Podcast
Questions and Answers
According to the 2017 ACC/AHA guidelines, what blood pressure reading is classified as Elevated?
According to the 2017 ACC/AHA guidelines, what blood pressure reading is classified as Elevated?
- 130-139/80-89 mmHg
- 120-129/less than 80 mmHg (correct)
- Less than 120/80 mmHg
- 140/90 mmHg or higher
In the context of hypertension management, what is the primary reason for recommending lifestyle modifications?
In the context of hypertension management, what is the primary reason for recommending lifestyle modifications?
- To replace the need for drug therapy completely.
- To quickly achieve blood pressure goals without medication.
- To complement drug therapy and potentially reduce the required dosage. (correct)
- To diagnose the underlying cause of hypertension.
What is the general recommendation regarding blood pressure measurement technique to ensure an accurate reading?
What is the general recommendation regarding blood pressure measurement technique to ensure an accurate reading?
- Take multiple measurements until two consecutive readings are the same.
- Take two measurements, 5 minutes apart, and average the results.
- Take three measurements at 1-minute intervals and use the average of the last two. (correct)
- Take one measurement after 15 minutes of relaxation.
According to the provided information, what is the general blood pressure target for most patients requiring antihypertensive treatment?
According to the provided information, what is the general blood pressure target for most patients requiring antihypertensive treatment?
What is a key consideration when selecting a blood pressure cuff size for accurate measurement?
What is a key consideration when selecting a blood pressure cuff size for accurate measurement?
What is the general recommendation for sodium intake as part of a nonpharmacologic intervention to manage hypertension?
What is the general recommendation for sodium intake as part of a nonpharmacologic intervention to manage hypertension?
Which of the following best describes the mechanism of action of thiazide diuretics in treating hypertension?
Which of the following best describes the mechanism of action of thiazide diuretics in treating hypertension?
What electrolyte imbalances are commonly associated with thiazide diuretic use?
What electrolyte imbalances are commonly associated with thiazide diuretic use?
What condition would be considered a contraindication or require caution when prescribing thiazide diuretics?
What condition would be considered a contraindication or require caution when prescribing thiazide diuretics?
What is the primary mechanism of action of ACE inhibitors in the management of hypertension?
What is the primary mechanism of action of ACE inhibitors in the management of hypertension?
Which of the following is a common side effect associated with ACE inhibitors, but not typically associated with ARBs?
Which of the following is a common side effect associated with ACE inhibitors, but not typically associated with ARBs?
What should be monitored within two weeks of initiating or changing the dose of an ACE inhibitor or ARB?
What should be monitored within two weeks of initiating or changing the dose of an ACE inhibitor or ARB?
Which of the following conditions is a contraindication for the use of ACE inhibitors and ARBs?
Which of the following conditions is a contraindication for the use of ACE inhibitors and ARBs?
How do angiotensin II receptor blockers (ARBs) primarily lower blood pressure?
How do angiotensin II receptor blockers (ARBs) primarily lower blood pressure?
What is the primary mechanism of action of calcium channel blockers (CCBs) in treating hypertension?
What is the primary mechanism of action of calcium channel blockers (CCBs) in treating hypertension?
What is the key difference between dihydropyridine and non-dihydropyridine calcium channel blockers (CCBs)?
What is the key difference between dihydropyridine and non-dihydropyridine calcium channel blockers (CCBs)?
Peripheral edema is a side effect that is most commonly associated with which class of antihypertensive medications?
Peripheral edema is a side effect that is most commonly associated with which class of antihypertensive medications?
Why should Non-dihydropyridine calcium channel blockers like diltiazem and verapamil be avoided in patients with heart failure?
Why should Non-dihydropyridine calcium channel blockers like diltiazem and verapamil be avoided in patients with heart failure?
A patient with hypertension also has benign prostatic hyperplasia (BPH). Which class of antihypertensive agents should be used with caution, if at all?
A patient with hypertension also has benign prostatic hyperplasia (BPH). Which class of antihypertensive agents should be used with caution, if at all?
Which of the following best describes the mechanism of action of aldosterone antagonists, such as spironolactone, in treating hypertension?
Which of the following best describes the mechanism of action of aldosterone antagonists, such as spironolactone, in treating hypertension?
What is a notable side effect often associated with spironolactone but less so with eplerenone?
What is a notable side effect often associated with spironolactone but less so with eplerenone?
Which antihypertensive drug class is known to directly inhibit sodium channels in the distal renal tubule?
Which antihypertensive drug class is known to directly inhibit sodium channels in the distal renal tubule?
