Hypertension Management Quiz
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Questions and Answers

What percentage of hypertension cases are classified as primary or essential?

  • 50%
  • 10%
  • 90% (correct)
  • 25%

    • Which of the following is NOT a major risk factor that increases mortality in hypertension?

  • Hypotension (correct)
  • Family history
  • Smoking
  • Diabetes Mellitus

    • Which type of hypertension has an identifiable cause?

  • Secondary Hypertension (correct)
  • Essential Hypertension
  • Acute Hypertension
  • Primary Hypertension

    • What is one of the main therapeutic goals of antihypertensive treatment?

    <p>To slow or interrupt progressive tissue and organ damage</p> Signup and view all the answers

    Which of the following is a non-pharmacological intervention for hypertension?

    <p>Regular aerobic exercise</p> Signup and view all the answers

    What is the primary action of dihydropyridines?

    <p>Relax arteries and arterioles</p> Signup and view all the answers

    Which of the following calcium channel blockers primarily affects the heart?

    <p>Verapamil</p> Signup and view all the answers

    What is a common adverse effect of calcium channel blockers?

    <p>Constipation</p> Signup and view all the answers

    How do non-dihydropyridines affect heart function?

    <p>Reduce calcium entry</p> Signup and view all the answers

    In patients with low renin activity, which hypertension treatment is likely to be least effective?

    <p>Beta blockers</p> Signup and view all the answers

    What is the impact of calcium channel blockers on blood pressure?

    <p>Effects seen in 3 to 4 weeks</p> Signup and view all the answers

    What distinguishes the action of dihydropyridines from non-dihydropyridines?

    <p>Dihydropyridines primarily affect arterioles, while non-dihydropyridines affect the heart</p> Signup and view all the answers

    Which calcium channel blocker is associated with higher myocardial infarction (MI) events when in rapid release formulation?

    <p>Nifedipine</p> Signup and view all the answers

    Which category indicates that there is positive evidence of human fetal risk, but potential benefits may still warrant use of the drug in pregnant women?

    <p>Category D</p> Signup and view all the answers

    What is a primary therapeutic use of ACE inhibitors?

    <p>Lower blood pressure</p> Signup and view all the answers

    Which diuretic is classified as a potassium-sparing agent?

    <p>Spironolactone</p> Signup and view all the answers

    What effect do thiazide diuretics initially have on the body?

    <p>Decrease blood volume</p> Signup and view all the answers

    Which of the following statements about angiotensin receptor blockers is true?

    <p>They are contraindicated during pregnancy.</p> Signup and view all the answers

    Which mechanism of action is associated with loop diuretics like Furosemide?

    <p>Prevent sodium reabsorption in the nephrons</p> Signup and view all the answers

    What is a benefit of using ACE inhibitors in diabetic nephropathy?

    <p>Reduces intraglomerular pressure</p> Signup and view all the answers

    What characteristic distinguishes potassium-sparing diuretics from others?

    <p>They promote potassium retention.</p> Signup and view all the answers

    What is a key characteristic of nonselective beta blockers?

    <p>They block both beta-1 and beta-2 receptors.</p> Signup and view all the answers

    Which beta blocker is primarily eliminated by the kidney?

    <p>Nadolol</p> Signup and view all the answers

    What potential side effect is associated with propranolol?

    <p>Nightmares</p> Signup and view all the answers

    What is the primary action of Nitroprusside in treating hypertensive emergencies?

    <p>Dilates veins and arteries for rapid blood pressure reduction</p> Signup and view all the answers

    Which condition is a contraindication for beta blockers?

    <p>Bronchospastic disease</p> Signup and view all the answers

    Which condition can result from a hypertensive emergency if left untreated?

    <p>Progressive vascular damage</p> Signup and view all the answers

    How does methyldopa primarily function to lower blood pressure?

    <p>As an alpha-2 agonist, reducing norepinephrine release.</p> Signup and view all the answers

    What is the major side effect of Nitroprusside that requires careful monitoring?

    <p>Excessive lowering of blood pressure</p> Signup and view all the answers

    Which alternative medication for hypertensive emergencies does NOT produce reflex tachycardia?

    <p>Labetalol</p> Signup and view all the answers

    What is a significant benefit of clonidine as a treatment?

    <p>Smoother blood pressure control with fewer side effects.</p> Signup and view all the answers

    What specific precaution must be taken when administering Nitroprusside intravenously?

    <p>Monitor for cyanide toxicity after prolonged use</p> Signup and view all the answers

    Which beta blocker is favored during pregnancy?

    <p>Methyldopa</p> Signup and view all the answers

    What happens during withdrawal from clonidine?

