Hypertension Therapeutics Review Flashcards

Vocabulary practice flashcards covering epidemiology, diagnosis, risk assessment, lifestyle management, pharmacology, compelling indications, resistant hypertension, and hypertensive crises based on the 2025 ACC/AHA guidelines.

Hemodynamic Equation of Blood Pressure

The relationship where blood pressure ($BP$) equals cardiac output ($CO$) multiplied by systemic vascular resistance ($SVR$), expressed as $BP = CO \times SVR$.

Primary (Essential) Hypertension

The most common form of hypertension ($90\%$ of cases) arising from genetic factors (heritability $30-50\%$) and environmental influences such as excess sodium, low potassium, physical inactivity, and obesity.

Secondary Hypertension

High blood pressure caused by an identifiable underlying medical condition ($5-25\%$ of cases), suggested by red flags including onset at age $<30$, stage $2$ or resistant hypertension, abrupt onset, or target-organ damage out of proportion to blood pressure levels.

White-Coat Hypertension

A blood pressure phenotype characterized by elevated blood pressure measurements in a clinical setting but normal out-of-office blood pressure readings.

Masked Hypertension

A blood pressure phenotype characterized by normal blood pressure measurements in a clinical setting but elevated out-of-office blood pressure readings.

2025 ACC/AHA Stage 1 Hypertension

A blood pressure classification defined as a systolic blood pressure of $130-139\,mm\,Hg$ or a diastolic blood pressure of $80-89\,mm\,Hg$.

2025 ACC/AHA Stage 2 Hypertension

A blood pressure classification defined as a systolic blood pressure of $\ge 140\,mm\,Hg$ or a diastolic blood pressure of $\ge 90\,mm\,Hg$.

PREVENT Risk Tool

The AHA 2023 risk assessment equation (Predicting Risk of CVD Events) for adults aged $30-79$ that calculates 10-year total cardiovascular disease risk (ASCVD plus heart failure) without using race as a variable.

DASH Eating Pattern

A heart-healthy dietary intervention rich in fruits, vegetables, whole grains, and low-fat dairy with reduced saturated and total fat, providing an average systolic blood pressure reduction of $-5$ to $-8\,mm\,Hg$ in hypertensive patients.

Thiazide Diuretics Mechanism of Action

Inhibition of the $\text{Na}^+/\text{Cl}^-$ cotransporter in the distal convoluted tubule, causing initial natriuresis and a chronic reduction in systemic vascular resistance.

ACE Inhibitors Mechanism of Action

Inhibition of angiotensin-converting enzyme, blocking the conversion of angiotensin I to angiotensin II to decrease vasoconstriction and aldosterone production while preventing bradykinin breakdown.

Angiotensin II Receptor Blockers (ARBs) Mechanism of Action

Direct blockade of angiotensin II at the $\text{AT}_1$ receptor, providing complete receptor-level RAAS inhibition without altering bradykinin metabolism.

Dihydropyridine CCBs Mechanism of Action

Blockade of L-type voltage-gated calcium channels in vascular smooth muscle cells, inducing arterial vasodilation and decreasing peripheral vascular resistance with minimal direct cardiac effect.

Non-Dihydropyridine Calcium Channel Blockers

Myocardial-selective L-type calcium channel blockers (diltiazem and verapamil) that lower heart rate and cardiac contractility, used primarily for arrhythmia rate control rather than primary hypertension treatment.

Mineralocorticoid Receptor Antagonists (MRAs)

Aldosterone receptor antagonists (spironolactone and eplerenone) that serve as the preferred fourth-line add-on agent for resistant hypertension.

Quadruple GDMT for HFrEF

The foundational four-class regimen for heart failure with reduced ejection fraction, consisting of a guideline-directed beta-blocker, an MRA, an ARNI (or ACEi/ARB), and an SGLT2 inhibitor.

Resistant Hypertension

Blood pressure above goal despite using $3$ antihypertensive agents of complementary mechanisms (including a diuretic) at maximally tolerated doses, or blood pressure requiring $\ge 4$ agents to achieve control.

Pseudoresistance

An apparent unresponsiveness to antihypertensive therapy caused by inaccurate measurement, white-coat effect ($~37.5\%$), medication nonadherence ($~50\%$), or interfering substances ($~20\%$).

Hypertensive Emergency

Severe blood pressure elevation ($>180/120\,mm\,Hg$) accompanied by evidence of acute target-organ damage, requiring ICU admission and continuous titratable IV therapy.

Severe Asymptomatic Hypertension

Markedly elevated blood pressure ($>180/120\,mm\,Hg$) without acute target-organ damage, managed by intensifying or restarting oral medications in an outpatient setting rather than acute parenteral lowering.

BARKH Criteria

A mnemonic representing common acute target-organ damage presentations in hypertensive emergencies: Brain/neurologic, Aortic dissection, Renal/AKI, Kidney/Heart (acute HF/ACS), and Hyperadrenergic/Eclampsia states.

Clevidipine

An ultra-short-acting dihydropyridine calcium channel blocker IV lipid emulsion with a $5-15\,min$ offset, contraindicated in patients with soy/egg allergies or lipid metabolism disorders.

Labetalol

A combined alpha-1 and beta-blocker IV agent with an onset of ~$5\,min$ and duration of $3-6\,hours$, contraindicated in reactive airway disease, severe bradycardia, heart block, and decompensated heart failure.

Nitroprusside

A potent parenteral vasodilator with an onset/offset of $1-2\,min$ that carries a risk of cyanide and thiocyanate toxicity, contraindicated in pregnancy and acute cerebrovascular disease.