Hypertension and Diabetes Exam Objectives PDF

**Exam 1 Objectives** **Hypertension** - When given a patient case, classify the blood pressure according to the 2017 ACC/AHA Guidelines on the Management of High Blood Pressure. - A table with text and numbers AI-generated content may be incorrect. - To classif...

**Exam 1 Objectives** **Hypertension** - When given a patient case, classify the blood pressure according to the 2017 ACC/AHA Guidelines on the Management of High Blood Pressure. - A table with text and numbers AI-generated content may be incorrect. - To classify = 2 different measurements - To diagnose = 2 in-office measurements + outside measurements to confirm - White Coat: office higher, outside lower - Masked: office lower, outside higher - Identify common modifiable and non-modifiable risk factors for hypertension. - Modifiable: diet (DASH), weight loss, reducing Na intake, increasing physical activity, reduce alcohol, smoking cessation, stress - Non-modifiable: age, genetics, race, family history - Given a patient case, create a treatment and monitoring plan for the management of hypertension (including both pharmacologic and non-pharmacologic treatments). - Pharmacologic: preferred thiazides, CCBs, ACEi or ARBs (not combined) - Non-pharmacologic: diet, exercise, weight management, lifestyle mods - Follow-up in 1 month, then every 6-12 months - When given a patient case, modify an existing antihypertensive regimen based on response to therapy and new findings (e.g., new laboratory data, tolerability, etc.). - If not a patient goal, adding drug therapies improves BP reduction and shows fewer adverse effects compared to using only one agent or increasing current regimen dose - Average reduction of 7 mmHg over 4 mmHg - Recognize special considerations that require additional care or attention in the management of hypertension, including pregnant patients, patients with resistant hypertension, and hypertensive emergency. - Black individuals: more likely to be resistant to ACEi/ARB monotherapy; use CCB or thiazides or both - Pregnant: goal \180/120 AND target organ damage, no organ damage is hypertensive urgency; IV antihypertensives - Compare the relative safety, efficacy, and place in therapy of common blood pressure lowering drugs, including thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, and mineralocorticoid receptor antagonists. - Thiazides: effective, reduces CV events, chlorthalidone more potent than hydrochlorothiazide; HYPOkalemia, HYPOnatremia, HYPERcalcemia, HYPERglycemia, gout - First-line, isolated systolic HTN, useful as add-on - ACEIs: reduces BP/CV, renoprotective in TDM/CKD, improves HFrEF/post-MI; dry cough, angioedema, HYPERkalemia - First-line with compelling indications, less effective in black patients as monotherapy - ARBs: similar to ACEIs, renoprotective without dry cough; better tolerated than ACE, HYPERkalemia - First-line alternative to ACEi, preferred in TDM/CKD/HF - CCBs: DHPs and non-DHPs - DHP: potent (black and elderly), reduces stroke risk, preferred in isolated systolic HTN; peripheral edema, reflex tachycardia - First-line general HTN, safe in pregnancy - Non-DHP: lowers and controls HR (AFib); bradycardia, AV block, constipation - Preferred in AFib or angina, avoid in HFrEF - BBs: less effective than other first-line agents, strong CV benefits with CAD/post-MI/HF; bradycardia, fatigue, sexual dysfunction, masked HYPOglycemia, avoid in asthma/COPD - Not first-line unless comorbidities, carvedilol and metoprolol succinate preferred in HF - MRAs: most effective add-on therapy for resistant HTN, reduces mortality in HF/HFrEF; HYPERkalemia, gynecomastia - Resistant HTN, HFrEF - Support treatment decisions for the management of high blood pressure using primary literature and relevant guideline recommendations. - Co-existing conditions - CKD or proteinuria: use ACEi or ARB - HFrEF: use beta-blockers, ACEi/ARB/ARNI/MRA - Angina: use BB or CCB - BPH: use alpha-1 blockers - Fluid overload: use loops - Resistant: use alpha-agonists or vasodilators -  - A diagram of a patient\'s treatment AI-generated content may be incorrect. **Diabetes** - Analyze the indications, contraindications, and potential side effects of each class of diabetes drugs. - Biguanides (metformin) - First-line T2DM; avoid in severe kidney disease (GFR \