Applied HTN Questions

Given a patient has dyslipidemia or BPH, what antihypertensive drug is recommended to treat this comorbidity?

Alpha blockers

What antihypertensive drugs have favorable effects on angina and severe CAD?

Beta blockers

Non-dihydropyridine CCBs (diltiazem, verapamil)

What antihypertensive drugs have favorable effects on atrial tachycardia and fibrillation?

Beta blockers

Non-dihydropyridine

ACEI or ARBs

How many months after initiating hypertensive therapy should you follow up?

What medications require earlier monitoring?

1-2 months

Diuretics, ACE, ARB

What antihypertensive medications are favorable for use in CKD With albuminuria + DM?

ACEI or ARB

What antihypertensive medications are favorable for secondary stroke prevention?

ACEI, ARB, or thiazide

What are the 4 first line therapies for hypertension?

ACEI, ARB, thiazide, CCB

For clinical CVD, a 10-year CVD risk over 7.5%, CKD, or DM, what is the initial treatment and next steps?

Initiate medications

Add medications

For blood pressure over 130/80 with no CKD, 10-year risk of CVD over 7.5%, CKD, or DM, what is the initial treatment and next steps?

3–6-month lifestyle recommendations

Initiate medications

What is the MOA of central alpha 2 agonists?

What are the drug names?

stimulate central alpha 2 receptors to inhibit NE release and sympathetic outflow

clonidine, methyldopa, guanfacine

Is methyldopa contraindicated in pregnancy?

No

When are alpha 1 antagonists used to treat hypertension?

Only with comorbid BPH

If a patient has asthma, what antihypertensive should you avoid?

Non-cardioselective beta blockers

What class of medications are hydrochlorothiazide, chlorthalidone, and indapamide?

Hydrochlorothiazide: thiazide-type

Chlorthalidone, indapamide: thiazide-like

What are the names of the thiazide diuretic medications? (list both types)

Thiazide-type: hydrochlorothiazide

Thiazide-like: indapamide, chlorthalidone

What are the names of the K+ sparing diuretics/MRAs?

Eplerenone, spironolactone

What class of antihypertensive medication is spironolactone and eplerenone?

K+ sparing diuretic/MRA

What line in therapy are eplerenone and spironolactone?

Fourth line

In what comorbid condition can eplerenone and spironolactone treat?

CKD + proteinuria

What medications increase potassium levels?

ACEI, ARB, K+ sparing diuretics

What class of antihypertensives are contraindicated in patients with bilateral renal artery stenosis or pregnancy?

ACEI and ARBs

What class of antihypertensives should be avoided in patients with peripheral edema?

CCBs

Above what blood pressure is stage 2 hypertension?

140/90

What medications can be used to improve CCB induced edema?

ACE-I/ARB or nitrates

What are the drug interactions of the CCBs?

Diltiazem and Verapamil: CYP3A4 and PGP inhibitor

Nifedipine, amlodipine, felodipine: CYP3A4 substrate

What suffix do ACEI end in?

-pril

What drugs can increase serum potassium levels?

ACEI, ARB, spironolactone/eplerenone

What suffix do ARBs end in?

-sartan

What sympathetic receptor is found in the heart and the juxtaglomerular cells that release renin?

Beta 1

What blood pressure measurement is the peak arterial pressure during ventricular ejection?

Systolic blood pressure

What blood pressure measurement is the peak arterial pressure at the end of isometric relaxation?

Diastolic blood pressure

Inhibition of what cellular component would decrease vascular smooth muscle contraction?

L-type calcium channel

What class of drug are hydralazine and minoxidil?

Direct vasodilator

Can alpha 2 agonists be stopped immediately or do you need to taper?

Taper

What suffix do beta blockers end in?

-lol

What class of medication is metoprolol, labetalol, esmolol, and propranolol

Beta blockers

What line in therapy are beta blockers?

Fourth line

What class of medication is carvedilol?

Is it selective or non-selective?

