Podcast
Questions and Answers
What percentage of Americans with hypertension are known to receive adequate treatment?
What percentage of Americans with hypertension are known to receive adequate treatment?
- 20%
- 74%
- 85%
- 48% (correct)
What is the main characteristic of primary hypertension?
What is the main characteristic of primary hypertension?
- It typically occurs only in children.
- It has a definitive identifiable cause.
- It is the most common form of hypertension. (correct)
- It is often reversible with treatment.
Which of the following complications is NOT associated with untreated hypertension?
Which of the following complications is NOT associated with untreated hypertension?
- Stroke
- Asthma (correct)
- Heart disease
- Kidney disease
What is a significant challenge in the management of hypertension?
What is a significant challenge in the management of hypertension?
What does the classification of hypertension include?
What does the classification of hypertension include?
What is the primary strategy to slow progression of renal damage in nephrosclerosis?
What is the primary strategy to slow progression of renal damage in nephrosclerosis?
Which antihypertensive class is preferred in patients with diabetic nephropathy?
Which antihypertensive class is preferred in patients with diabetic nephropathy?
What should be the initial approach to treating hypertension in older adults?
What should be the initial approach to treating hypertension in older adults?
Why should ACE inhibitors be avoided in young women who are sexually active or pregnant?
Why should ACE inhibitors be avoided in young women who are sexually active or pregnant?
What is a common reason for the higher incidence of hypertension in African Americans compared to Caucasians?
What is a common reason for the higher incidence of hypertension in African Americans compared to Caucasians?
What is primary hypertension characterized by?
What is primary hypertension characterized by?
Which demographic is at the highest risk for developing primary hypertension?
Which demographic is at the highest risk for developing primary hypertension?
What is the primary distinction of secondary hypertension compared to primary hypertension?
What is the primary distinction of secondary hypertension compared to primary hypertension?
What blood pressure readings confirm a diagnosis of hypertension in adults?
What blood pressure readings confirm a diagnosis of hypertension in adults?
Which of the following is not identified as a major cardiovascular risk factor in hypertension evaluation?
Which of the following is not identified as a major cardiovascular risk factor in hypertension evaluation?
What is one of the ultimate treatment goals for managing hypertension?
What is one of the ultimate treatment goals for managing hypertension?
What is the first step in managing hypertension according to the treatment algorithm?
What is the first step in managing hypertension according to the treatment algorithm?
Which class of drugs is primarily recommended for initial therapy in patients without compelling indications?
Which class of drugs is primarily recommended for initial therapy in patients without compelling indications?
What should be considered before adding another antihypertensive drug?
What should be considered before adding another antihypertensive drug?
What is the rationale behind using drugs from different classes in hypertension therapy?
What is the rationale behind using drugs from different classes in hypertension therapy?
What can be a consequence of using high doses of antihypertensive drugs initially?
What can be a consequence of using high doses of antihypertensive drugs initially?
When can a step-down therapy be considered in hypertension management?
When can a step-down therapy be considered in hypertension management?
Which antihypertensive drug class is discouraged as first-line therapy due to its association with adverse cardiovascular events?
Which antihypertensive drug class is discouraged as first-line therapy due to its association with adverse cardiovascular events?
What is a significant benefit of using multiple drugs in hypertension therapy?
What is a significant benefit of using multiple drugs in hypertension therapy?
Which of the following is NOT a recommended initial drug for patients with hypertension without compelling indications?
Which of the following is NOT a recommended initial drug for patients with hypertension without compelling indications?
What significant change occurs in baroreceptors when blood pressure is reduced slowly?
What significant change occurs in baroreceptors when blood pressure is reduced slowly?
What is the primary mechanism by which antihypertensive drugs lower blood pressure?
What is the primary mechanism by which antihypertensive drugs lower blood pressure?
Which of the following drug classes can block reflex tachycardia to aid in reducing blood pressure?
Which of the following drug classes can block reflex tachycardia to aid in reducing blood pressure?
How does the renin-angiotensin-aldosterone system (RAAS) contribute to increased blood pressure?
How does the renin-angiotensin-aldosterone system (RAAS) contribute to increased blood pressure?
What role do baroreceptors play in blood pressure regulation?
What role do baroreceptors play in blood pressure regulation?
Which antihypertensive drug class primarily acts by reducing blood volume?
Which antihypertensive drug class primarily acts by reducing blood volume?
