Module 4 HTN Study Guide
1. Compare and contrast age indications, BP goals, and recommended drug choices. (CO 3)
Adults: The 2017 ACC/AHA guidelines recommend starting hypertension treatment at a
lower threshold of 130/80 mmHg compared to the previous 140/90 mmHg, emphasizing
earlier intervention. Recommended drug classes include ACE inhibitors, ARBs, calcium
channel blockers (CCBs), and thiazide diuretics.
Children and Adolescents: For children up to 12 years, hypertension is defined as average
systolic or diastolic BP ≥95th percentile for gender, age, and height on ≥3 occasions. For
adolescents (13 years and older), BP levels ≥130/80 mmHg should be considered
hypertensive. Lifestyle changes are first-line interventions, with pharmacological treatments
recommended if BP remains high, focusing on ACE inhibitors, ARBs, β-blockers, CCBs, and
diuretics.
2. Differentiate major anti-hypertensive drug classes based on indications, dosing ranges,
methods of action, contraindications, major side effects, and any special indications for use.
(You do NOT need to know individual drugs unless one is emphasized--only drug categories
(CO 3)
ACE Inhibitors: Used for heart failure, myocardial infarction, and diabetic nephropathy.
They block the conversion of angiotensin I to angiotensin II, lowering BP and reducing
peripheral vascular resistance.
ARBs: Block the action of angiotensin II at its receptor site and are used in similar
indications as ACE inhibitors, especially in patients who cannot tolerate ACE inhibitors.
Calcium Channel Blockers: Include dihydropyridines (which mainly cause vascular smooth
muscle relaxation) and non-dihydropyridines (which also affect the heart rate and
contractility). Used in hypertension, especially in elderly patients due to decreased arterial
compliance.
Thiazide Diuretics: Increase the excretion of sodium and water, commonly used in
hypertension management, especially effective in preventing calcium stone recurrence.
Beta Blockers: Not recommended as first-line therapy unless there is a compelling indication
such as heart failure or post-myocardial infarction.
3. Define the 2017 ACC/AHA National Guidelines and categories on HTN and apply to clinical
situations. (CO 3)
The 2017 ACC/AHA guidelines for the management of hypertension mark a significant update from the
JNC 7 report released in 2003, reflecting new findings on blood pressure-related cardiovascular risk and
optimizing treatment strategies. Here's an elaboration on these guidelines and their application in clinical
settings:
Definition of Blood Pressure Categories
Normal BP: <120 systolic and <80 diastolic (mm Hg)
Elevated BP: 120-129 systolic and <80 diastolic
Hypertension Stage 1: 130-139 systolic or 80-89 diastolic
Hypertension Stage 2: ≥140 systolic or ≥90 diastolic
Key Points and Clinical Application:
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, Accurate BP Measurement: The guidelines emphasize the importance of accurate blood pressure
measurement. Clinicians must ensure that BP is measured under standardized conditions to avoid
misdiagnosis or inappropriate management. This involves taking multiple readings on different
occasions before diagnosing hypertension.
Use of Out-of-Office and Self-Monitoring: To confirm the diagnosis of hypertension and for
titrating medications, the guidelines recommend ambulatory blood pressure monitoring (ABPM) or
home blood pressure monitoring (HBPM). These methods help identify white coat hypertension and
masked hypertension, ensuring that patients are neither over-treated nor under-treated.
Risk of Cardiovascular Disease (CVD): The guidelines highlight that the risk of CVD increases
progressively from systolic BP levels of less than 115 mm Hg to over 180 mm Hg. Therefore, even
patients with what might be considered near-normal systolic BP levels are at increased risk and might
benefit from lifestyle modifications.
Screening for Secondary Hypertension: For new-onset or uncontrolled hypertension, especially in
patients who do not respond to standard treatments or present atypical features (e.g., young age onset
or very high BP), screening for secondary causes is crucial. This includes evaluating for kidney
disease, sleep apnea, and endocrine disorders.