In what clinical scenario are loop diuretics most commonly used in the context of hypertension management?
In what clinical scenario are loop diuretics most commonly used in the context of hypertension management?
What is the primary mechanism of action of beta-blockers in the treatment of hypertension?
What is the primary mechanism of action of beta-blockers in the treatment of hypertension?
Why is abrupt cessation of beta-blocker therapy potentially dangerous?
Why is abrupt cessation of beta-blocker therapy potentially dangerous?
What potential effect of beta-blockers requires special consideration in patients with diabetes?
What potential effect of beta-blockers requires special consideration in patients with diabetes?
In which of the following conditions are beta-blockers generally NOT considered first-line antihypertensive agents?
In which of the following conditions are beta-blockers generally NOT considered first-line antihypertensive agents?
What is the primary mechanism by which alpha-2 agonists, such as clonidine, reduce blood pressure?
What is the primary mechanism by which alpha-2 agonists, such as clonidine, reduce blood pressure?
Which side effect is of particular concern with the use of alpha-2 agonists, especially in elderly patients?
Which side effect is of particular concern with the use of alpha-2 agonists, especially in elderly patients?
What is the primary mechanism of action of hydralazine in treating hypertension?
What is the primary mechanism of action of hydralazine in treating hypertension?
Why is hydralazine often dosed multiple times a day?
Why is hydralazine often dosed multiple times a day?
A patient is prescribed chlorthalidone for hypertension. Besides blood pressure, what other laboratory parameter should be monitored regularly?
A patient is prescribed chlorthalidone for hypertension. Besides blood pressure, what other laboratory parameter should be monitored regularly?
A patient taking lisinopril develops a persistent, dry cough. Which of the following medications would be the most appropriate alternative?
A patient taking lisinopril develops a persistent, dry cough. Which of the following medications would be the most appropriate alternative?
Which of the following is a first-line agent in treating hypertension and is preferred for black patients?
Which of the following is a first-line agent in treating hypertension and is preferred for black patients?
According to the information provided, what should be done with beta blockers before surgery?
According to the information provided, what should be done with beta blockers before surgery?
A patient has stage 2 hypertension according to ACC/AHA guidelines. What is the general recommendation regarding the initiation of antihypertensive medication?
A patient has stage 2 hypertension according to ACC/AHA guidelines. What is the general recommendation regarding the initiation of antihypertensive medication?
A patient with resistant hypertension is already taking an ACE inhibitor, a thiazide diuretic, and a beta-blocker. Which of the following medications would be the MOST appropriate next addition to their treatment regimen?
A patient with resistant hypertension is already taking an ACE inhibitor, a thiazide diuretic, and a beta-blocker. Which of the following medications would be the MOST appropriate next addition to their treatment regimen?
A patient with hypertension and a history of angioedema while taking an ACE inhibitor. Which of the following medications would be the MOST appropriate antihypertensive to prescribe initially?
A patient with hypertension and a history of angioedema while taking an ACE inhibitor. Which of the following medications would be the MOST appropriate antihypertensive to prescribe initially?
While counseling a patient being started on chlorthalidone for hypertension, which of the following points is MOST important to emphasize regarding lifestyle modifications?
While counseling a patient being started on chlorthalidone for hypertension, which of the following points is MOST important to emphasize regarding lifestyle modifications?
A patient who is prescribed chlorthalidone is also taking NSAIDs for chronic pain. What potential interaction should the healthcare provider be aware of?
A patient who is prescribed chlorthalidone is also taking NSAIDs for chronic pain. What potential interaction should the healthcare provider be aware of?
For accurate blood pressure readings, which of the following instructions should be given to a patient?
For accurate blood pressure readings, which of the following instructions should be given to a patient?
Combining an ACE inhibitor with which other medication class could lead to an elevated risk of hyperkalemia?
Combining an ACE inhibitor with which other medication class could lead to an elevated risk of hyperkalemia?
When initiating a patient on lisinopril, which of the following should be monitored within the first two weeks?
When initiating a patient on lisinopril, which of the following should be monitored within the first two weeks?
Which of the following is a significant adverse effect more commonly associated with spironolactone compared to eplerenone?
Which of the following is a significant adverse effect more commonly associated with spironolactone compared to eplerenone?
In a patient with hypertension and a history of gout, which diuretic should be used with caution?
In a patient with hypertension and a history of gout, which diuretic should be used with caution?
Why is it important to gradually taper beta-blocker therapy rather than abruptly discontinuing it?
Why is it important to gradually taper beta-blocker therapy rather than abruptly discontinuing it?
