Hypertension 101
According to the AHA guidelines, what is the definition of hypertension?
Systolic BP > 130 mmHg or diastolic BP > 80 mmHg
Name one modifiable risk factor for hypertension
Possible answers: Obesity, smoking, high sodium intake, alcohol use, stress, sedentary lifestyle
Which organ plays the biggest role in long-term blood pressure regulation?
Kidneys
White coat hypertension
What are the first-line anti-hypertensive drug classes for most patients?
Thiazide diuretics, ACE inhibitors, ARBs, CCBs
What are the two major types of hypertension?
Primary (essential) and secondary hypertension
Name one non-modifiable risk factor for hypertension
Possible answers: age, genetics, family history, ethnicity
Hypertensive retinopathy and optic disc swelling (papilledema in hypertensive emergency)
A 30-year-old with resistant hypertension and hypokalemia likely has what condition?
Primary hyperaldosteronism
What antihypertensive drug class is contraindicated in pregnancy?
ACE inhibitors and ARBs due to teratogenic effects
Use: "Hypertensive Moms Need Love”: Hydralazine, Methyldopa, Nifedipine, or Labetalol
What percentage of hypertension cases are primary?
About 90-95%
What is the most common cause of secondary hypertension?
Renal artery stenosis
What type of stroke is most associated with chronic hypertension?
Lacunar infarcts due to small vessel disease
A hypertensive patient prevents with acute confusion and papilledema. What is your next step?
Start IV antihypertensives immediately (this is a hypertensive emergency!)
What is the recommended initial treatment for a Black patient with hypertension (Without CKD or heart failure)?
A CCB or thiazide diuretic
What are two major hemodynamic factors that determine blood pressure?
Cardiac output (CO) and systemic vascular resistance (SVR)
What endocrine disorder can cause secondary hypertension and hypokalemia?
Primary hyperaldosteronism (Conn's syndrome) due to excess aldosterone production
How does chronic hypertension lead to increased stroke risk?
Causes vascular remodeling, weakening of blood vessel walls, and increased risk of ischemic and hemorrhagic stroke
A patient with hypertension, epigastric bruit, and worsening kidney function after starting an ACE inhibitor likely has what condition?
Renal artery stenosis
What medication is preferred for resistant hypertension?
Spironolactone (aldosterone antagonist - reduces sodium retention and lowers BP in patients with hyperaldosteronism)
How does hypertension contribute to heart failure?
Increase afterload leads to left ventricular hypertrophy (LVH), causing diastolic dysfunction and eventually systolic heart failure
How does chronic kidney disease (CKD) contribute to hypertension?
Reduced kidney function leads to fluid retention and activation of RAAS, increasing BP
Chronic high BP leads to glomerular hypertension, proteinuria, and irreversible nephron loss
A patient has hypertension and pheochromocytoma. What drug class should be avoided initially?
Beta-blockers (should use alpha-blockade first to avoid hypertensive crisis)
A patient with hypertension and diabetes needs medication. What class is preferred and why?
ACE inhibitors or ARBs, as they provide renal protection and reduce proteinuria in diabetic patients