Hypertension Treatment Goals

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Questions and Answers

What is the primary goal of treating hypertension?

  • Preventing any reduction in blood pressure that is below normal.
  • Lowering blood pressure to a specific target.
  • Focusing solely on reducing systolic blood pressure.
  • Reducing morbidity and mortality from cardiovascular events and kidney disease. (correct)

According to the 2017 ACC/AHA guideline, what is the recommended blood pressure goal for most patients with hypertension?

  • Less than 130/90 mm Hg.
  • Less than 120/80 mm Hg.
  • Less than 140/90 mm Hg.
  • Less than 130/80 mm Hg. (correct)

In what population does the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend a systolic blood pressure (SBP) goal of less than 120 mm Hg?

  • Patients with chronic kidney disease not receiving dialysis. (correct)
  • Patients with diabetes.
  • Patients with ASCVD
  • Older ambulatory patients.

What was the main finding of the Systolic Blood Pressure Intervention Trial (SPRINT)?

<p>Lower blood pressure goals are associated with a significantly lower risk of cardiovascular events. (A)</p> Signup and view all the answers

What is clinical inertia in the context of hypertension management?

<p>A healthcare provider's failure to intensify treatment when a patient's blood pressure is not at goal. (A)</p> Signup and view all the answers

For a patient with elevated blood pressure or stage 1 hypertension at low risk of ASCVD, what is the appropriate initial treatment strategy?

<p>Lifestyle modifications alone. (C)</p> Signup and view all the answers

When should drug therapy be initiated in low-risk patients with hypertension?

<p>When blood pressure is ≥140/90 mm Hg with a goal BP of &lt;130/80 mm Hg. (C)</p> Signup and view all the answers

How should blood pressure control be managed in the context of compelling indications?

<p>Blood pressure control should be managed concurrently with the compelling indication. (C)</p> Signup and view all the answers

According to the guidelines, what is the first-line antihypertensive treatment option for most patients?

<p>ACE inhibitors, ARBs, CCBs, or thiazide diuretics. (D)</p> Signup and view all the answers

In which situation should beta-blocker therapy be reserved?

<p>To treat a specific, compelling indication or in combination with first-line agents for patients without a compelling indication. (C)</p> Signup and view all the answers

If albuminuria is present in a patient with diabetes, how should they be treated?

<p>Like chronic kidney disease, using an ACEi or ARB titrated to the maximum tolerated dose. (C)</p> Signup and view all the answers

According to the information, which diuretic is a 'thiazide-like' diuretic?

<p>Chlorthalidone (A)</p> Signup and view all the answers

Why are loop diuretics not first-line agents in most patients with hypertension?

<p>They are less potent than thiazide diuretics. (A)</p> Signup and view all the answers

Which diuretics are preferred over thiazides in patients with severe kidney dysfunction?

<p>Loop diuretics. (A)</p> Signup and view all the answers

Which class of diuretics should be reserved for patients experiencing diuretic-induced hypokalemia?

<p>Potassium-sparing diuretics (C)</p> Signup and view all the answers

Abrupt discontinuation of which drug class may cause rebound hypertension?

<p>Beta-blockers (D)</p> Signup and view all the answers

According to the information provided, nonselective beta-blockers should be avoided in patients with which co-existing condition?

<p>Asthma (D)</p> Signup and view all the answers

Which of the following is a common characteristic of mixed alpha- and beta-blockers?

<p>Production of vasodilation (A)</p> Signup and view all the answers

Beta-blockers with Intrinsic Sympathomimetic Activity (ISA) are contraindicated in patients with which condition?

<p>Stable ischemic heart disease (A)</p> Signup and view all the answers

What was the key finding regarding doxazosin in the ALLHAT study?

<p>It had a significantly higher risk of heart failure versus chlorthalidone. (A)</p> Signup and view all the answers

According to the ALLHAT study, which therapy was superior in preventing one or more major forms of cardiovascular disease?

<p>Chlorthalidone-based therapy. (A)</p> Signup and view all the answers

Which of the following is not an established benefit of ACE inhibitors?

<p>Prevention of kidney stones (A)</p> Signup and view all the answers

Which statement is true regarding ACE inhibitor-induced cough?

<p>It is caused by elevated levels of bradykinin (B)</p> Signup and view all the answers

What is the primary action of Angiotensin Receptor Blockers (ARBs) in reducing blood pressure?

