Goals of Antihypertensive Therapy correct answers To reduce cardiovascular morbidity and mortality
Ultimate goal: Maximally reduce CV risk without decreasing the enjoyment of life
Risk Factors for HTN correct answers Smoking
Dyslipidemia
Physical inactivity
BMI over or equal to 30
Diabete...
AGNP (AANP) HTN Review (A+ Graded already)
Goals of Antihypertensive Therapy correct answers To reduce cardiovascular morbidity and mortality
Ultimate goal: Maximally reduce CV risk without decreasing the enjoyment of life
Risk Factors for HTN correct answers Smoking
Dyslipidemia
Physical inactivity
BMI over or equal to 30
Diabetes mellitus: >55 for men and >65 for women(>60)
Male gender or postmenopausal female
Family history of CV disease: women <65, men<55
Microalbuminuria or est GFR <60ml /min.
Doubles the risk of CV diseases, such as: correct answers CHD, CHF, ischemic and hemorrhagic
stroke, renal failure, and peripheral artery disease
In African Americans correct answers HTN appears earlier, is generally more severe, and results in higher rates of morbidity and mortality
Persons who are normotensive at 55, have a ___% lifetime risk of developing HTN correct answers 90%
African Americans develop high blood pressure more often, and at an earlier age, than whites and Mexican Americans do. Among African Americans, more women than men have the condition correct answers Men (%) Women (%) African Americans 42.2 44.1
Mexican Americans 24.8 28.6 Whites 31.2 28.3 All 31.8 30.3
JNC VII Classifications for HTN ::: "NORMAL" correct answers <120 systolic <80 diastolic
JNC VII Classifications for HTN ::: "Pre-HTN" correct answers S: 120-139 D: 80-89
JNC VII Classifications for HTN ::: "Stage I HTN" correct answers S: 140-159 D: 90-99
JNC VII Classifications for HTN ::: "Stage II HTN " correct answers S: equal or >160 D: equal or>100
JNC VII Classifications for HTN ::: "Persistent - Severe" correct answers chronically elevated SBP and DBP >110-120mm Hg HTN Screening Recommendations... USPSTF recommends every ___ years for persons with BP<120/80 correct answers 2 years
HTN Screening Recommendations... JNC VII recommends every ___ years for persons with systolic 120-139 or diastolic 80-89 correct answers 1 year
Diagnosis of HTN should be based upon: correct answers The average of two or more properly measured readings at each of two or more visits after an initial screen.
Blood Pressure Goals of Therapy correct answers Uncomplicated HTN <140/90, blacks <135/85
Diabetic patients, proteinuric chronic kidney disease: <130/80 (some studies recommend <120/80) Atherosclerotic CVD: < or equal to 130/80
Patients with renal failure and proteinuria: (>1gram in 24 hours) <120/80
In elderly patients with severe systolic HTN: <160 is reasonable if attempts to reach 140 result intolerable side effects.
Prehypertension: 120-139 systolic or 80-89 diastolic correct answers Slightly elevated BP may increase stroke risk
by nearly 80%
Progression of essential HTN correct answers 1. Prehypertension(ages 10-30): increased CO
2. Early HTN (ages 20-40): increasesd peripheral resisistance
3. Established HTN(ages 30-50)
4. Complicated HTN(ages 40-60)
HTN tends to be familial and is likely to be consequence of interaction between environmental and genetic factors. correct answers 80-95% of patients diagnosed with HTN have primary or essential HTN
Essential or primary hypertension correct answers Pathophysiology and causes remain areas of active research
Many theories and different links to multiple risk factors
"Patients who develop hypertension are known to develop a systemic hypertensive response secondary to vasoconstrictive stimuli."
Secondary hypertension correct answers Most mechanisms leading to secondary HTN are understood... A Result of another underlying condition Secondary Hypertension: Causes correct answers Acute stress
Vascular disorders
Dissecting AA
Endocrine disorders
Adrenal
Neurologic-neurogenic
Obstructive sleep apnea
Medications
Pregnancy complications-Preeclampsia, Eclampsia
Renal disorders, renovascular disorders
Severe anemia
Tyramine-containing foods
Mendelian forms of HTN
Pathogenesis of HTN correct answers Any factor producing alteration in PVR(peripheral vascular resistance),HR(heart rate), or SV(stroke volume) affects systemic arterial BP through four mechanisms: Arterial baroreceptor and chemoreceptor systems Regulation of body fluid volume Vascular autoregulation Renin-angiotensin-aldosterone system
Pathogenesis of Essential HTN correct answers Complex and multifactorial Factors affecting blood pressure Humoral mediators Vascular reactivity Circulating blood volume Vascular caliber Blood viscosity Cardiac output Blood vessel elasticity Neural stimulation
Factors Affecting Arterial Pressure correct answers Factors Affecting Cardiac Output correct answers Sodium intake
Renal function
Mineralocorticoids
Inotropic effects occur through extracellular volume augmentation and increase in heart rate and contractility
Factors Affecting PVR correct answers PVR is dependent upon the sympathetic nervous system, humoral factors, and local autoregulation.
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