What is a consequence of the baroreceptor reflex when using antihypertensive medications?
What is a consequence of the baroreceptor reflex when using antihypertensive medications?
Which method is NOT an effective strategy to counteract the RAAS while using antihypertensive drugs?
Which method is NOT an effective strategy to counteract the RAAS while using antihypertensive drugs?
What happens to baroreceptors after prolonged antihypertensive treatment?
What happens to baroreceptors after prolonged antihypertensive treatment?
What is one major mechanism through which antihypertensive drugs lower blood pressure?
What is one major mechanism through which antihypertensive drugs lower blood pressure?
What primarily contributes to the reduction of blood pressure when antihypertensive drugs act in the brain stem?
What primarily contributes to the reduction of blood pressure when antihypertensive drugs act in the brain stem?
Which site of action for antihypertensive drugs promotes dilation of arterioles and veins?
Which site of action for antihypertensive drugs promotes dilation of arterioles and veins?
What effect does the blockade of β1-adrenergic receptors on the heart have?
What effect does the blockade of β1-adrenergic receptors on the heart have?
Which antihypertensive drug works by promoting salt and water excretion in the renal tubules?
Which antihypertensive drug works by promoting salt and water excretion in the renal tubules?
Which class of drugs is NOT typically used to suppress the sympathetic nervous system's influence on the heart and blood vessels?
Which class of drugs is NOT typically used to suppress the sympathetic nervous system's influence on the heart and blood vessels?
Which mechanism does NOT directly contribute to the actions of drugs targeting the renin-angiotensin-aldosterone system?
Which mechanism does NOT directly contribute to the actions of drugs targeting the renin-angiotensin-aldosterone system?
Which of the following is a consequence of blocking aldosterone receptors in the kidney?
Which of the following is a consequence of blocking aldosterone receptors in the kidney?
Ganglionic blocking agents have a significant reduction in blood pressure but are rarely used due to what reason?
Ganglionic blocking agents have a significant reduction in blood pressure but are rarely used due to what reason?
Inhibitors of angiotensin-converting enzyme (ACE) primarily lead to what physiological effect?
Inhibitors of angiotensin-converting enzyme (ACE) primarily lead to what physiological effect?
What is the primary reason for the lifelong need for treatment in patients with hypertension?
What is the primary reason for the lifelong need for treatment in patients with hypertension?
Which type of hypertension accounts for the majority of cases?
Which type of hypertension accounts for the majority of cases?
What class of patients is least likely to receive adequate treatment for hypertension?
What class of patients is least likely to receive adequate treatment for hypertension?
What is one significant consequence of untreated chronic hypertension?
What is one significant consequence of untreated chronic hypertension?
What distinguishes primary hypertension from secondary hypertension?
What distinguishes primary hypertension from secondary hypertension?
What factors influence cardiac output, which in turn affects blood pressure?
What factors influence cardiac output, which in turn affects blood pressure?
How does the baroreceptor reflex primarily oppose antihypertensive treatment?
How does the baroreceptor reflex primarily oppose antihypertensive treatment?
Which of the following drugs directly inhibits renin release?
Which of the following drugs directly inhibits renin release?
What is the result of activating the renin-angiotensin-aldosterone system (RAAS)?
What is the result of activating the renin-angiotensin-aldosterone system (RAAS)?
How can long-term therapy influence the sensitivity of baroreceptors to blood pressure changes?
How can long-term therapy influence the sensitivity of baroreceptors to blood pressure changes?
What type of drug acts by promoting arteriolar dilation to control blood pressure?
What type of drug acts by promoting arteriolar dilation to control blood pressure?
What is one way the sympathetic nervous system helps regulate blood pressure?
What is one way the sympathetic nervous system helps regulate blood pressure?
Which mechanism counteracts the blood pressure-lowering effects of antihypertensive medications through renal action?
Which mechanism counteracts the blood pressure-lowering effects of antihypertensive medications through renal action?
What is a characteristic feature of primary hypertension?
What is a characteristic feature of primary hypertension?
What increases the risk factor for primary hypertension among different demographic groups?
What increases the risk factor for primary hypertension among different demographic groups?
What diagnostic method is most accurately recommended for confirming hypertension?
What diagnostic method is most accurately recommended for confirming hypertension?
Which lifestyle modification is strongly encouraged for all patients with chronic hypertension?