    <p>Headache and potential hypertensive crisis.</p> Signup and view all the answers

    Which of the following is not a side effect of methyldopa?

    <p>Increased blood glucose</p> Signup and view all the answers

    What is the primary reason that selective beta blockers are considered beneficial?

    <p>They selectively block beta-1 receptors at lower doses.</p> Signup and view all the answers

    Which patient population is particularly suitable for the use of vasodilators such as hydralazine and minoxidil?

    <p>Patients with refractory edema and renal failure</p> Signup and view all the answers

    What factor is NOT considered when choosing the 'drug(s) of choice' for a patient?

    <p>Patient's favorite medication</p> Signup and view all the answers

    What is one of the major side effects of hydralazine?

    <p>Salt and water retention</p> Signup and view all the answers

    Which statement regarding the initial monotherapy for hypertension is accurate?

    <p>Diuretics are one of the first-line therapies shown to reduce morbidity and mortality.</p> Signup and view all the answers

    Why is it important to avoid giving two drugs with similar mechanisms in the treatment of hypertension?

    <p>It may increase the risk of drug resistance.</p> Signup and view all the answers

    Which vasodilator predominantly acts on both arterioles and venules?

    <p>Nitroprusside</p> Signup and view all the answers

    What is a common side effect of minoxidil that distinguishes it from other vasodilators?

    <p>Hypertrichosis</p> Signup and view all the answers

    What aspect of drug therapy for hypertension is important for patient management over time?

    <p>Patients need to be educated on the importance of lifelong treatment.</p> Signup and view all the answers

    Study Notes

    Hypertension

    • Definition: Raised arterial blood pressure above "normal"
    • Classification of Blood Pressure for Adults Age 18 and Older:
      • Optimal: Systolic <120 and Diastolic <80
      • Normal: Systolic <130 and Diastolic <85
      • High-normal: Systolic 130-139 or Diastolic 85-89
      • Hypertension Stage 1: Systolic 140-159 or Diastolic 90-99
      • Hypertension Stage 2: Systolic 160-179 or Diastolic 100-109
      • Hypertension Stage 3: Systolic ≥180 or Diastolic ≥110
    • Current Criteria for Adults:
      • Systolic > 140 mm Hg and/or Diastolic > 90 mm Hg
      • Prevalence: About 25% of the US population
      • Incidence increases with age
    • Prevalence of Hypertension in the US (1988-1991):
      • The percentage of the US population with hypertension increases with age.

    Types of Hypertension

    • Primary ("Essential"):
      • Unknown cause
      • Accounts for 90% of cases
      • Drug therapy is the main course of treatment for this type
    • Secondary:
      • Identifiable cause
      • Accounts for 10% of cases of Hypertension
      • Examples include renal vascular disease, primary and secondary aldosteronism, pheochromocytoma, and drugs (e.g., oral contraceptives, sympathomimetics, and drugs of abuse)

    Why Reduce High Blood Pressure?

    • Slow or interrupt progressive tissue and organ damage to:
      • Brain
      • Eyes
      • Kidneys
      • Heart
    • Prolongs life

    Treatment Rationale

    • Long-term goal: Reduce mortality due to hypertension-induced disease.
      • Examples of hypertension-induced diseases:
        • Stroke
        • Congestive heart failure
        • Coronary artery disease
        • Nephropathy
        • Peripheral artery disease
        • Retinopathy

    Major Risk Factors That Increase Mortality in Hypertension

    • Smoking
    • Dyslipidemias
    • Diabetes Mellitus
    • Age > 60
    • Gender: Men, Postmenopausal women
    • Family history

    Current Problems

    • Awareness issues due to lack of symptoms
    • Treatment problems (inappropriate prescribing)
    • Patient noncompliance (10% stop taking medication)
    • Treatment complexity

    Non-Pharmacological Interventions

    • Diet:
      • Reduction of sodium intake
      • Caloric restriction for obese patients
      • Restriction of cholesterol and saturated fat intake.
    • Stress reduction
    • Regular aerobic exercise
    • Weight reduction (if required)
    • Control of other risk factors (blood lipids, smoking)

    Physiological Mechanisms (controlling blood pressure)

    • Blood Pressure = Cardiac Output x Total Peripheral Resistance.
    • Cardiac output: Heart rate x stroke volume.
    • Reflex control (Baroreceptor mechanism): Short-term regulation of blood pressure by pressure sensing areas throughout the CV system. Minute by minute control
    • Renin-angiotensin system: Longer-term regulation of blood pressure. Acting over weeks and months.

