3 Hypertension Flashcards
What is the epidemiology of HTN?
- leading risk factor for CVD
- 50% of HTN patients are compliant with meds
- leading cause of mortality in US
What are the fast and slow regulation of BP mechanisms?
- Fast : Baroceptor (arch and carotid sinus)
- change sin pressure
- Slow: RAS (kidneys)
- Natriuetic peptites
- counter to RAAS
What regulates arterial blood flow?
- Sympathetic activity
- NorEph
Explain Hemodynamics with TPR
- Blood flow parallels CO
- Increase TPR = increase driving pressure to maintain BP at set rate
- Decrease TPR = decrease driving pressure
Explain the baroreflex? What happens during Chronic Hypertension?
- 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)
What is the Renin-Angiostensin- Aldosterone System (RAAS)?
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)
What are the two types of Hypertension?
- Essential
- Secondary
What is Essential hypertension?
- cause unknown
- 95-99% of cases
- Interation between environmental factors and genetics
What is secondary Hypertension?
1-5% of cases
Results from biochemical/mechanical pathology
Potentially reversible
What are some hypertension contributors?
- Diet (salt sensitiveity)
- Obesity/Inactivity
- Abnormalities of the adrenal cortex
- sleep apnea
- SNS activity
- Kidney disease
- Congenital Vascular disroders
- recreational drugs and alc
What is normal BP values for adults?
100-120 / 60-80 mmHg
What is prehypertensive values for adults?
120-129/80-89
What are HBP values?
Stage 1: 140-159/90-99
Stage 2: 160+/90-99
Stage 3: 180+ / 110
What is a HTN Crises. Urgencies, and Emergencies?
- 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
What are common end organ damange HTN emergencies?
- 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
What is Pulse Pressure?
PP = SBP - DBP = 40-60 normal (above = endothelial dysfunction)
- high mortality/morbidity over 60
- Predictor of CV risk rather than SBP
What are some cofounding variables to HTN readings?
- ambulatory vs home readings
- normal diurnal variation (AM vs PM)
- Masked HTN
- White coat syndrome
- Errors
What are common problems to BP readings?
- Full bladder
- unsupported back/feet/arm
- Crossed legs
- Cuff over clothing
- talking
How does pain affect BP?
Systolic +15-25
Diastolic + 10-20
How does chronic pain change hemodynamics?
- 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
What is a hypertensive response with exercise?
SBP > 220 mmHg for men >190mmHg for women
DBP >10 or >90mmHg
can be useful for unmasking HTN in clinical setting
What is a hypotensive response to exercise?
10mmHg decrease in exercise SBP high risk for fatal and non fatal CV events and mortality
Heart cant take work level
What is the course of action of you see resting >140/90
- Proceed with usual care
- Contact PCP
- Monitor closely
What is the course of action for resting >160/80?
- Hold resistance exercise, consider aerobic
- Contact PCP
- Monitor closely
