<120; <80
What is the SBP & DBP for "Normal Patients" ?
120-129; <80
What is the SBP & DBP for " Prehypertension"?
130-139; 80-89
What is the SBP & DBP for "HTN- Stage 1"?
>140; >90
What is the SBP & DBP for "HTN-Stage 2"?
if >20/10mmHg
When do we start a Stage 2: HTN patient on 2 different medications?
need ASCVD risk; may or may not start medication; more aggressive treatment/follow up
What are the clinical guidelines for a Stage 1: HTN patient?
pulmonary disease, valvular heart disease, ED, PAD/PVD, heart block/ bradycardia
Which disease states do we avoid Beta-blockers in? (5)
b, c
Which disease states do we avoid non-DHP CCBs?
a) Pulmonary disease
b) heart failure
c) valvular heart disease
d) erectile dysfunction
e) PAD/PVD
f) Heart block/ Bradycardia
g) Pregnancy
d
Which disease states do we avoid aldosterone antagonists?
a) Pulmonary disease
b) heart failure
c) valvular heart disease
d) erectile dysfunction
e) PAD/PVD
f) Heart block/ Bradycardia
g) Pregnancy
g
Which disease state do we avoid ACEIs and ARBs?
a) Pulmonary disease
b) heart failure
c) valvular heart disease
d) erectile dysfunction
e) PAD/PVD
f) Heart block/ Bradycardia
g) Pregnancy
ACEI or ARB + thiazide; ACEI or ARB + CCB
What are the preferred medication combos for HTN?
ACEI + ARB
Which medication combo do we avoid in HTN?
carbonic anhydrase inhibitors, osmotic diuretics
Which diuretics are not useful for HTN?
acetazoldamide, dorzolamide
What are the carbonic anhydrase inhibitors? (2)
mannitol
What is the Osmotic diuretic?
f; must combine w/ other BP medication
Potassium-sparing Diuretics are effective as standalone therapies. T/F?
significant CKD w GFR< 40 ml/min
When do we avoid Potassium-sparing diuretics?
increased risk of hyperkalemia; we are blocking aldosterone; less Na+ uptake into the cell; less excretion of potassium
Why are Potassium-sparing diuretics a bad combo in RAAS or aldosterone antagonists? Why?
treatment-resistant, ckd; GFR <30ml/min, hyponatremic patients
Which types of patients are Loop Diuretics reserved for? (3)
primary aldosteronism, heart failure, resistant HTN
Spironolactone & Eplerenone are preferred agents in patients who possess what conditions? (3)
low Na+ diet, Caucasians, patients w low renin levels
Which patients have a better response to ACEI/ARBs? (3)
african americans, chronic NSAID users
Which patients have an attenuated response to ACEI/ARBS? (2)
pregnancy, bilateral renal artery stenosis
When do we NOT use ACEI/ARBS? (2)
aliskiren, increased lithium serum concentrations, potassium-sparing diuretics, direct renin inhibitors
Which DDI's should we watch out for when prescribing ACEI/ARBs?
increase in SrCr of at least 30%
How do we monitor for renal artery stenosis in patients on ACEI/ARBs?
c
There are no renal dose adjustments in _______.
a) thiazides
b) ACEi
c) ARBs
d) Aliskiren
false; less than 1%
The cross-reactivity of ACEI and ARBs is high. T/F?
6 weeks
If you stop an ACEi for angioedema cross-reactivity, how long should you wait before starting an ARB?
on a thiazide, volume-depleted, elderly; risk of hypotension
Starting doses for ACEI/ARBs should be reduced by 50% in patients who are what? Why?
don't crush up oral pellets; take with milk or water
Counseling points for Aliskiren (2) ?
heart failure w/ reduced EF, stable ischemic heart disease, Acute coronary syndrome, diabetes, CKD
What are Compelling Indications for ACEI & ARB use? (5)
angioedema, pregnancy, rash
Which AE's do we discontinue ACEi/ARBs? (3)
methyldopa, nifedipine, labetalol
Which Medications do we use in pregnancy? (3)
b, f
Which medications do we AVOID in Valvular Heart disease?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
b
Which medication is the treatment of choice in Thoracic Aortic Aneurysms?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
c
Which medication is the treatment of choice for gout?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
d
Which medication is the medication of choice for Benign Prostatic Hyperplasia?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
b, e
Which medication is used for Afib?
a) methyldopa
b) beta blocker
c) Losartan
d) Alpha blocker
e) ARB
f) non-DHP CCB
ACEi or ARB + BB
What is the HTN-medication combo for Caucasians?
CCB + diuretic
What is the HTN-medication combo for African Americans?
d
Which diuretic is used in Heart failure patients?
a) osmotic
b) thiazide
c) potassium sparing
d) loop
e) AA/MRAs
dofetilide, sotalol, droperidol
A patient on thiazide diuretics + _____ = increased risk of arrythmias. (3)
lithium
A patient on thiazide diuretics + _____ = lithium toxicity
digoxin
A patient on thiazide diuretics + ______ = digoxin toxicity
increases; electrolyte
Combining diuretics ________ risk of various _________ abnormalities.
decrease efficacy
NSAIDs _________ of thiazides.
c
Which thiazide may have some effect on Ca++ blockade?
a) HCTZ
b) chlorothalidone
c) indapamide
d) metalozone
d,e
Which diuretics do we have to watch K+ & SrCR?
a) osmotic
b) thiazide
c) potassium sparing
d) loop
e) MRAs
e
Which ACEi is the only "true once daily"?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
a
Which ACEi do we watch for Sulfa allergies?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
a, c
Which ACEi is NOT a prodrug?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
b
Which is the only available via IV?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
a
Which is required to be taken 2-3x/ day?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
d
Which is required to be taken with food to increase absorption?
a) Captopril
b) Enalapril
c) Lisinopril
d) Moexipril
e) Trandolapril
SBP-DBP; 40-60
The formula for Pulse Pressure? Normal range?
structure changes/ Afib
High pulse pressure =
poor heart function, low CO
Low pulse pressure =
(SBP x 1/3) + (DBP x 2/3) ; 70-100
MAP formula? Normal range?
increased risk of blood clots, CVA, HF
High MAP =
low perfusion to brain/kidneys
Low MAP =
Mean arterial pressure
-average pressure throughout the cardiac cycle
pulse pressure
- a measure of arterial wall tension
elevated bp, 4th heart sound, av nicking, cardiomyopathy, carotid bruits
Signs of Hypertension (5)
headache, fatigue, dizziness, facial flushing
Symptoms of HTN (4)
2-3 measurements over 2-3 visits
Diagnosis of HTN?
false
CVD risk is equal in White-Coat HTN and Masked-HTN. T/F?
b
Do we treat a patient who has White-Coat HTN with a normal BP reading at home?
a) yes
b) no
sleep deficits, heavy drinking, physical inactivity, smoking, perceived health
Incidence-impacting factors? (5)