AGNP exam 1 LATEST UPDATED 2026
mechanisms of BP control - ANSWER-defects in excess NA, sympathetic
hyperactivity, psychosocial factors, RAAS, nitric oxide def., inc. insulin
Every increase of 20 systolic and 10 diastolic= - ANSWER-doubled risk for CVD,
starting at 115/75
HTN most prevalent in - ANSWER-AA, women >50, men >45
RF for HTN - ANSWER-age, arterial stiffness, dec baroreceptor sensitivity, inc
sympathetic nervous system sensitivity, endothelial dysfunction, decreased Na
excretion, decreased plasma renin load, genetics
obesity BMI>30, metabolic syndrome, DM, high fat and K diets, sedentary, OSA,
ETOH/tob
ETOH and HTN - ANSWER->2oz/d = linked to htn due to increased catecholamines
HTN is difficult to control if >4oz/d or binge drinking
smoking and HTN - ANSWER-increases BP d/t increased plasma norepinephrine
Meds that increase BP - ANSWER-NSAIDS (inc by 5)
,estrogen-progesterone (causes mild sustained inc in bp in premenopausal women)
glucocorticoids (d/t Na retention)
Ephedrine products
History taking for HTN - ANSWER-prior known Hx, Tx for htn, response to therapy
prior MI/CVA/PVD/CKD/DM
assess for ED/dyslipidemia/inflamm disease/chronic conditions
family Hx
Meds
physical activity level, diet, ETOH/tob., weight, drugs, psychosocial
PE for HTN - ANSWER-Weight and BMI, BP
skin for hirsutism, cushing's findings, neurofibromatosis
Thyroid for nodules, goiter, bruit
Optic fundi for arterial narrowing, AV knicking, vasc. tortuosity
Carotids for bruits, diminuation of pulses
Renal, Iliac, Femoral, Abd bruits
Abd aorta pulsation
PVD
PMI displaced laterally
Loud S1, rapid closure of aortic valve
S4, atrial contraction into poorly compliant LV
Mitral/Atrial regurgitation murmur common
,pulmonary for crackles, signs of HF
Abd for enlarged kidneys, masses, distended bladder
Measuring BP - ANSWER-sit quiet, feet on floor for 5 mins. arm supported at heart
level, size of cuff 80% of arm, 2-3 measurements 1 min apart
Non-Dip HTN - ANSWER-ABPM detects a non-dip pattern, loss of nocturnal dip (at
least 10% during sleep)...is a predictor of CV risk, inc thrombotic stroke risk,
accentuation of morning BP associated with increased ICH (wake up stroke).
Labile HTN - ANSWER-BP intermittently spikes above normal. Often progresses
into sustained htn.
White coat HTN - ANSWER-persistently high 140/90 at office only. Pt needs to
monitor at home for 2 weeks and call with results
Masked HTN - ANSWER-normal BP in office, HTN at home or when ambulating,
occurs 15-20% without diagnosis.
Isolated Diastolic HTN - ANSWER-DBP >90, sys<140.
Common in elderly, obese, aortic stenosis, heavy etoh/tob
Isolated Systolic HTN - ANSWER-SBP >140, common in elderly
, Secondary HTN - ANSWER-BP increase d/t definable etiology, often abrupt and
severe. suspect if it develops at early age or if those prev. controlled become
refractory or if htn resistant to 3 medications.
