3 Hypertension Flashcards

1
Q

What is the epidemiology of HTN?

A
  • leading risk factor for CVD
  • 50% of HTN patients are compliant with meds
  • leading cause of mortality in US
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2
Q

What are the fast and slow regulation of BP mechanisms?

A
  • Fast : Baroceptor (arch and carotid sinus)
    • change sin pressure
  • Slow: RAS (kidneys)
  • Natriuetic peptites
    • counter to RAAS
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3
Q

What regulates arterial blood flow?

A
  • Sympathetic activity
    • NorEph
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4
Q

Explain Hemodynamics with TPR

A
  • Blood flow parallels CO
  • Increase TPR = increase driving pressure to maintain BP at set rate
  • Decrease TPR = decrease driving pressure
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5
Q

Explain the baroreflex? What happens during Chronic Hypertension?

A
  • Mean Arterial pressure 85-100mmHg
  • respond to stretching of arterial wall
    • negaive feedback loop with vagus and glossopharyngeal
  • Carotid sinus receptors range from 60-180mmHg

With Hypertension: Receptrs shift to the R (elevates)

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6
Q

What is the Renin-Angiostensin- Aldosterone System (RAAS)?

A

Detects low BF throough arteries of kindey

  • SNS activity (Beta 1 receptors)
  • Decreased BP in Renal ARtery

Increases vascular resistance and BP

  • maintains pressure/prevent losing ability tp perfuse tissues

Renin + Angiotensin = Angiotensin I -> Ang II (constrictor/fluid retention)

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7
Q

What are the two types of Hypertension?

A
  • Essential
  • Secondary
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8
Q

What is Essential hypertension?

A
  • cause unknown
  • 95-99% of cases
  • Interation between environmental factors and genetics
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9
Q

What is secondary Hypertension?

A

1-5% of cases

Results from biochemical/mechanical pathology

Potentially reversible

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10
Q

What are some hypertension contributors?

A
  • Diet (salt sensitiveity)
  • Obesity/Inactivity
  • Abnormalities of the adrenal cortex
  • sleep apnea
  • SNS activity
  • Kidney disease
  • Congenital Vascular disroders
  • recreational drugs and alc
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11
Q

What is normal BP values for adults?

A

100-120 / 60-80 mmHg

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12
Q

What is prehypertensive values for adults?

A

120-129/80-89

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13
Q

What are HBP values?

A

Stage 1: 140-159/90-99

Stage 2: 160+/90-99

Stage 3: 180+ / 110

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14
Q

What is a HTN Crises. Urgencies, and Emergencies?

A
  • Urgencies BP> 180/110
    • no signs of organ damage
    • headache, nosebleed, faintness
  • Emergencies BP > 180/120
    • Signs/symptoms of organ damage
    • Most Chest pain, dyspnea
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15
Q

What are common end organ damange HTN emergencies?

A
  • Acute pulmonary edea
  • Acute left Ventricular dysfunction
  • Acute cornoary syndrome
  • Cerebral infarction
  • Hypertensive encephalopahy

Can cause acute injury to kidnesy

BP 300/150

kidney focal small hemorrhages

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16
Q

What is Pulse Pressure?

A

PP = SBP - DBP = 40-60 normal (above = endothelial dysfunction)

  • high mortality/morbidity over 60
  • Predictor of CV risk rather than SBP
17
Q

What are some cofounding variables to HTN readings?

A
  • ambulatory vs home readings
  • normal diurnal variation (AM vs PM)
  • Masked HTN
  • White coat syndrome
  • Errors
18
Q

What are common problems to BP readings?

A
  • Full bladder
  • unsupported back/feet/arm
  • Crossed legs
  • Cuff over clothing
  • talking
19
Q

How does pain affect BP?

A

Systolic +15-25

Diastolic + 10-20

20
Q

How does chronic pain change hemodynamics?

A
  • Diminshed tolerance to pain stimuli
  • Reduced BO response and baroreflex to painful stim
  • Higher HR than healthy stubjects to pain
  • Lower PNS and increased SNS
  • Increased HTN
21
Q

What is a hypertensive response with exercise?

A

SBP > 220 mmHg for men >190mmHg for women

DBP >10 or >90mmHg

can be useful for unmasking HTN in clinical setting

22
Q

What is a hypotensive response to exercise?

A

10mmHg decrease in exercise SBP high risk for fatal and non fatal CV events and mortality

Heart cant take work level

23
Q

What is the course of action of you see resting >140/90

A
  • Proceed with usual care
  • Contact PCP
  • Monitor closely
24
Q

What is the course of action for resting >160/80?

A
  • Hold resistance exercise, consider aerobic
  • Contact PCP
  • Monitor closely
25
Q

What is the course of action if you see resting >180/110?

A
  • Hold Exam
  • Examine for organ damange
  • Contact PCP
  • Consider contacting EMS
    • Contact if organ failure
26
Q

What happens diring post exercise hypertension?

A
  • Cut off score for exercise is 180/110
  • low grade exercise 5-10 minutes and monitor/recovery
  • use as reflectin for interventions
  • contact provider if you do not feel comfortable
27
Q

Why should you consider eccentric exercises?

A
  • improves strength compared to concentric training
  • Lower RPE, SVR, O2 consumption, Cardiac index, Peak SBP and HR at similar workouts
  • can increase more soreness thatn COn
28
Q

What questionnaires do you use?

A
  • Physical activity readiness QUestionnaire
  • Duke Activity index
    • (predictive mortality) - peak VO2
  • AHA/ACSM - Fitness