Which lifestyle modification is strongly encouraged for all patients with chronic hypertension?
Which factor is NOT considered a major cardiovascular risk factor in patients with hypertension?
Which factor is NOT considered a major cardiovascular risk factor in patients with hypertension?
What is the ultimate treatment goal in managing hypertension?
What is the ultimate treatment goal in managing hypertension?
What condition can arise from untreated hypertension in African Americans?
What condition can arise from untreated hypertension in African Americans?
Which class of antihypertensive agents is least effective in African Americans without the presence of other conditions?
Which class of antihypertensive agents is least effective in African Americans without the presence of other conditions?
What should be the first line of action for treating hypertension in older adults?
What should be the first line of action for treating hypertension in older adults?
Which diuretic is preferred in patients with advanced renal insufficiency?
Which diuretic is preferred in patients with advanced renal insufficiency?
Which adverse effect is associated with antihypertensive drug therapy?
Which adverse effect is associated with antihypertensive drug therapy?
What is the primary effect of antihypertensive drugs acting at the sympathetic ganglia?
What is the primary effect of antihypertensive drugs acting at the sympathetic ganglia?
How do diuretics contribute to lowering blood pressure?
How do diuretics contribute to lowering blood pressure?
What effect does blockade of β1-adrenergic receptors on juxtaglomerular cells have?
What effect does blockade of β1-adrenergic receptors on juxtaglomerular cells have?
Which class of antihypertensive drugs acts directly on vascular smooth muscle?
Which class of antihypertensive drugs acts directly on vascular smooth muscle?
What is the primary action of drugs that inhibit renin?
What is the primary action of drugs that inhibit renin?
What mechanism primarily contributes to reduced blood pressure when antihypertensive drugs act on the brain stem?
What mechanism primarily contributes to reduced blood pressure when antihypertensive drugs act on the brain stem?
What happens to blood pressure with vasodilation of arterioles?
What happens to blood pressure with vasodilation of arterioles?
Which site of action for antihypertensive drugs does NOT primarily promote dilation of blood vessels?
Which site of action for antihypertensive drugs does NOT primarily promote dilation of blood vessels?
How does the blockade of aldosterone receptors in the kidneys affect blood pressure?
How does the blockade of aldosterone receptors in the kidneys affect blood pressure?
What role do ACE inhibitors play in blood pressure management?
What role do ACE inhibitors play in blood pressure management?
What is the initial drug recommended for most patients without compelling indications for hypertension treatment?
What is the initial drug recommended for most patients without compelling indications for hypertension treatment?
Which reason should be assessed before considering an additional antihypertensive medication?
Which reason should be assessed before considering an additional antihypertensive medication?
What is a potential benefit of using multiple antihypertensive medications?
What is a potential benefit of using multiple antihypertensive medications?
What is the effect on baroreceptors when blood pressure is gradually reduced?
What is the effect on baroreceptors when blood pressure is gradually reduced?
Which of the following combinations is appropriate for hypertension treatment?
Which of the following combinations is appropriate for hypertension treatment?
What should be done if step-down therapy is unsuccessful after one year of controlled blood pressure?
What should be done if step-down therapy is unsuccessful after one year of controlled blood pressure?
What is the rationale for using a lower initial dosage of antihypertensive drugs?
What is the rationale for using a lower initial dosage of antihypertensive drugs?
In patients with compelling indications for hypertension treatment, which drug class is typically recommended?
In patients with compelling indications for hypertension treatment, which drug class is typically recommended?
How should dosage adjustments be made over time when managing hypertension?
How should dosage adjustments be made over time when managing hypertension?
What is a significant consequence of using α1 blockers in initial therapy for hypertension?
What is a significant consequence of using α1 blockers in initial therapy for hypertension?
What is the primary reason hypertension requires lifelong treatment?
What is the primary reason hypertension requires lifelong treatment?
Which of the following complications is a direct risk of untreated hypertension?
Which of the following complications is a direct risk of untreated hypertension?
What percentage of adults with hypertension do not take sufficient medication to control their blood pressure?
What percentage of adults with hypertension do not take sufficient medication to control their blood pressure?
Which statement best describes primary hypertension?
Which statement best describes primary hypertension?
What is the primary characteristic of secondary hypertension?
What is the primary characteristic of secondary hypertension?
Which group has the highest risk of developing primary hypertension?
Which group has the highest risk of developing primary hypertension?
