Updated: 7/28/2022

Hypertension

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Topic
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N/A
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Questions
8
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Evidence
16
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Topic
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  • Snapshot
  • Introduction
  • Presentation
    • Physical exam
      • S4 heart sound with prolonged hypertension
  • Studies
    • Studies to evaluate for end-organ damage
      • electrocardiography
      • urinalysis
      • fasting blood glucose
      • hematocrit
      • electrolytes (including calcium)
      • creatinine
      • lipids profile
    • Blood Pressure
      CategorySystolic (mmHg)
      And/OrDiastolic (mmHg)
      Normal
      • < 120
      • And
      • < 80
      Elevated
      • 120-129
      • And
      • < 80
      Hypertension stage 1
      • 130-139
      • Or
      • 80-89
      Hypertension stage 2
      • > 140
      • Or
      • > 90
      Hypertensive crisis
      • > 180
      • And/Or
      • >120
  • Treatment
    • Goals of treatment
      • want to get BP < 140/90 mmHg in most patients
      • consider treating patients with ACE inhibitors even sooner if they have an underlying condition that can lead to hyperfiltration damage (diabetes, scleroderma renal crisis)
    • Medical
      • lifestyle modifications
        • indications
          • first line of treatment
        • modalities
          • including weight loss (most effective)
          • exercise
          • abstaining from alcohol 
          • smoking cessation
          • salt restriction
          • decrease in fat intake
          • and cholesterol control
            • to reduce risk of CAD
      • diuretic (HCTZ) and β-blockers(first line medications)
        • indications
          • lifestyle modification fail after 6 months to 1 year
        • medications include
          • diuretic (first-line HCTZ) and
          • β-blockers (no comorbid disease)
      • calcium channel blockers and ACEIs (second-line medications)
        • indications
          • lifestyle modification and first line medication fail
    • Drug
      Indications
      Contraindications
      Side Effects
      β-blockers
      • No comorbid disease
      • Previous MI
      • CAD
      • Pregnancy
        • use labetolol
        • avoid atenolol due to intrauterine growth restriction
      • Young Caucasian
      • Low EF
      • Angina
      • CAD
      • Coexistent benign essential tremor
      • Perioperative BP management
      • COPD
      • Hyperkalemia
      • Hypoglycemic events
      • Asthmatics
      • Bradycardia
      • Bronchospasm
      • Erectile dysfunction
      Thiazide diuretics
      • 1st-line medication if no comorbid disease
      • 1st-line medication in isolated systolic hypertension
      • African-Americans
      • CHF
      • Osteoporosis (thiazides)
      • Gout
      • Diabetes (thiazide)
      • Renal failure (K+ sparing)
      • Decrease excretion of calcium and uric acid; hypoNa
      ACEIs
      • Diabetics
      • Previous MI
      • Chronic Kidney Disease
      • Low EF
      • Pregnancy
      • Renal artery stenosis
      • Renal failure
      • Cough (substitute ARB)
      • Angioedema
      • Hyperkalemia
      Calcium channel blockers
      • Second-line agents
      • If other medication fails or if needed for controlling comorbidities
      • Lower extremity edema
      α-blockers
      • BPH
      • CHF: can increase risk of heart failure
      • Dizziness
      • Headache
      • Weakness
  • Complications
  • High Yield Medication Chart for Hypertension Treatment for Diseases
    • Disease
      Blood Pressure Medication Indication
      Coronary artery disease
      • β-Blocker
      Hyperthyroidism
      Grave's disease
      Congestive heart failure
      • β-Blocker
      • ACE-I
      • ARB
      Migraine
      • β-Blocker
      • Calcium channel blcoker
      Osteoporosis
      • Thiazide diuretics
      Hypocalcemia
      Depression
      • Avoidβ-blockers
      Asthma
      Pregnancy
      • α-Methyldopa
      • Labetalol
      • Nifedipine
      Benign prostatic hypertrophy
      • α-Blocker
      Diabetes
      • ACE-I
      • ARB
      Scleroderma
      • ACE-I
      Peri-operative blood pressure management
      • β-blockers (metoprolol)
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Questions (8)
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(M2.CV.17.4694) A 45-year-old male is presenting for routine health maintenance. He has no complaints. His pulse if 75/min, blood pressure is 155/90 mm Hg, and respiratory rate is 15/min. His body mass index is 25 kg/m2. The physical exam is within normal limits. He denies any shortness of breath, daytime sleepiness, headaches, sweating, or palpitations. He does not recall having an elevated blood pressure measurement before. Which of the following is the best next step?

QID: 107826

Refer patient to cardiologist

0%

(0/8)

Treat with thiazide diuretic

0%

(0/8)

Repeat the blood pressure measurement

100%

(8/8)

Obtained computed tomagraphy scan

0%

(0/8)

Provide reassurance

0%

(0/8)

M 6 C

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(M2.CV.16.4686) A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a headache about one hour ago. His vitals on admission are the following: blood pressure of 160/110 mmHg, pulse 95/min, temperature 98.6 deg F (37.2 deg C), and respirations 20/min. On exam, the patient has an audible abdominal bruit. After administration of antihypertensive medications, the patient has a blood pressure of 178/120 mmHg. The patient reports his headache has increased to a 10/10 pain level, that he has trouble seeing, and he can't move his extremities and seems confused. After stabilizing the patient, what is the best next step to diagnose the patient's condition?

QID: 107387

CT head with intravenous contrast

12%

(1/8)

CT head without intravenous contrast

88%

(7/8)

MRI head with intravenous constrast

0%

(0/8)

MRI head without intravenous constrast

0%

(0/8)

Doppler ultrasound of the carotids

0%

(0/8)

M 6 D

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(M3.CV.16.10) A 45-year-old female with no significant past medical history present to her primary care physician for her annual check up. She missed her several appointments in the past as she says that she does not like coming to the doctor's office. When she last presented 1 year ago, she was found to have an elevated blood pressure reading. She states that she has been in her usual state of health and has no new complaints. Vital signs in the office are as follows: T 98.8 F, BP 153/95 mmHg, HR 80 bpm, RR 14 rpm, SaO2 99% on RA. She appears very anxious during the exam. The remainder of the exam is unremarkable. She reports that her blood pressure was normal when she checked it at the pharmacy 3 months ago. What test would you consider in order to further evaluate this patient?

QID: 103301

Measure TSH and free T4

0%

(0/3)

Repeat vital signs at her next visit

0%

(0/3)

Measure creatinine level

33%

(1/3)

Ambulatory blood pressure monitoring

67%

(2/3)

Obtain an EKG

0%

(0/3)

M 10 D

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Evidence (16)
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EXPERT COMMENTS (65)
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