Name the major risk factors for developing cardiovascular disease
HTN
age
low HDL
smoking
high LDL
Identify the complications of hypertension
Target organ damage
· Stroke
· Myocardial infarction
· Angina
· Heart failure
· Kidney failure (end-stage kidney disease)
· Early death
Primary HTN is caused by __________.
unknown causes
Is primary HTN curable or controlable?
controlable
Secondary HTN is caused by _______.
morbid diseases or medications
Is secondary HTN curable or controlable?
Curable by treating underlying cause
Prehypertension blood pressure goal ___________
Return to normal BP with lifestyle modifications
Hypertension blood pressure goal ______
<140/90 mmHg
Hypertension with Diabetes or renal diease blood pressure goal ______
<130/80 mmHg
Blood Pressure =
Cardiac Output (CO) x Total Peripheral Resistance (TPR)
Activation of α1 receptors causes ________ which _______ BP
vasoconstriction
increases
Activation of α2 receptors causes _______ BP
decreased
Activation of β1 receptors causes ________ which _______ BP
increased heart rate & contractility
increases
Angiotensin II cause _______ sympathetic outflow
increased
__________ are pressure sensing nodes in the _________ and ________
baroreceptors
carotid
aorta
When the baroreceptor sense a drop in BP the cause ______, _______, and ______________
vasoconstriction
↑ HR
forced cardiac constriction
The Natriuretic Hormone has what effect on the Na/K ATPase?
inhibition
When the Na/K ATPase is blocked, does this prevent Na excretion or reuptake?
What effect does this have on blood volume & BP?
excretion
Na retention will --> ↑blood volume --> ↑BP
Prostacyclin, Bradykinin, & Nitric Oxide are what kind of substances?
Vasodilating Substances
Angiotensin II & Endothelin I are what kind of substances?
Vasoconstricting Substances
HTN is defined as a Systolic blood pressure (SBP) _____ OR
Diastolic blood pressure (DBP) _______ with _____ different readings on ____ different days.
≥140mmHg
≥90mmHg
2
2
Normal BP is
<120 AND <80
Prehypertension is
120-139 OR 80-89
Stage 1 HTN is
140-159 OR 90-99
Stage 2 HTN is
≥160 OR ≥100
Hypertensive Crisis is
≥180 OR ≥120
A Hypertensive Crisis that has no target organ (non-symptomatic) is a _______________
hypertensive urgency
A Hypertensive Crisis that involves a target organ is a _________.
hypertensive emergency
What are the 3 main ways to lower BP?
Reduce HR
Reduce volume
Vasodilation
What drugs reduce HR?
Beta Blockers
What drugs reduce volume?
diuretics
What drugs cause vasodilation?
ACE-Is
ARBs
α1 agonists
α2 blockers
CCBs
direct vasodilators
AHA recommends a BP of _____________ for left
ventricular dysfunction.
120/80 mm Hg
What compelling indications are required for a JNC7 BP recommendation of 130/80mmHg?
Diabetes
CKD
What class of antihypertensives is contraindicated in heart failure?
CCBs
What 2 classes of drugs are recommended in heart failure?
ACE-Is
ARBs
What 2 classes of drugs are the standard of care post-MI?
Beta Blockers
ACE-Is
What classes of antihypertensives are the standard of care for HTN with diabetes and why?
ACE-Is
ARBs
They are renal protective
What classes of antihypertensives are the standard of care for HTN with CKD and why?
ACE-Is
ARBs
They are renal protective
What classes of drugs are recommended for recurrent stroke prevention?
diuretics
ACE-Is
What antihypertensives should be avoided in asthma and why?
beta blockers
beta 2 receptors in lungs
What antihypertensives should be avoided in AV heart block?
beta blockers
CCBs
What antihypertensives should be avoided in hyponatremia?
diuretics
What antihypertensives should be avoided in K > 5 & SCr >2.5?
diuretics
ACE-Is
ARBs
Aldosterone antagonists
What antihypertensives should be avoided in pregnancy?
ACE-Is
ARBs
What antihypertensives should be avoided in angioedema?
ACE-Is
ARBs
Stage 1 HTN without compelling indications is usually treated with a _______________. _________, _________, __________, ____________, or a combination may be considered.
thiazide diuretic
ACE-Is
ARBs
BBs
CCBs
Stage 2 HTN is usually treated with a ____________ of a _________ and an _________, _________, ________, or ________
2 drug comb
thiazide diuretic
ACE-I
ARB
BB
CCB
What antihypertensives are going to be the first line agent for most patients without a compelling indication
thiazide diuretics
JNC-7 suggests starting patients with Stage 2 Hypertension on one antihypertensive agent
True or False
False
2 agents
Which diuretic is a more effective antihypertensive thiazide or loop
thiazide
Which is a more potent diuretic thiazide or loop?
loop
What benefit do thiazide diuretics have in osteoporosis?
↑Ca2+
Chlorthalidone is ________ more potent than hydrochlorothiazide
1.5x
What diuretic should be used when CrCl < 30ml/min
loop
What class of drugs does bumetanide belong to?
loop diuretics
Triamterene & Aldosterone antagonists are both
K+ sparing diuretics
K+ levels should be monitored within ____ days of starting a K+ sparing diuretic
7
SCr & electrolytes should be monitored within ___ weeks of starting a diuretic
4
________ is the only loop diuretic that does not contain a sulfonamide group
Ethacrynic acid
Spironolactone and Eplerenone belong to what class of drugs?
Aldosterone Antagonists
Contraindications of Aldosterone Antagonists include
Severe renal impairment
Hyperkalemia
Lisinopril & Enalapril belong to what class?
ACE-Is
For what compelling indications should ACE-Is be used?
DM
proteinuria
post MI
CHF
SCr & electrolytes should be monitored ________ after starting an ACE-I
2-3 weeks
ACE-Is are allowed to cause an increase in SCr of no more than a ____ from baseline