What is the main goal of treating hypertension?
What is the main goal of treating hypertension?
What diagnostic method is preferred to confirm hypertension?
What diagnostic method is preferred to confirm hypertension?
In patients with hypertension, what underlying condition could potentially allow for a cure?
In patients with hypertension, what underlying condition could potentially allow for a cure?
Which diagnostic test is NOT typically required for evaluating hypertension?
Which diagnostic test is NOT typically required for evaluating hypertension?
What lifestyle modification is recommended to help manage hypertension?
What lifestyle modification is recommended to help manage hypertension?
What measure is most effective in slowing the progression of renal damage in nephrosclerosis?
What measure is most effective in slowing the progression of renal damage in nephrosclerosis?
Which antihypertensive agents are considered most effective in patients with diabetes and nephropathy?
Which antihypertensive agents are considered most effective in patients with diabetes and nephropathy?
In African American patients, which class of antihypertensive drugs is generally first-line treatment?
In African American patients, which class of antihypertensive drugs is generally first-line treatment?
What is an important consideration when prescribing antihypertensive medications to older adults?
What is an important consideration when prescribing antihypertensive medications to older adults?
Why should potassium-sparing diuretics generally be avoided in patients with renal insufficiency?
Why should potassium-sparing diuretics generally be avoided in patients with renal insufficiency?
What is the primary function of the baroreceptor reflex in blood pressure regulation?
What is the primary function of the baroreceptor reflex in blood pressure regulation?
Which of the following drug classes can effectively reduce blood volume to lower blood pressure?
Which of the following drug classes can effectively reduce blood volume to lower blood pressure?
How does the renin-angiotensin-aldosterone system (RAAS) primarily elevate blood pressure?
How does the renin-angiotensin-aldosterone system (RAAS) primarily elevate blood pressure?
What mechanism allows α1 receptor activation to increase blood pressure?
What mechanism allows α1 receptor activation to increase blood pressure?
Which antihypertensive drug class is least likely to directly counteract the effects of the sympathetic nervous system?
Which antihypertensive drug class is least likely to directly counteract the effects of the sympathetic nervous system?
What happens to the baroreceptors when blood pressure is lowered over a prolonged period?
What happens to the baroreceptors when blood pressure is lowered over a prolonged period?
Which adverse effect may occur as a result of excessive sympathetic stimulation during antihypertensive therapy?
Which adverse effect may occur as a result of excessive sympathetic stimulation during antihypertensive therapy?
Which class of drugs would directly inhibit the conversion of angiotensin I to angiotensin II?
Which class of drugs would directly inhibit the conversion of angiotensin I to angiotensin II?
What is a primary mechanism through which antihypertensive drugs that act on the brain stem lower blood pressure?
What is a primary mechanism through which antihypertensive drugs that act on the brain stem lower blood pressure?
Which site of action for antihypertensive drugs primarily involves the blockade of β1-adrenergic receptors?
Which site of action for antihypertensive drugs primarily involves the blockade of β1-adrenergic receptors?
What is the primary effect of blockade of α1-adrenergic receptors on blood vessels?
What is the primary effect of blockade of α1-adrenergic receptors on blood vessels?
Which class of antihypertensive drugs acts by promoting excretion of sodium and water in the renal tubules?
Which class of antihypertensive drugs acts by promoting excretion of sodium and water in the renal tubules?
Inhibition of which component of the renin-angiotensin-aldosterone system (RAAS) has a direct effect on peripheral vasodilation?
Inhibition of which component of the renin-angiotensin-aldosterone system (RAAS) has a direct effect on peripheral vasodilation?
What is the initial recommended drug for most patients with hypertension who do not have compelling indications?
What is the initial recommended drug for most patients with hypertension who do not have compelling indications?
What effect do sympatholytic drugs have on heart activity during antihypertensive treatment?
What effect do sympatholytic drugs have on heart activity during antihypertensive treatment?
Why is it inappropriate to combine two β blockers in antihypertensive therapy?
Why is it inappropriate to combine two β blockers in antihypertensive therapy?
What is a significant role of diuretics in antihypertensive therapy?
What is a significant role of diuretics in antihypertensive therapy?
What is the primary benefit of starting antihypertensive medication at low dosages?
What is the primary benefit of starting antihypertensive medication at low dosages?
Which mechanism of action is NOT associated with calcium channel blockers (CCBs)?
