4. Blood Pressure Conditions Flashcards
Definition Of Hypertension
4.1 Hypertension
Hypertension is defined as persistently rasied arterial blood pressure.
Primary Hypertension Definition
4.1 Hypertension
No identifiable cause for the hypertension.
- Occurs in about 90% of people with hypertension
Secondary Hypertension Definition
4.1 Hypertension
Has a known underlying cause such as renal, endocrine, vascular disorder or use of certain drugs.
What Is Hypertension An Important Treatable Cause Of?
4.1 Hypertension
Hypertension is one of the most important treatable cause of premature morbidity & mortality.
What Is Hypertension a Major Risk Factor For?
4.1 Hypertension
Stroke **
Myocardial Infarction/Coronary Artery Disease/Angina/All CVD(atherosclerosis) - *Ineffective function due to lack of oxygen because of plaque development in the myocardial circulation can then move to development of ischemic angina. Angina then can further develop and ultimately be such that individual develop myocardial infraction as a consequence of greatly reduced blood supply or one of the three coronary arteries becoming completely occluded leading to ischemia and necrosis of the myocardial tissue.
Heart Failure The heart like any muscle when having to work harder grows, it gets bigger and that results in this hypertrophy of the left ventricle particularly. The left ventricle is usually the first place where we see this remodeling because it has to pump against the high pressure of the arterial circulation(after load)
Chronic Kidney Disease The kidneys are fairly delicate organs, high pressure actually damages the organs of the kidney particularly the glomerulus where we have the bowman’s capsule infiltration. This results in scarring and fibrosis referred to as glomerular sclerosis, resulting in a dysfunctional nephron. This will then activate the RAAS system and eventually cause renal disease.*
A defective nephron impairs glomerular filtration(GFR), urine production and potentially hypertension. So hypertension here is damaging not only the kidneys but also driving a hypertensive state.
Ischemic kidney disease especially with the renal artery stenosis is a cause of hypertension.
Cognitive Decline* So cerebral ischemia is a reduction in blood flow to the cerebrum(brain tissue) and produces this vascular dementia which is a really fast onset dementia and is highly prevalent in our population aged 60-70*
Premature Death
Retinopathy, retinal hemorrhages and
impaired vision - damage to delicate capillaries of eye bed.
Risk Factors For Hypertension
4.1 Hypertension
- Advancing Age
- Black African/African-Caribbean origin: Most likely to be result of over activation sympathetic nervous system in black African/Caribbean, rather than fault with RAAS system that’s common cause in white Caucasian
- Social Deprivation
- Lifestyle Smoking, Excessive Alcohol Consumption, Excess Dietary Salt, Obesity, Infection, Lack of Physical Activity, Hypertension, Smoking
- Anxiety People who deal with stress in a negative way can often have raised heart rate and raised BP due to increased adrenaline Research on twins suggest up to 40% variability in blood pressure
may be explained by genetic factors
and cortisol levels. For short periods that’s not too much of an issue but over a lifespan that can also drive CVD.
Lifestyle
- Emotional Stress
Co-exsisting diabetes or kidney disease
Hypercholesterolaemia
**Sex: ** Men up to 65 years are higher risk than women
Aims Of Treatment For Hypertension
4.1 Hypertension
Reduce the risk of cardiovascular morbidity & Mortality, including myocardial infarction & stroke by lowering BP.
Non-Drug Treatment For Hypertension
4.1 Hypertension
In patients with suspected or diagnosed hypertension, offer lifestyle advice and support to enable patients to make healthy lifestyle changes.
* Usually try for 6 months for borderline BP patients to see if can lower enough without drugs, if however after 6 months no improvement would look to next steps(pharmalogical)
Weight- excess weight puts more stress on heart
Smoking cessation
Exercise- 30 mins 5 times a week, for moderate intensity exercise.
Salt- Encourage keeping dietary sodium intake low by reducing or substituting sodium salt as this can reduce BP. Salt substitutes not routinely recommended and certainly not in older people, diabetics, pregnant women, people with kidney disease and people on anti hypertensives(ACEIs/ARBs). Reduction only recommended in these groups.
Alcohol- calories, cause fluid retention increasing risk of hypertension (<14 units weekly)
Diet- more fruit/veg, less meat/saturated fats, Dairy products, Processed foods(high salt)
Caffeine- Discourage excessive consumption of coffee and other caffeine-rich products.
Organs at Risk Of Target Organ Damage By Hypertension
4.1 Hypertension
- CVS (heart/vessels)
- Kidneys
- Nervous System
- Eyes
Assessment Of Cardiovascular Risk & Target Organ Damage In Pts With Suspected Or Confirmed Hypertension
4.1 Hypertension
In patients with suspected or diagnosed hypertension, carry out investigations for target organ damage, and assess cardiovascular disease risk using a cardiovascular risk assessment tool and clinic blood pressure measurements.
Stages Of Hypertension
4.1 Hypertension
Optimal <120/80mmHg
Normal <130/85mmHg
High Normal 130-139/85-89
Stage 1: (Clinical) 140-149/90-99mmHg;
(Ambulatory/HBPM) 135-149/85-94
**Stage 2: ** (Clinical) 160-179/100-109mmHg
(Ambulatory/HBMP) >150/90mmHg
Stage 3: (Clinical) >180/120mmHg
[HBPM- Average home blood pressure monitoring]
Masked Hypertension
Definition
4.1 Hypertension
Clinic blood pressure measurements are normal (less than 140/90 mmHg) but blood pressure measurements are higher when taken outside the clinic using average daytime ABPM or average HBPM blood pressure measurements
White-Coat Hypertension Definition
4.1 Hypertension
Blood pressure that’s unusually raised when measured during clinician consultations but normal when measured in ‘non-threatening’ situations. Reported to occur in about 15– 30% of population, although may be inflated due to inadequate evaluation of people
- White-coat effect is a discrepancy of more than 20/10 mmHg between clinic and average daytime ABPM or average HBPM blood pressure measurements at diagnosis
Symptoms Of Hypertension
4.1 Hypertension
- Hypertension is usually asymptomatic(probably why have so many undiagnosed patients)
- Some patients can present with symptoms; common symptoms- headaches, nosebleeds, visual disturbances.
Treatment Decisions Based On Stage Of Hypertension
4.1 Hypertension
Stage 1: (Clinical) 140-159/90-99 (Ambulatory) 135-149/85-94
- Drug Treatment in patients <80 years with kidney disease, diabetes, CVD or 10% risk CVD in 10 years.
- Drug Treatment + Lifestyle Advice in patients <60 years with <10% risk of CVD in 10 years.
- Drug treatment in patients >80 years with BP >150/90mmHg
Stage 2: (Clinical) 160-179/100-109; (Ambulatory) >150/95
- Treat All patients
Stage 3: (Clinical) >180/120mmHg
- Medical Emergency