    Medications Used to Treat Hypertension

    • Adrenergic agents (beta- and alpha-blockers)
    • Angiotensin-converting enzyme (ACE) inhibitors
    • Angiotensin II receptor blockers (ARBs)
    • Calcium channel blockers
    • Diuretics
    • Vasodilators

    Adrenoceptor Antagonists

    • Alpha blockers:
      • Non-selective (e.g., Phenoxybenzamine, Phentolamine)- Block both alpha-1 and alpha-2 receptors.
      • Selective (e.g., Prazosin, Terazosin, Doxazosin) - selectively block alpha-1 receptors. Side effect of postural hypotension.
    • Beta blockers selective and non-selective
      • Non-selective (e.g., Propranolol, Timolol) - block both beta-1 and beta-2 receptors.
      • Cardioselective (e.g., Metoprolol, Atenolol) - block primarily beta-1 receptors.
      • Intrinsic sympathomimetic activity (ISA)
    • Beta blockers side effects: CNS effects, increased plasma triglycerides and decreased HDL, nausea, diarrhea, vomiting. Withdrawal syndrome. Beta blocker contraindications: unstable diabetes, and bronchospastic diseases

    Central Nervous System Sympatholytics

    • Clonidine
    • Methyldopa
    • Guanabenz
    • Guanfacine

    Clinically Significant Information: Clonidine, Methyldopa

    • Clonidine: Full agonist at alpha-2 receptors, partial agonist at alpha-1 receptors. Acts centrally, lowering sympathetic outflow and potentially reducing postural hypotension. Short half-life. Available as transdermal patch for increased compliance. Side effects: sedation, dry mouth, and withdrawal syndrome.
    • Methyldopa: Acts in the brain to lower BP, also appears to lower TPVR more than CO. Side effects: fever (mimics sepsis), dry mouth, and sedation.

    Calcium Channel Blockers

    • Dihydropyridines (e.g., Nifedipine, Amlodipine, Felodipine, Isradipine) - primarily affect arterioles.
    • Non-dihydropyridines (e.g., Verapamil, Diltiazem) - primarily affect the heart.

    Vasodilators

    • Hydralazine
    • Minoxidil
    • Diazoxide
    • Nitroprusside

    ACE Inhibitors

    • Reduces angiotensin II levels, vasoconstrictor effects, and aldosterone levels
    • Blocks the breakdown of bradykinin (a potent vasodilator)
    • Examples: Captopril and Enalapril. Hypotensive actions
    • Side effects: dry, non-productive cough, severe hypotension, acute renal failure, hyperkalemia
    • Contraindications: pregnancy

    Angiotensin Receptor Blockers (ARBs)

    • Block angiotensin type 1 receptors
    • Have no effect on bradykinin metabolism
    • Possibly reduced cough and angioedema, contraindicated in pregnancy
    • Examples: Losartan and Valsartan

    Thiazide Diuretics

    • Prevent sodium reabsorption in the nephrons, potentially lowering BP.
    • Decreases blood volume and CO.
    • Examples: Hydrochlorothiazide and Chlorothiazide.
    • Often used in combination with other antihypertensives

    Potassium-Sparing Diuretics

    • Examples: Spironolactone and Triamterene
    • Aldosterone antagonist (Spironolactone only)
    • Potentially combined with thiazides.

    Loop Diuretics

    • Examples: Furosemide, Ethacrynic acid, and Torsemide
    • Used in heart failure and renal failure. Continuous BP lowering effects

    Drug Therapy and Diagnosis

    • Lifelong disease with few symptoms, often need drugs taken daily.
    • Diagnosis should not be made from a single blood pressure reading but from repeated readings, and consideration of a complete medical history.
    • Essential Information for selection of drug therapy: Presence of other diseases, socioeconomic status, expected compliance, level of BP, presence of end-organ damage, age, sex, and race.
    • Need initial monotherapy, and may progress to multi drug therapy. Initial choice includes diuretics, ACE inhibitors or ARBs, calcium channel antagonists, and beta blockers.
    • Rationale for Multi-drug therapy: Additive effects, enhanced blood pressure lowering, and reduced side effects.
    • Rationale for combination drug therapies: Avoid giving two drugs with similar mechanisms and combine drugs to reduce reflex responses or potentially treat co-morbidities.
    • Hypertensive Emergencies: sudden, severe elevation of BP. Use in critically ill patients. Examples: Nitroprusside, Labetalol, and Nicardipine.

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    Description

    Test your knowledge on hypertension, including its classification, risk factors, and treatment options. This quiz covers essential concepts vital for understanding hypertension management and pharmacological interventions, as well as non-pharmacological approaches.

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