
  • 2-8 mmHg reduction
• Increase physical activity
  
  • 4-9 mmHg reduction
• Moderation of alcohol
  
  • 2-4 mmHg reduction

Question 5

Classification of HTN

Answer 5

• Normal = <120/<80
• PreHTN = 120-139/80-89
• Stage 1 HTN = 140-159/90-99
• Stage 2 HTN = >160/>100

Question 6

PreHTN tx

Answer 6

• lifestyle modification
• no antiHTN drugs
• if pt has chronic kidney disease, give drugs for this/other compelling indication

Question 7

Stage 1 HTN tx

Answer 7

• lifestyle modification
• thiazide diuretics for most
• may consider ACE-i, ARB, BB, CCB or combo
• drugs for compelling indications (e.g. chronic kidney disease)

Question 8

Stage 2 HTN tx

Answer 8

• lifestyle modification
• Two drug combo: thiazide diuretics + ACE-i/ARB or BB or CCB

Question 9

Secondary HTN definition/pathogenesis

Answer 9

• Secondary hypertension (secondary high blood pressure) = high BP caused by another medical condition.
• can be caused by conditions that affect your kidneys, arteries, heart or endocrine system.
• can also occur during pregnancy.

Question 10

Tx of secondary HTN

Answer 10

• control both the underlying condition and the high blood pressure ==>
• reduces the risk of serious complications — including heart disease, kidney failure and stroke.

Question 11

CVD risk factors

Answer 11

• HTN
• tobacco use
• physical inactivity
• metabolic syndrome: obese, diabetes, dyslipidemia
• microalbuminuria/GFR <60 ml/min
• age
• Fhx

Question 12

Possible causes of HTN

Answer 12

• sleep apnea
• drug-induce
• chronic kidney disease
• primary aldosteronism
• renovascular disease
• chronic steroids/Cushing’s
• coarctation of aorta
• thyroid/parathyroid disease
• RAD PACTS: reno, apnea, drug, primary, aorta coarc, chronic, thyroid, steroids