May be d/t genetic syndromes, kidney disease, 70-80% blocked RAAS, primary
hyperaldosteronism, adrenal adenoma, cushings, pheochromocytoma, coarc of
aorta
Malignant HTN - ANSWER-rapid increase in DBP >130, manifested by increased
ICP
s/s= restlessness, changed LOC, n/v, blurred vision, CN palsy, HF symptoms
HTN urgency - ANSWER-SBP >180, DBP >120
severe elevation with NO target organ damage
HTN emergency - ANSWER->180/>120 WITH new or worsening target organ
damage
TOD examples - ANSWER-ACS, flash pulmonary edema, ARF, aortic dissection,
CVA, encephalopathy, papilledema
JNC 8 - ANSWER-normal: <120/<80
Prehtn: 120-139/80-89
stage 1: 140-159/90-99
stage 2: >160/>100
mechanisms of BP control - ANSWER-defects in excess NA, sympathetic
hyperactivity, psychosocial factors, RAAS, nitric oxide def., inc. insulin
Every increase of 20 systolic and 10 diastolic= - ANSWER-doubled risk for CVD,
starting at 115/75
HTN most prevalent in - ANSWER-AA, women >50, men >45
RF for HTN - ANSWER-age, arterial stiffness, dec baroreceptor sensitivity, inc
sympathetic nervous system sensitivity, endothelial dysfunction, decreased Na
excretion, decreased plasma renin load, genetics
obesity BMI>30, metabolic syndrome, DM, high fat and K diets, sedentary, OSA,
ETOH/tob
ETOH and HTN - ANSWER->2oz/d = linked to htn due to increased catecholamines
HTN is difficult to control if >4oz/d or binge drinking
smoking and HTN - ANSWER-increases BP d/t increased plasma norepinephrine
Meds that increase BP - ANSWER-NSAIDS (inc by 5)
,estrogen-progesterone (causes mild sustained inc in bp in premenopausal women)
glucocorticoids (d/t Na retention)
Ephedrine products
History taking for HTN - ANSWER-prior known Hx, Tx for htn, response to therapy
prior MI/CVA/PVD/CKD/DM
assess for ED/dyslipidemia/inflamm disease/chronic conditions
family Hx
Meds
physical activity level, diet, ETOH/tob., weight, drugs, psychosocial
PE for HTN - ANSWER-Weight and BMI, BP
skin for hirsutism, cushing's findings, neurofibromatosis
Thyroid for nodules, goiter, bruit
Optic fundi for arterial narrowing, AV knicking, vasc. tortuosity
Carotids for bruits, diminuation of pulses
Renal, Iliac, Femoral, Abd bruits
Abd aorta pulsation
PVD
PMI displaced laterally
Loud S1, rapid closure of aortic valve
S4, atrial contraction into poorly compliant LV
Mitral/Atrial regurgitation murmur common
,pulmonary for crackles, signs of HF
Abd for enlarged kidneys, masses, distended bladder
Measuring BP - ANSWER-sit quiet, feet on floor for 5 mins. arm supported at heart
level, size of cuff 80% of arm, 2-3 measurements 1 min apart
Non-Dip HTN - ANSWER-ABPM detects a non-dip pattern, loss of nocturnal dip (at
least 10% during sleep)...is a predictor of CV risk, inc thrombotic stroke risk,
accentuation of morning BP associated with increased ICH (wake up stroke).
Labile HTN - ANSWER-BP intermittently spikes above normal. Often progresses
into sustained htn.
White coat HTN - ANSWER-persistently high 140/90 at office only. Pt needs to
monitor at home for 2 weeks and call with results
Masked HTN - ANSWER-normal BP in office, HTN at home or when ambulating,
occurs 15-20% without diagnosis.
Isolated Diastolic HTN - ANSWER-DBP >90, sys<140.
Common in elderly, obese, aortic stenosis, heavy etoh/tob
Isolated Systolic HTN - ANSWER-SBP >140, common in elderly
, Secondary HTN - ANSWER-BP increase d/t definable etiology, often abrupt and
severe. suspect if it develops at early age or if those prev. controlled become
refractory or if htn resistant to 3 medications.
May be d/t genetic syndromes, kidney disease, 70-80% blocked RAAS, primary
hyperaldosteronism, adrenal adenoma, cushings, pheochromocytoma, coarc of
aorta
Malignant HTN - ANSWER-rapid increase in DBP >130, manifested by increased
ICP
s/s= restlessness, changed LOC, n/v, blurred vision, CN palsy, HF symptoms
HTN urgency - ANSWER-SBP >180, DBP >120
severe elevation with NO target organ damage
HTN emergency - ANSWER->180/>120 WITH new or worsening target organ
damage
TOD examples - ANSWER-ACS, flash pulmonary edema, ARF, aortic dissection,
CVA, encephalopathy, papilledema
JNC 8 - ANSWER-normal: <120/<80
Prehtn: 120-139/80-89
stage 1: 140-159/90-99
stage 2: >160/>100
