A7- Hypertension Flashcards
Definition of Arterial Blood Pressure
Definition: the force exerted by the blood against the walls of the blood vessels
Adequate to maintain tissue perfusion during activity and rest
Arterial blood pressure: primary function of cardiac output and vascular resistance
The major factors that help to maintain blood pressure (BP) include the _________ ______ ________ and the _______
The major factors that help to maintain blood pressure (BP) include the sympathetic nervous system and the kidneys
Increasing blood pressure is associated with a progressive increase in the risk of _____ and __________ _____
Increasing blood pressure is associated with a progressive increase in the risk of stroke and cardiovascular disease
What is Systemic Hypertension
Hypertension is currently defined as a usual BP of 140/90mmHg or higher, for which the benefits of drug treatment have been definitively established in randomised placebo controlled trials
What is the recommended bp for high risk patients, especially pts with CAD
For certain high risk patients, especially those with CAD, the recommended medical treatment threshold recently has been lowered to 130/80mmHg
Define the classes of HTN
How do you calculate pulse pressure
PP = SBP- DBP
WHat does pulse pressure indicate
greater stiffness in large conduit arteries, primarily the thoracic aorta
pulse pressure is a measure of….
synamic cyclic stress during systole
When is PP better than BP
PP may be a better marker of increased CV risk than either systolic BP or diatolic BP alone in older persons
How do you examine patients with HTN
Appropriate measurement of BP in both arms
- Optic fundi (eyes)
- Calculation of BMI (waist circumference may also be useful)
- Auscultation for carotid, abdominal and femoral bruits
- Palpation of the thyroid gland
- Thorough examination of heart and lungs
- Lower extremities for oedema and pulses
What are some basic and optional testing for laborstory tests for primary hypeternsion
What is the mnemonic for secondary causes of HTN
WHat are some drugs that raise BP
These findings suggest which endocrine disorder?
These findings suggest which disorder?
These findings suggest which disorder?
What Blood pressure measurement do you
- BP should be measured at least twice after 5 minutes of rest, with the patient seated in a chair, the back supported, and the arm bare and at heart level
- A large adult sized cuff should be used to measure BP in over weight adults because the standard-sized cuff can spuriously elevate readings
- Tobacco and caffeine should be avoided for at least 30 minutes
- BP should be measured in both arms and both patient and doctor should not be talking during BP measurement
- After 3 minutes of standing, the later to exclude a significant postural fall in BP, particularly in older persons and in patients with diabetes or other conditions (e.g. Parkinson’s disease) that predispose to autonomic insufficiency
What is recommended for patient with mild to moderate elevation in BP
They should not be diagnosed with hypertension unless the BP remains elevated after three to six visits unless there is evidene of ongoing end-organ damage
What is the main cause of white coat htn
anxiety
what is diagnosis of white coat hypertension
The diagnosis of white coat htn (also called isolated clinic or office hypertension) is applied to patients with office readings that averafe more than 140/90 mmHg and reliabl eout-of-office readings that average less than 140/90 mmHg
How can you minimise white coat effect
Bp taken by nurse or technician rather than a clinician
How is ABPM detrermined
ABPM is determied using a device worn by the patient that takes blood pressure (BP) measurements over 24 gto 48 hour period usually every 15 t 20 minutes during the daytime and every 30 to 60 minutes during sleep.
These blood pressure are recorded on the evice and the averafe day or night blood pressures are determined from the data by a computer
ABPM should be considered in the following situations:
Suspected white coat hypertension
Suspected episodic hypertension
Hypeetension resistant to increasing medication
Hypotensive symptoms while taking antihypertensive medications
Autonomi dysfunction
What is the alternative if ABPM is not available
Self-recorded home BP measurements
As many as 10 to 40 percent of patients who are normotensive by conventional clinic measurement are hypertensive by ABPM
What is the ohenomenon called
Masked hypertension or isolated ambulatory hypertension
Why treat hypertension?
to decrease
-Cerebrovascular Accidents
Coronary events
Heart failure
Progression of renal disease
Progression to severe hypertension
All cause mortality
Lifestyle measures in management of hypertension
- Offer lifestyle advice to all patients undergoing assessment or treatment for hypertension.
- Assess patients’ diet and exercise patterns and encourage appropriate lifestyle changes.
- Advise patients to:
- – Avoid excessive alcohol consumption.
- – Avoid excessive consumption of coffee and other caffeine-rich products.
- – Limit dietary sodium intake by reducing intake or substituting sodium salt.
- Offer smoking cessation help and advice.
- Encourage stress reduction.
WHat is the management plan for BP lowering treatment at different initial office BP Levels
Hypertension drugs guidelines
different stages
What is the core drug treatment strategy for uncomplicated hypertension
what is a symplicity catheter
The Symplicity Spyral catheter positions electrodes to generate 360 degrees of ablation, and can treat the renal branches to maximise the probability of complete denervation. Reaches the main artery, branches and accessory vessels within a broad diameter range (3–8mm) to treat a wide range of patients
Hypertensive Emergency Treatment for disease specific recommendations
Acute ischemic stroke
Intracranial Haemorrahge
SAH
Hypertensive Encephalopathy
WHat are the drug used for HTN in pregnancy
remember Her New Lab Method
Hydralazine
Nifedipine
Labetalol
Methyldopa