Which mechanism of action is NOT associated with calcium channel blockers (CCBs)?
What is a limitation of ganglionic blocking agents in hypertension treatment?
What is a limitation of ganglionic blocking agents in hypertension treatment?
What happens to baroreceptors when blood pressure is reduced slowly over time?
What happens to baroreceptors when blood pressure is reduced slowly over time?
What is a key effect of antihypertensive drugs targeting the renal tubules?
What is a key effect of antihypertensive drugs targeting the renal tubules?
What is a critical step after controlling blood pressure for at least one year in hypertensive patients?
What is a critical step after controlling blood pressure for at least one year in hypertensive patients?
What is an example of a compelling indication for choosing specific antihypertensive drugs?
What is an example of a compelling indication for choosing specific antihypertensive drugs?
What should be assessed before considering the addition of another antihypertensive drug?
What should be assessed before considering the addition of another antihypertensive drug?
Why are centrally acting sympatholytics and direct-acting vasodilators not used as first-line treatments?
Why are centrally acting sympatholytics and direct-acting vasodilators not used as first-line treatments?
What is an important practice when combining antihypertensive medications?
What is an important practice when combining antihypertensive medications?
What type of medication is not typically recommended for initial therapy in patients with hypertension?
What type of medication is not typically recommended for initial therapy in patients with hypertension?
Flashcards
Primary Hypertension
Primary Hypertension
Hypertension that has no specific identifiable cause. It is diagnosed by ruling out other possible causes of elevated blood pressure.
Secondary Hypertension
Secondary Hypertension
Hypertension caused by an underlying medical condition, like kidney disease or thyroid issues. This type is less common than primary hypertension.
Systolic Pressure
Systolic Pressure
The top number in a blood pressure reading, reflecting the pressure in your arteries when your heart beats.
Diastolic Pressure
Diastolic Pressure
Signup and view all the flashcards
Preeclampsia
Preeclampsia
Signup and view all the flashcards
DASH Diet
DASH Diet
Signup and view all the flashcards
Treatment Goals of Hypertension
Treatment Goals of Hypertension
Signup and view all the flashcards
Ambulatory Blood Pressure Monitoring (ABPM)
Ambulatory Blood Pressure Monitoring (ABPM)
Signup and view all the flashcards
Patient Evaluation for Hypertension
Patient Evaluation for Hypertension
Signup and view all the flashcards
Blood Pressure
Blood Pressure
Signup and view all the flashcards
Hypertension
Hypertension
Signup and view all the flashcards
β-Blockers
β-Blockers
Signup and view all the flashcards
Diuretics
Diuretics
Signup and view all the flashcards
Calcium Channel Blockers
Calcium Channel Blockers
Signup and view all the flashcards
Renin-Angiotensin-Aldosterone System (RAAS)
Renin-Angiotensin-Aldosterone System (RAAS)
Signup and view all the flashcards
Sympathetic Nervous System
Sympathetic Nervous System
Signup and view all the flashcards
Baroreceptor Reflex
Baroreceptor Reflex
Signup and view all the flashcards
Hypertension in African Americans
Hypertension in African Americans
Signup and view all the flashcards
ACEIs
ACEIs
Signup and view all the flashcards
ACEIs/ARBs and Pregnancy
ACEIs/ARBs and Pregnancy
Signup and view all the flashcards
Isolated Systolic Hypertension in Older Adults
Isolated Systolic Hypertension in Older Adults
Signup and view all the flashcards
First-line Treatment for Hypertension
First-line Treatment for Hypertension
Signup and view all the flashcards
Initial Drug for Non-Compelling Hypertension
Initial Drug for Non-Compelling Hypertension
Signup and view all the flashcards
Compelling Indications in Hypertension
Compelling Indications in Hypertension
Signup and view all the flashcards
Drug Class Combinations for Hypertension
Drug Class Combinations for Hypertension
Signup and view all the flashcards
Benefits of Multidrug Therapy
Benefits of Multidrug Therapy
Signup and view all the flashcards
Dosing Strategy for Hypertension Treatment
Dosing Strategy for Hypertension Treatment
Signup and view all the flashcards
Step-Down Therapy for Hypertension
Step-Down Therapy for Hypertension
Signup and view all the flashcards
Hypertension and Renal Disease
Hypertension and Renal Disease
Signup and view all the flashcards
Hypertension and Diabetes
Hypertension and Diabetes
Signup and view all the flashcards
Individualizing Hypertension Treatment
Individualizing Hypertension Treatment
Signup and view all the flashcards
How do brain stem acting antihypertensive drugs work?
