Hypertension

Question 1

What is the arbitrary definition of prehypertension?

Answer 1

• SBP 120-139
• DBP 80-89

Question 2

What does fibromuscular dysplasia cause in young, female pts?

Answer 2

renal artery stenosis

Question 3

Name 7 environmental factors that contribute to essential HTN.

Answer 3

• high dietary Na intake
• excess caloric intake
• EtOH
• stress
• sedentary lifestyle
• smoking
• low K+ or Ca++ intake

Question 4

What is the prognosis for untreated malignant HTN?

Answer 4

renal failure in less than 1 year

Question 5

What is the major determinant of ECF volume?

Answer 5

total Na content

Question 6

What is renovascular HTN?

Answer 6

abnormal signal to release renin

Question 7

What is non-malignant HTN?

Answer 7

HTN in the absence of hypertensive neuroretinopathy

Question 7

What are the fundoscopic findings that indicate HTN-induced arteriolitis?

Answer 7

• flame shaped (striate) hemorrhages
• cotton wool spots (soft exudates)
• papilledema

Question 8

What is the long term physiologic effect of a diuretic?

Answer 8

decreased peripheral vascular resistance (PVR)

Question 8

What is secondary hyperaldosteronism?

Answer 8

increased renin secretion

Question 9

What is naturesis?

Answer 9

renal Na excretion

Question 10

What causes renal artery stenosis in older pts, esp male smokers?

Answer 10

atherosclerosis

Question 10

Maligant HTN is characterized by necrotizing arteriolitis in the _____, _____, _____, and _____.

Answer 10

kidneys, retinas, heart, and CNS

Question 11

What lifestyle modifications can reduce BP?

Answer 11

• weight reduction
• DASH diet
• dietary Na+ reduction
• physical activity
• moderation of EtOH

Question 12

What is the arbitrary definition of HTN?

Answer 12

• SBP>140
• DBP>90

Question 12

What is pheochromocytoma?

Answer 12

a benign tumor of the adrenal medulla causing excess catecholamines

Question 14

Name some various factors contributing to secondary HTN.

Answer 14

• Cushings/Chronic steroid therapy
• pheochromocytoma
• 1a hyperaldosteronism
• coarctation of the aorta
• sleep apnea
• drug induced
• thyroid/parathyroid disease

Question 15

What is the tx for renal artery stenosis in those with fibromuscular dysplasia?

Answer 15

percutaneous balloon dilatation

Question 15

What are the ABCDs of HTN treatment?

Answer 15

• A = ACEis and ARBs
• B = beta blockers
• C = Ca++ channel blockers
• D = diuretics

Question 17

How is renin stimulated to be released?

Answer 17

• activation of beta-sympathetic nerves
• stimulation of renal baroreceptors
• activation of the macula densa chemoreceptor

Question 19

What is the renal Na excretion called?

Answer 19

naturesis

Question 20

What is primary/essential HTN?

Answer 20

an unknown, single reversible cause of HTN

Question 22

Increased TPR primarily occurs at the level of the _____.

Answer 22

precapillary arterioles

Question 23

Name 2 signs of primary hyperaldosteronism.

Answer 23

• hypokalemic metabolic acidosis
• resistant HTN
• ****NO edema

Question 24

What is the BP goal for diabetics or pts with CKD?

Answer 24

* less than 130 SBP * less than 80 DBP

Question 25

What usually causes renal artery stenosis in female pts younger than 30yo?

Answer 25

fibromuscular dysplasia

Question 26

What is the acute physiologic effect of a diuretic?

Answer 26

decreased ECF and plasma volume with reduced CO

Question 27

What is primary hyperaldsteronism?

Answer 27

defect of the adrenal cortex (adenoma, hyperplasia)- secretion independent of extra-adrenal stimuli

Question 28

What is a hypertensive crisis?

Answer 28

when asymptomatic HTN pts take a turn into symptomatic, acutely elevated BP

Question 28

This is HTN in the absence of hypertensive neuroretinopathy .

Answer 28

non-malignant HTN

Question 29

What is the first line treatment for essential HTN?

Answer 29

thiazide diuretics

Question 31

Physiologically, HTN can only result from _____ and/or \_\_\_\_\_.

Answer 31

increase in CO; increase in total peripheral resistance

Question 32

The Frank-Starling mechanism suggest that an increase in ECF volume due to renal Na and water retention should result in increased \_\_\_\_, \_\_\_\_, and \_\_\_\_\_.

Answer 32

blood volume, venous return, and stroke volume

Question 33

What does TPR stand for?

Answer 33

total peripheral resistance

Question 35

Secondary HTN is rare. When would you check for it?

Answer 35

* in very young pts (\>30yo) * in pts with restistant HTN that are already on at least 4 drugs

Question 36

* What do the following fundoscopic findings indicate? flame shaped (striate) hemorrhages * cotton wool spots (soft exudates) * papilledema

Answer 36

HTN-induced arteriolitis of malignant HTN

Question 37

What is malignant HTN?

Answer 37

* marked elevation of BP * hypertensive vasculopathy * hypertensive neuroretinopathy

Question 38

People who are normotensive at age 50 have a \_\_\_\_% lifetime risk of developing HTN.

Answer 38

90