What is the primary reason non-dihydropyridine calcium channel blockers like diltiazem and verapamil should be used cautiously in patients with heart failure?
What is the primary reason non-dihydropyridine calcium channel blockers like diltiazem and verapamil should be used cautiously in patients with heart failure?
For most patients, what is the recommended blood pressure target according to the ACC/AHA guidelines?
For most patients, what is the recommended blood pressure target according to the ACC/AHA guidelines?
A patient with hypertension is also being treated for benign prostatic hyperplasia (BPH). Which class of antihypertensive medications should be used with caution?
A patient with hypertension is also being treated for benign prostatic hyperplasia (BPH). Which class of antihypertensive medications should be used with caution?
Which antihypertensive drug class is known to potentially mask the symptoms of hypoglycemia in patients with diabetes?
Which antihypertensive drug class is known to potentially mask the symptoms of hypoglycemia in patients with diabetes?
Among the thiazide diuretics, which agent is generally preferred due to its longer half-life and evidence to support its use?
Among the thiazide diuretics, which agent is generally preferred due to its longer half-life and evidence to support its use?
For a patient starting on a thiazide diuretic, what electrolyte imbalances are most important to monitor within the first few weeks?
For a patient starting on a thiazide diuretic, what electrolyte imbalances are most important to monitor within the first few weeks?
A patient taking an ACE inhibitor develops angioedema. Which of the following antihypertensive medications is contraindicated?
A patient taking an ACE inhibitor develops angioedema. Which of the following antihypertensive medications is contraindicated?
According to the 2017 ACC/AHA hypertension guidelines, at what stage of hypertension should two first-line agents from different classes be considered initially?
According to the 2017 ACC/AHA hypertension guidelines, at what stage of hypertension should two first-line agents from different classes be considered initially?
Which class of diuretics acts by directly inhibiting sodium channels in the distal renal tubule?
Which class of diuretics acts by directly inhibiting sodium channels in the distal renal tubule?
ACE inhibitors block the conversion of Angiotensin I to Angiotensin II. What is the effect of ARBs?
ACE inhibitors block the conversion of Angiotensin I to Angiotensin II. What is the effect of ARBs?
Dihydropyridines are more effective at affecting what area of the body?
Dihydropyridines are more effective at affecting what area of the body?
Potassium sparing diuretics are often combined with what medication class?
Potassium sparing diuretics are often combined with what medication class?
Alpha-2 agonists act as vasodilators; act in the central nervous system to reduce sympathetic outflow from the CNS. What serious effect can arise from their use?
Alpha-2 agonists act as vasodilators; act in the central nervous system to reduce sympathetic outflow from the CNS. What serious effect can arise from their use?
What is a common side effect from Dihydropyridine Calcium Channel Blockers that primarily affects the lower extremities?
What is a common side effect from Dihydropyridine Calcium Channel Blockers that primarily affects the lower extremities?
ACE-I have been shown to have decreased effectiveness in preventing heart failure and stroke in what population? (Select the best answer)
ACE-I have been shown to have decreased effectiveness in preventing heart failure and stroke in what population? (Select the best answer)
Loop diuretics have a higher risk of profound diuresis/dehydration. What is a monitoring parameter in addition to renal function to monitor for this?
Loop diuretics have a higher risk of profound diuresis/dehydration. What is a monitoring parameter in addition to renal function to monitor for this?
A 52 year old male with repeat blood pressure of 135/78 mmHg. No prior
history of HTN or other medical conditions. No current HTN medications.
What stage HTN is this?
His calculated ASCVD Risk is 15%. What medication would you start
first?
A 52 year old male with repeat blood pressure of 135/78 mmHg. No prior history of HTN or other medical conditions. No current HTN medications. What stage HTN is this? His calculated ASCVD Risk is 15%. What medication would you start first?
Flashcards
What is normal blood pressure?
What is normal blood pressure?
Blood pressure where systolic is less than 120 mmHg and diastolic is less than 80 mmHg.
What is elevated blood pressure?
What is elevated blood pressure?
Blood pressure where systolic is 120-129 mmHg, and diastolic is less than 80 mmHg.
What is Stage 1 Hypertension?
What is Stage 1 Hypertension?
Blood pressure where systolic is 130-139 mmHg or diastolic is 80-89 mmHg.
What is Stage 2 Hypertension?
What is Stage 2 Hypertension?
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What is the DASH diet?
What is the DASH diet?
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How is hypertension diagnosed?
How is hypertension diagnosed?
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How do Thiazide diuretics work?
How do Thiazide diuretics work?