How do brain stem acting antihypertensive drugs work?
Signup and view all the flashcards
What is the mechanism of action of adrenergic neuron blocking agents?
What is the mechanism of action of adrenergic neuron blocking agents?
Signup and view all the flashcards
How do β1 blockers lower blood pressure?
How do β1 blockers lower blood pressure?
Signup and view all the flashcards
What is the mechanism of action of antihypertensive drugs that act directly on vascular smooth muscle?
What is the mechanism of action of antihypertensive drugs that act directly on vascular smooth muscle?
Signup and view all the flashcards
How do diuretics lower blood pressure?
How do diuretics lower blood pressure?
Signup and view all the flashcards
How do β-blockers on juxtaglomerular cells lower blood pressure?
How do β-blockers on juxtaglomerular cells lower blood pressure?
Signup and view all the flashcards
How do renin inhibitors work to reduce blood pressure?
How do renin inhibitors work to reduce blood pressure?
Signup and view all the flashcards
How do ACE inhibitors lower blood pressure?
How do ACE inhibitors lower blood pressure?
Signup and view all the flashcards
How do angiotensin II receptor blockers (ARBs) lower blood pressure?
How do angiotensin II receptor blockers (ARBs) lower blood pressure?
Signup and view all the flashcards
How do aldosterone receptor blockers lower blood pressure?
How do aldosterone receptor blockers lower blood pressure?
Signup and view all the flashcards
What is hypertension?
What is hypertension?
Signup and view all the flashcards
What is primary hypertension?
What is primary hypertension?
Signup and view all the flashcards
What is secondary hypertension?
What is secondary hypertension?
Signup and view all the flashcards
What is the goal of hypertension treatment?
What is the goal of hypertension treatment?
Signup and view all the flashcards
Can hypertension be cured?
Can hypertension be cured?
Signup and view all the flashcards
Factors that Increase Cardiovascular Risk
Factors that Increase Cardiovascular Risk
Signup and view all the flashcards
Adrenergic Neuron Blocking Agents
Adrenergic Neuron Blocking Agents
Signup and view all the flashcards
ACE Inhibitors (ACEIs)
ACE Inhibitors (ACEIs)
Signup and view all the flashcards
Angiotensin II Receptor Blockers (ARBs)
Angiotensin II Receptor Blockers (ARBs)
Signup and view all the flashcards
Renin Inhibitors (DRIs)
Renin Inhibitors (DRIs)
Signup and view all the flashcards
Aldosterone Receptor Blockers
Aldosterone Receptor Blockers
Signup and view all the flashcards
Direct-acting Vasodilators
Direct-acting Vasodilators
Signup and view all the flashcards
Brain Stem Acting Antihypertensives
Brain Stem Acting Antihypertensives
Signup and view all the flashcards
Direct-Acting Vascular Smooth Muscle Relaxants
Direct-Acting Vascular Smooth Muscle Relaxants
Signup and view all the flashcards
Diuretics and Blood Pressure
Diuretics and Blood Pressure
Signup and view all the flashcards
β1 Blockers on Juxtaglomerular Cells
β1 Blockers on Juxtaglomerular Cells
Signup and view all the flashcards
Renin Inhibitors
Renin Inhibitors
Signup and view all the flashcards
ACE Inhibitors & Blood Pressure
ACE Inhibitors & Blood Pressure
Signup and view all the flashcards
Antihypertensive Medications for Diabetes
Antihypertensive Medications for Diabetes
Signup and view all the flashcards
First-Line Treatment for Hypertension in African Americans
First-Line Treatment for Hypertension in African Americans
Signup and view all the flashcards
What is the first-line treatment for hypertension?
What is the first-line treatment for hypertension?
Signup and view all the flashcards
What is the goal of treating hypertension?
What is the goal of treating hypertension?
Signup and view all the flashcards
What is the Renin-Angiotensin-Aldosterone System (RAAS)?
What is the Renin-Angiotensin-Aldosterone System (RAAS)?
Signup and view all the flashcards
What is the Baroreceptor Reflex?
What is the Baroreceptor Reflex?