Lifestyle Modifications: The guidelines strongly advocate for nonpharmacologic interventions,
which include dietary changes (reduction in sodium intake, increased potassium, and a healthy diet
rich in fruits and vegetables), regular physical activity, moderation of alcohol intake, and weight loss
if overweight or obese. These changes can significantly reduce BP and decrease the overall
cardiovascular risk.
Pharmacologic Treatment: Medication is recommended for:
o Patients with a history of CVD and BP ≥130/80 mm Hg.
o Those without CVD but with an estimated 10-year ASCVD risk of ≥10% and BP ≥130/80 mm
Hg.
o Patients with stage 1 hypertension and low ASCVD risk should consider medication if BP does
not respond to lifestyle changes alone.
Special Populations: Treatment targets and choices may vary based on demographic factors such as
age, race, and the presence of conditions like diabetes or CKD. For instance, in African American
adults without heart failure or CKD, initial treatment should include a thiazide-type diuretic or a
CCB.
Application to Clinical Scenarios:
A 50-year-old African American Male with Type 2 Diabetes: Start with a thiazide diuretic or
CCB and monitor for the need to add an ACE inhibitor or ARB, especially if there is proteinuria
or diabetic kidney disease.
A 65-year-old Caucasian Female with Chronic Kidney Disease: Initiate treatment with an
ACE inhibitor to protect renal function, alongside strict BP control targets (<130/80 mm Hg).
A 30-year-old Male with Newly Diagnosed Hypertension: Confirm diagnosis with ABPM or
HBPM before starting pharmacologic treatment, considering lifestyle interventions first unless
BP is in the Stage 2 range.
These guidelines necessitate a personalized approach based on individual risk factors and comorbid
conditions, ensuring both effective blood pressure control and overall cardiovascular risk reduction.
4. Define BP targets and preferred medications by age, race, diabetes, and CKD.(CO 3)
This study source was downloaded by 100000900703063 from CourseHero.com on 09-30-2025 21:11:47 GMT -05:00
https://www.coursehero.com/file/250476062/module-4-htn-study-guide-revdocx/
1. Compare and contrast age indications, BP goals, and recommended drug choices. (CO 3)
Adults: The 2017 ACC/AHA guidelines recommend starting hypertension treatment at a
lower threshold of 130/80 mmHg compared to the previous 140/90 mmHg, emphasizing
earlier intervention. Recommended drug classes include ACE inhibitors, ARBs, calcium
channel blockers (CCBs), and thiazide diuretics.
Children and Adolescents: For children up to 12 years, hypertension is defined as average
systolic or diastolic BP ≥95th percentile for gender, age, and height on ≥3 occasions. For
adolescents (13 years and older), BP levels ≥130/80 mmHg should be considered
hypertensive. Lifestyle changes are first-line interventions, with pharmacological treatments
recommended if BP remains high, focusing on ACE inhibitors, ARBs, β-blockers, CCBs, and
diuretics.
2. Differentiate major anti-hypertensive drug classes based on indications, dosing ranges,
methods of action, contraindications, major side effects, and any special indications for use.
(You do NOT need to know individual drugs unless one is emphasized--only drug categories
(CO 3)
ACE Inhibitors: Used for heart failure, myocardial infarction, and diabetic nephropathy.
They block the conversion of angiotensin I to angiotensin II, lowering BP and reducing
peripheral vascular resistance.
ARBs: Block the action of angiotensin II at its receptor site and are used in similar
indications as ACE inhibitors, especially in patients who cannot tolerate ACE inhibitors.
Calcium Channel Blockers: Include dihydropyridines (which mainly cause vascular smooth
muscle relaxation) and non-dihydropyridines (which also affect the heart rate and
contractility). Used in hypertension, especially in elderly patients due to decreased arterial
compliance.
Thiazide Diuretics: Increase the excretion of sodium and water, commonly used in
hypertension management, especially effective in preventing calcium stone recurrence.
Beta Blockers: Not recommended as first-line therapy unless there is a compelling indication
such as heart failure or post-myocardial infarction.
