Definitions & Guidelines
History, Physical, & Lab Evaluation
Pathophysiology
Treatment
100
The ACC/AHA definition of hypertension
BP > 130/80
100
A patient should be seated quietly for this amount of time before a BP measurement is taken.
- 5 minutes
- Arm should be supported at heart level
- Back should be supported, not on exam table
- Cuff's bladder should be at least 80% of arm circumference
100
Percentage of hypertension that is not attributable to an identifiable cause.
- 95-98%
Causes of secondary HTN include:
- Obstructive sleep apnea
- Primary aldosteronism
- Renovascular disease
- Renal parenchymal disease
- Drug or alcohol induced (including NSAIDS, sympathomimetics, cocaine, etc.)
- Pheochromocytoma
- Coarctation of the aorta
- Thyroid or parathyroid disease
- Cushing's syndrome
- Primary hyperparathyroidism
100
Number of medications that should be started at time of diagnosis if BP is > 20/10 mmHg over goal
Two medications.
Meta-analyses indicate a slight preference for thiazides as first-line.
200
USPSTF guidelines recommend screening for high blood pressure in this patient population.
The USPSTF recommends screening for high blood pressure in adults aged 18 years or older.
200
Three elements of an initial focused history in a patient with a possible new diagnosis of hypertension
- Family history of cardiovascular disease
- Family history of colon cancer
- History of cancer
- History of diabetes
- History of glaucoma
- History of high cholesterol
- History or symptoms of cardiovascular disease
- History or symptoms of congestive heart failure
- Medications, including over-the-counter and complementary medications
- Smoking, alcohol, and/or drug use
200
Two examples of end-organ disease that may be caused by hypertension.
- Heart - Left ventricular hypertrophy, angina or myocardial infarction, heart failure
- Brain - Cerebrovascular accident or transient ischemic attack
- Kidneys - Chronic renal failure
- Blood vessels - Peripheral vascular disease
- Eyes - Retinopathy
200
Two behavioral/lifestyle modifications recommended by the ACC/AHA for patients with hypertension.
- Heart healthy diets (e.g. "DASH Diet")
- Sodium restriction
- Potassium supplementation (dietary)
- Increased physical activity
- Limited alcohol intake
- Weight loss
300
Requirements for diagnosing hypertension in a clinic setting.
- At least two elevated measurements—five minutes apart, one in each arm—should be made on two or more visits.
- USPSTF also recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
- A patient cannot be diagnosed with hypertension if the patient is acutely ill or in acute pain at the time of the measurement.
300
Three questions that can be used to elicit a patient's explanatory model of their hypertension.
- What do you think caused your problem? What do you call it?
- Why do you think it started when it did?
- How does it affect your life?
- How severe is it? What worries you the most?
- What kind of treatment do you think would work?
- How can the doctor be most helpful to you?
- What is most important for you?
- Have you seen anyone else about this problem? Other physicians? Anyone else besides a physician?
- Have you used nonmedical remedies or treatments for your problem?
- Who advises you about your health?
300
Two endocrine disorders that can be causes of secondary hypertension.
Cushing's disease
- Hypo- or hyperthyroidism
300
The four classes of medications indicated for treatment of hypertension in the general adult population.
Thiazides
Calcium Channel Blockers (CCBs)
ACE Inhibitors (ACE-Is)
Angiotensin Receptor Blockers (ARBs)
400
Two methods recommended for measurement of blood pressure outside of the clinic setting.
- Ambulatory Blood Pressure Monitoring (ABPM) - formal 24-hour blood pressure measurements using a provider-provided device, or
- Home Blood Pressure Monitoring (HBPM) - blood pressure readings taken by a patient at home.
400
Five tests that should be ordered with a new diagnosis of hypertension.
- Lipid panel - assess for ASCVD/cardiovascular risk factors
- BMP - assess/establish baseline for electrolyte abnormalities (K+, Na+) and GFR
- TSH - assess for hypo- or hyperthyroidism
- UA - evaluate for proteinuria (hypertensive nephropathy) and glucosuria (poorly controlled DM)
- Urinary albumin / albumin:creatinine ratio - monitor renal disease progression related to htn
- EKG - assess for arrhythmia, signs of ischemia, LVH
400
Five risk factors for high blood pressure.
- Diabetes
- Hypercholesterolemia
- Obesity
- Smoking
- Increased age
- Family history of premature CVD (males under age 55, females under age 65)
- Physical inactivity
- Chronic kidney disease (estimated GFR less than 60 mL/minute)
- Unhealthy diet
400
Two contraindications or complications of the use of ACE inhibitors and ARBs.
- Pregnancy or patients who can become pregnant and are not using contraception
- ACEis and ARBs should not be used in combination
- Hyperkalemia, particularly in CKD or patients using K+-sparing drugs
- Acute renal failure in patients with renal artery stenosis
- Angioedema
500
Low-dose aspirin therapy should be initiated for cardiovascular disease and colorectal cancer risk reduction in adults age 50 to 59 if...
The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
500
Two findings on fundoscopic exam consistent with a diagnosis of hypertension.
Assess for arteriovenous nicking, cotton-wool spots, flame hemorrhages, exudates, and other changes associated with hypertensive retinopathy (see diagram), or papilledema associated with hypertensive emergencies.
500
Two reasons to suspect a secondary cause of hypertension.
Assessment for secondary causes of hypertension is appropriate if hypertension increases in severity, has a poor response to treatment, or if a patient has history or physical exam findings that point to a secondary cause.
500
Two reasons a patient with hypertension should be referred to a nephrologist or cardiologist.
Generally, failure to achieve blood pressure goal in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic may warrant referral to a nephrologist or cardiologist.
Concern for end-organ damage involving kidney or cardiovascular system.