Signup and view all the flashcards
How do Direct-Acting Vascular Smooth Muscle Relaxants lower blood pressure?
How do Direct-Acting Vascular Smooth Muscle Relaxants lower blood pressure?
Signup and view all the flashcards
How is Hypertension Diagnosed?
How is Hypertension Diagnosed?
Signup and view all the flashcards
Why is ambulatory blood pressure monitoring (ABPM) crucial for hypertension diagnosis?
Why is ambulatory blood pressure monitoring (ABPM) crucial for hypertension diagnosis?
Signup and view all the flashcards
How is Chronic Hypertension Managed?
How is Chronic Hypertension Managed?
Signup and view all the flashcards
What are the Treatment Goals for Hypertension?
What are the Treatment Goals for Hypertension?
Signup and view all the flashcards
What are the actions of adrenergic neuron blocking agents?
What are the actions of adrenergic neuron blocking agents?
Signup and view all the flashcards
How do β₁ blockers lower blood pressure?
How do β₁ blockers lower blood pressure?
Signup and view all the flashcards
Explain how diuretics lower blood pressure.
Explain how diuretics lower blood pressure.
Signup and view all the flashcards
How do β₁ blockers on juxtaglomerular cells lower blood pressure?
How do β₁ blockers on juxtaglomerular cells lower blood pressure?
Signup and view all the flashcards
How do ACE inhibitors affect blood pressure?
How do ACE inhibitors affect blood pressure?
Signup and view all the flashcards
What are the common antihypertensive medications for diabetes?
What are the common antihypertensive medications for diabetes?
Signup and view all the flashcards
What is the first-line treatment for hypertension in African Americans?
What is the first-line treatment for hypertension in African Americans?
Signup and view all the flashcards
Isolated Systolic Hypertension
Isolated Systolic Hypertension
Signup and view all the flashcards
Multidrug Therapy for Hypertension
Multidrug Therapy for Hypertension
Signup and view all the flashcards
Study Notes
Hypertension: Treatment Overview
- Hypertension, or high blood pressure, is a prevalent, chronic condition affecting millions globally (over 1 billion), a leading cause of mortality, and has seen a nearly 20% increase in the past two decades.
- Untreated hypertension leads to severe complications like heart disease, kidney disease, and stroke.
- While treatment can mitigate symptoms and long-term issues, a cure is not possible; therefore, lifelong management is crucial.
- Treatment nonadherence is a significant concern, with undertreatment prevalent in affected populations, as evidenced by only 74% of Americans with the disease undergoing treatment and only 48% taking sufficient medicine to control blood pressure. Nearly 2 million American children, 85 million American adults and more than 1 billion people worldwide are affected.
Types of Hypertension
- Primary (Essential) Hypertension: The most common type, with no identifiable cause. Diagnosis is based on ruling out other causes. It’s a chronic, progressive condition leading to a continuous, gradual increase in blood pressure over time. Affects about 30% of US adults. Risk factors include age (older are more at risk), race (African Americans more than Caucasians), and gender (postmenopausal women more than premenopausal women).
- Secondary Hypertension: Elevated blood pressure resulting from a known underlying cause (e.g., Cushing syndrome, pheochromocytoma, oral contraceptives). Treating the underlying cause can lead to a cure. Secondary hypertension is less common, affecting less than 10% of hypertensive patients.
Basic Considerations in Hypertension Diagnosis
- Diagnosis: Based on multiple readings, not just one initial measurement. Repeat blood pressure measurements are needed over several office visits, with two measurements at least 5 minutes apart, in a seated position with feet on the floor, checking both arms. Ideally, ambulatory blood pressure monitoring (ABPM) is used to confirm diagnosis because office readings are often higher leading to inaccurate, false-positive results.
- Ambulatory Blood Pressure Monitoring (ABPM): Preferred for accurate diagnosis due to unreliability of office-based readings; they sometimes produce false positives, leading to unnecessary treatment. Experts recommend using ABPM for diagnosis.
Patient Evaluation
- Objective: Assess potential causes of hypertension and factors increasing cardiovascular risk.
- Evaluate for treatable underlying causes: Cushing syndrome, pheochromocytoma, oral contraceptive use.
- Assess for factors increasing cardiovascular risk, requiring aggressive therapy: Existing target-organ damage (heart disease, left ventricular hypertrophy, angina, prior MI, coronary revascularization, heart failure, stroke, chronic kidney disease, peripheral arterial disease, retinopathy), major cardiovascular risk factors (cigarette smoking, physical inactivity, dyslipidemia, diabetes, microalbuminuria, age >55 (men), >65 (women), family history of premature cardiovascular disease).