3. Define the 2017 ACC/AHA National Guidelines and categories on HTN and apply to clinical
situations. (CO 3)
The 2017 ACC/AHA guidelines for the management of hypertension mark a significant update from the
JNC 7 report released in 2003, reflecting new findings on blood pressure-related cardiovascular risk and
optimizing treatment strategies. Here's an elaboration on these guidelines and their application in clinical
settings:
Definition of Blood Pressure Categories
Normal BP: <120 systolic and <80 diastolic (mm Hg)
Elevated BP: 120-129 systolic and <80 diastolic
Hypertension Stage 1: 130-139 systolic or 80-89 diastolic
Hypertension Stage 2: ≥140 systolic or ≥90 diastolic
Key Points and Clinical Application:
This study source was downloaded by 100000900703063 from CourseHero.com on 09-30-2025 21:11:47 GMT -05:00
https://www.coursehero.com/file/250476062/module-4-htn-study-guide-revdocx/
, Accurate BP Measurement: The guidelines emphasize the importance of accurate blood pressure
measurement. Clinicians must ensure that BP is measured under standardized conditions to avoid
misdiagnosis or inappropriate management. This involves taking multiple readings on different
occasions before diagnosing hypertension.
Use of Out-of-Office and Self-Monitoring: To confirm the diagnosis of hypertension and for
titrating medications, the guidelines recommend ambulatory blood pressure monitoring (ABPM) or
home blood pressure monitoring (HBPM). These methods help identify white coat hypertension and
masked hypertension, ensuring that patients are neither over-treated nor under-treated.
Risk of Cardiovascular Disease (CVD): The guidelines highlight that the risk of CVD increases
progressively from systolic BP levels of less than 115 mm Hg to over 180 mm Hg. Therefore, even
patients with what might be considered near-normal systolic BP levels are at increased risk and might
benefit from lifestyle modifications.
Screening for Secondary Hypertension: For new-onset or uncontrolled hypertension, especially in
patients who do not respond to standard treatments or present atypical features (e.g., young age onset
or very high BP), screening for secondary causes is crucial. This includes evaluating for kidney
disease, sleep apnea, and endocrine disorders.
Lifestyle Modifications: The guidelines strongly advocate for nonpharmacologic interventions,
which include dietary changes (reduction in sodium intake, increased potassium, and a healthy diet
rich in fruits and vegetables), regular physical activity, moderation of alcohol intake, and weight loss
if overweight or obese. These changes can significantly reduce BP and decrease the overall
cardiovascular risk.
Pharmacologic Treatment: Medication is recommended for:
o Patients with a history of CVD and BP ≥130/80 mm Hg.
o Those without CVD but with an estimated 10-year ASCVD risk of ≥10% and BP ≥130/80 mm
Hg.
o Patients with stage 1 hypertension and low ASCVD risk should consider medication if BP does
not respond to lifestyle changes alone.
Special Populations: Treatment targets and choices may vary based on demographic factors such as
age, race, and the presence of conditions like diabetes or CKD. For instance, in African American
adults without heart failure or CKD, initial treatment should include a thiazide-type diuretic or a
CCB.
Application to Clinical Scenarios:
A 50-year-old African American Male with Type 2 Diabetes: Start with a thiazide diuretic or
CCB and monitor for the need to add an ACE inhibitor or ARB, especially if there is proteinuria
or diabetic kidney disease.
A 65-year-old Caucasian Female with Chronic Kidney Disease: Initiate treatment with an
ACE inhibitor to protect renal function, alongside strict BP control targets (<130/80 mm Hg).
A 30-year-old Male with Newly Diagnosed Hypertension: Confirm diagnosis with ABPM or
HBPM before starting pharmacologic treatment, considering lifestyle interventions first unless
BP is in the Stage 2 range.
These guidelines necessitate a personalized approach based on individual risk factors and comorbid
conditions, ensuring both effective blood pressure control and overall cardiovascular risk reduction.
4. Define BP targets and preferred medications by age, race, diabetes, and CKD.(CO 3)
This study source was downloaded by 100000900703063 from CourseHero.com on 09-30-2025 21:11:47 GMT -05:00
https://www.coursehero.com/file/250476062/module-4-htn-study-guide-revdocx/