<p>Blocking the AT1 receptor. (B)</p> Signup and view all the answers

What condition is a contraindication for the use of an ACEI, ARB, or direct renin inhibitor?

<p>Pregnancy (B)</p> Signup and view all the answers

What should patients be monitored for within 4 weeks of starting or increasing the dose of their ACE inhibitor, to mitigate serious adverse events?

<p>Serum potassium and creatinine values (A)</p> Signup and view all the answers

Amlodipine lowers blood pressure by:

<p>Blocking the influx of calcium across the cell membrane. (D)</p> Signup and view all the answers

For patients with a history of gout, which class of diuretics should be used with caution?

<p>Thiazide diuretics. (B)</p> Signup and view all the answers

When is chronotherapy indicated as a treatment for hypertension?

<p>Data are lacking based on the current evidence, demonstrating an advantage for chronotherapy in treating hypertension. (D)</p> Signup and view all the answers

What is the American Society of Hypertension recommendation for the ideal combination therapy?

<p>ACEi and Calcium Channel Blocker (C)</p> Signup and view all the answers

What consideration should be kept in mind about increasing antihypertensive medications?

<p>Using low-dose combinations also provides greater BP reductions than high doses of single agents, with fewer drug-related side effects. (A)</p> Signup and view all the answers

If a patient taking hydralazine or minoxidil begins showing compensatory baroreceptor responses, what medication should also be prescribed?

<p>Beta-blocker (A)</p> Signup and view all the answers

What is a consideration to keep in mind regarding potassium-sparing diuretics and aldosterone?

<p>The benefits of blocking aldosterone by using a mineralocorticoid receptor antagonist (B)</p> Signup and view all the answers

Flashcards

Overall Goal of Hypertension Treatment

Reduce morbidity and mortality from CV events and kidney disease.

Goal BP for most hypertensive patients

A BP of <130/80 mm Hg.

Clinical Inertia in Hypertension

Office visit where no therapeutic action is taken to lower BP in a patient with uncontrolled hypertension.

DASH Diet

Diet rich in fruits, vegetables, and low-fat dairy with reduced saturated and total fat.

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Preferred Initial Antihypertensive Agents

ACE inhibitors, ARBs, CCBs, or thiazide diuretics.

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Nondihydropyridine CCBs Use

Block the A-V node, reduce heart rate, treat hypertension.

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Thiazide Diuretics

Hydrochlorothiazide, chlorthalidone, indapamide, metolazone

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Hypertension in Older People

The SBP is greater than 50 years and older.

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Orthostatic Hypotension

Defined as an SBP decrease of >20 mm Hg or DBP decrease of >10 mm Hg when changing from supine to standing.

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Hypertension in Children

Defined as SBP or DBP that is >95th percentile for sex, age, and height at least three times in children.

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Aliskiren

Monitor BP, Kidney Function

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Direct arterial vasodilator

Hydralazine and minoxidil

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Prazosin and terazosin

Decreases workload of the heart

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ALLHAT Trial

A randomized study that compared the effects on the combined endpoint of fatal CHD or nonfatal MI.

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Beta Blockers and CVD

Treatment with a beta blocker reduce CV events better in patients.

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Compelling Indications

Hypertension requires a specific assessment of patients with co-occurring conditions.

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Amiloride and Triamterene

They are weak and for those on postassium sparrings.

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Self-monitoring device

It is used to moniter BP values and patients with pseudoresistance.

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What is Aliskiren

It blocks the RAAS activating point.

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What does Methyldopa do

Long-term follow-up data supports safety.

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Clonidine, guanfacine, and methyldopa function

Inhibit BP by stimulating alpha2-adrenergic receptor.

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Study Notes

  • Reducing morbidity and mortality from cardiovascular events and kidney disease is the overall goal for treating hypertension.
  • Select antihypertensive drug therapy based on evidence that demonstrates a reduction in morbidity and mortality, and not merely a reduction in blood pressure.
  • A surrogate goal of therapy is achieved by treating patients with hypertension to achieve a desired goal blood pressure.
  • Reducing blood pressure to a goal does not guarantee the prevention of hypertension-associated complications but it does significantly lower the risk.
  • Targeting a goal blood pressure is the standard of care for how clinicians evaluate response to therapy.
  • It is the primary method used to determine the need for titration and regimen modification.

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