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Name common Thiazide diuretics
Name common Thiazide diuretics
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What are Thiazide diuretics side effects?
What are Thiazide diuretics side effects?
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What to monitor on Thiazide diuretics?
What to monitor on Thiazide diuretics?
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How do ACE inhibitors work?
How do ACE inhibitors work?
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What are the side effects of ACE inhibitors?
What are the side effects of ACE inhibitors?
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How do ARBs (Angiotensin II Receptor Blockers) work?
How do ARBs (Angiotensin II Receptor Blockers) work?
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Examples of ARBs.
Examples of ARBs.
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What are the side effects of ARBs?
What are the side effects of ARBs?
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What to monitor when using ARBs?
What to monitor when using ARBs?
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When are ARBs contraindicated?
When are ARBs contraindicated?
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How do Calcium Channel Blockers (CCBs) work?
How do Calcium Channel Blockers (CCBs) work?
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What are Dihydropyridines?
What are Dihydropyridines?
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Side effects of Dihydropyridines?
Side effects of Dihydropyridines?
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What are Non-dihydropyridines?
What are Non-dihydropyridines?
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What are the side effects of Non-dihydropyridines?
What are the side effects of Non-dihydropyridines?
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What is Beta-blockers?
What is Beta-blockers?
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How do aldosterone antagonists work?
How do aldosterone antagonists work?
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What are examples of aldosterone antagonists?
What are examples of aldosterone antagonists?
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What are the side effects of aldosterone antagonists?
What are the side effects of aldosterone antagonists?
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How do potassium-sparing diuretics work?
How do potassium-sparing diuretics work?
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What are the side effects of potassium-sparing diuretics?
What are the side effects of potassium-sparing diuretics?
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How do loop diuretics work?
How do loop diuretics work?
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What are the side effects of loop diuretics?
What are the side effects of loop diuretics?
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How do beta-blockers work?
How do beta-blockers work?
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What are Beta-blockers side effects?
What are Beta-blockers side effects?
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How do alpha-2 agonists work?
How do alpha-2 agonists work?
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Side effects of alpha-2 agonists?
Side effects of alpha-2 agonists?
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How do vasodilators work?
How do vasodilators work?
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What the side effects of vasodilators?
What the side effects of vasodilators?
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Study Notes
- Antihypertensive Medications
Lecture Objectives
- Describe the pharmacology/mechanism of action of antihypertensive medications
- Identify common and serious side effects of antihypertensive medications
- List monitoring parameters
- Discuss selection of medication based on patient's medical history and co-morbidities
Lecture Overview
- Review hypertension guidelines
- Pathophysiology of hypertension & pharmacotherapy targets
- First-line Agents: ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics
- Other Agents: Beta blockers, other diuretics, alpha-2 agonists, and vasodilators
- Cases
Hypertension presentation
- Elevated blood pressure is often the only sign
- The condition is often asymptomatic
- Signs and symptoms may arise due to cardiovascular, cerebrovascular, retinal, and renal complications of disease
- Hypertension is known as "The silent killer"
- First heart attack: 7 out of 10 patients have high blood pressure
- First stroke: 8 out of 10 patients have high blood pressure
- Chronic heart failure: 7 out of 10 patients have high blood pressure
Diagnosis and Goals
- All individuals age 18+ should be screened for hypertension yearly
- Use the average of two or more properly measured blood pressure readings taken 1-2 minutes apart
- Blood pressure must be elevated when measured at two or more visits spaced 1-4 weeks apart
- The exception is made for individuals with HTN emergency (≥180/120mmHg) or ≥160/100mmHg with known end-organ damage
- Blood pressure lowering with antihypertensive therapy is associated with 35-40% reduction in stroke, 20-25% reduction in myocardial infarction and >50% reduction in heart failure
Blood Pressure Monitoring Technique
- Follow these steps to ensure an accurate reading
- The room should be Quiet and a comfortable temperature
- No smoking, coffee, or exercise for 30 minutes
- Empty bladder
- Relax for 3-5 minutes
- Taking 3 measurments at 1 minute intervals then use the average of the last 2 measurements
Blood Pressure Cuff Size
- 22-26cm arm circumference. recommended small adult cuff size
- 27-34cm arm circumference, recommended standard adult cuff size
- 35-44cm arm circumference, recommended large adult cuff size
- Greater than 45cm arm circumference, thigh size
Goals of Treatment
- The 2017 ACC/AHA Guidelines from the American College of Cardiology and American Heart Association should be followed
- Includes ASCVD risk scoring
- Includes direction on screening for masked or white coat hypertension
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