Beta blocker; Non-selective

What class of medication is metoprolol, nebivolol, and bisoprolol?

Is it selective or non-selective?

Beta blocker; Selective

During isovolumetric contraction, the closing of which valves produces S1 (lup)?

AV valves

What are the targets of dihydropyridine CCBs and non-dihydropyridine CCBs?

Dihydropyridine: Vascular smooth muscle

Non-dihydropyridine: SA/AV nodes and myocardium

The closing of which valves produces S2 (dup)?

Semilunar valves

What class of drug is acetazolamide?

Carbonic anhydrase inhibitor diuretic

Which class of diuretics can lead to an increase in calcium excretion in the urine?

Loop diuretics

What transporter produces the osmotic gradient for sodium reabsorption through the basolateral membrane?

Na+/K+-ATPase

What receptor in the ascending limb controls electrolyte reabsorption?

NKCC2

Explain why loop diuretics cause increased calcium excretion

Loop diuretics inhibit NKCC2 transporters. These transporters import Na+, K+, and 2 Cl- from urine into tubular cells (neutral). ROMK transporters move K+ from tubular cells back into the urine (-). The gradient promotes paracellular reabsorption of Mg and Ca. Inhibition of NKCC2 ultimately removes the gradient, preventing the reabsorption of Ca.

What urinary electrolyte concentrations are increased through use of loop diuretics?

Na, K, Ca, Mg

Explain the MOA of thiazide diuretics and why it causes hypokalemia

NCC transporoters move Na and Cl from the urine into the tubule cell. Thiazides inhibit NCC. Inhibition of this transporter creates a gradient that promotes the secretion of potassium from the extracellular space into the tubule cell and thus excretion into the urine.

Explain the RAAS system given hypotension.

Juxtaglomerular cells sense low pressure and release renin. Renin converts angiotensinogen from the liver into angiotensin I. ACE converts angiotensin I into angiotensin II. angiotensin II promotes vasoconstriction, sodium reabsorption, and aldosterone release. Aldosterone promotes sodium retention and potassium secretion.

What are the goals of therapy for a hypertensive crisis without a compelling condition?

SBP reduced no more than 25% in 1 hour

Then to <160/100 in next 2-6 hours

Then cautiously to 130 to 140 during the next 24-48 hours

What classes of antihypertensives will decrease heartrate?

Beta blockers, CCBs, and central alpha 2 agonists

What sufix do the names of the central alpha 1 antagonists end in?

-zosin

What are the names of the cardioselective and non-selective beta blockers?

Cardioselective: Metoprolol, atenolol, esmolol

Non-selective: Propranolol, nadolol

Can beta blockers be stopped immediately or do you need to taper?

Taper

For patients with resistant hypertension, what is the preferred add-on therapy?

MRAs

What is measuring the Ankle Brachial Index used for?

Diagnose and determine the severity of peripheral artery disease

What value is considered normal when measuring Jugular Venous Pressure?

<9 cm

What is Hepatojugular Reflux used to evaluate?

Right heart failure

What is the difference in treatments given severe HTN and HTN emergency?

Severe HTN: Treated using oral antihypertensives unless:

• perioperative hypertension

• intractable epistaxis

• sympathomimetic drug overdose

• increased circulating catecholamines

• MAOI-tyramine interaction

HTN emergency: IV antihypertensives

What systolic and diastolic pressures indicate a severe hypertension or a hypertensive emergency?

What sets severe hypertension and hypertensive emergencies apart?

SBP>180

DBP>120

Acute organ damage

Explain the goals of treatment for HTN in acute stroke

Lower to < 185/110 to give thrombolytics

Keep BP < 180/105 for endovascular treatment

Which medications are known to increase blood pressure?

Tacrolimus and NSAIDs

When are thiazide diuretics contraindicated?

Gout and diabetes

Are eplerenone and spironolactone selective or non-selective?

Eplerenone: selective

Spironolactone: non-selective