- Diagnostic Tests: Electrocardiogram (ECG), complete urinalysis, hemoglobin/hematocrit, and blood levels of sodium, potassium, calcium, creatinine, glucose, uric acid, triglycerides, and cholesterol (total, LDL, HDL).
Treatment Goals
- Overall Goal: Reduce cardiovascular and renal morbidity and mortality without negatively affecting quality of life.
- Target BP Values (Adults): SBP < 130 mmHg and DBP < 80 mmHg.
Therapeutic Interventions: Hypertension Management
- Lifestyle Modifications: Crucial for all patients, impacting blood pressure and other cardiovascular risks; include sodium restriction, DASH diet, alcohol moderation, aerobic exercise, healthy weight, and smoking cessation.
- Drug Therapy: Used alongside lifestyle modifications for effective blood pressure control. Collaboration between prescriber and patient, using various drug classes.
Classes of Antihypertensive Drugs
- Detailed information about Classes of Antihypertensive Drugs (Diuretics, Sympatholytics, CCBs, RAAS Suppressants) remains the same (as provided in the original notes).
Treatment Algorithm
- Initial Steps: Lifestyle modifications first, followed by drug therapy if needed. Single-drug initiation is common.
- Drug Selection Considerations: Evaluate compelling indications influencing initial drug selection; add drugs if needed, but consider patient response and minimal side effects. Combination therapy is important for effective and safe lower dosage treatments, targeting BP control from multiple sites.
- Initial Drug Choice for Patients without Compelling Indication: Thiazide diuretics are currently recommended, based on long-term trials of effectiveness, tolerance, and affordability.
- Patients with Compelling Indications: Specific drugs indicated for heart failure or diabetes (as indicated in Table 41.3).
Individualizing Therapy
- Details about Individualizing Therapy (Renal Disease, Diabetes) remain the same (as provided in the original notes). Specific dosage adjustment needed.
Minimizing Adverse Effects
- Tailoring Regimens: Adjust drug selection and dosages based on individual patient response and sensitivity, identified side effects.
- Collaborative Approach: Create a treatment plan involving the patient and prescriber; address specific concerns and potential issues / triggers.
- Monitoring for Adverse Effects: Close monitoring and reporting of any side effects.
- Low Initial Doses: Begin with low doses and gradually increase. Minimizes risk of abrupt/severe BP lowering.
Promoting Adherence Treatment
- Patient Education: Explain hypertension as a serious condition and the importance of adherence; explain the nature of the asymptomatic condition; stress long-term commitment.
- Minimizing Side Effects: Choose appropriate, well-tolerated medications.
- Collaborative Relationships: Emphasize the partnership.
- Simplified Regimens: Prioritize once or twice daily dosing.
- Important Considerations: Address chronic asymptomatic nature and the sustained, lifelong commitment to treatment.
Hypertension in Pregnancy
- Chronic Hypertension: Hypertension pre-existing or detected before 20 weeks; continue existing anti-hypertensive drugs, except ACEIs, ARBs, and DRIs (due to potential fetal harm).
- Preeclampsia: Develops after week 20, potentially serious; treatment depends on severity and fetal maturity; delivery is often the cure.
- Differentiation: Understand the distinction between chronic hypertension and preeclampsia in prenatal care; different treatments are used.
- Severe Hypertension: SBP >160 mm Hg or DBP >110 mm Hg requires treatment.
- Mild Hypertension: SBP 140 to 159 mm Hg or DBP 90 to 109 mm Hg generally does not require treatment.
Special Populations
- African Americans: Often more severe, higher-risk hypertension; diuretics often first-choice treatment, but other drugs might prove more effective, depending.
- Children and Adolescents: Secondary hypertension is more common; treatment is similar to adults, with careful dose adjustment and avoidance of ACEIs, ARBs during pregnancy.
- Older Adults: Isolated systolic hypertension is typical; orthostatic hypotension is a risk; initial lower doses; slower dosage escalation.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz provides an overview of hypertension, including its prevalence, complications, and the importance of lifelong management. It also covers the two main types of hypertension: primary and secondary. Understand the difference between essential hypertension and the more treatable secondary causes.
