Assessment and Management of Patients with Hypertension Flashcards
1
Q
Most common chronic disease among U.S. adults
A
Hypertension
2
Q
Hypertension = a systolic blood pressure (SBP) of
A
140 mm Hg or higher
3
Q
Hypertension =a diastolic blood pressure (DBP) of
A
90 mm Hg or higher
4
Q
To diagnose hypertension, 2 accurate blood pressure measurements must taken
A
1 to 4 weeks apart by a health care provider
5
Q
Primary hypertension is also called
A
essential hypertension
6
Q
In primary hypertension, 95% of patients do not have
A
an identifiable cause
7
Q
Type of hypertension:
5% of patients; renal disease, sleep apnea, pregnancy related
A
Secondary hypertension
8
Q
About ___% of the adult population of the U.S. has hypertension
A
33% or 1/3
9
Q
about 1/3 of people with hypertension, do not
A
know they have it
10
Q
About ___% do not have their hypertension under control
A
45-50%
11
Q
In systolic BP, blood is
A
pushing out
12
Q
In diastolic BP, the heart is
A
at rest
13
Q
When the arteries feed the heart muscle, if the diastolic BP is too high it leads to
A
compromised nutrition
14
Q
Genetics = __% of hypertension cases
A
30%
15
Q
3 Determinants of high BP:
A
Heart rate
Stroke Volume
Peripheral vascular resistance
16
Q
Amount of blood pumped out of the ventricles on each beat
A
Stroke Volume
17
Q
The resistance in the circulatory system that is used to create blood pressure
A
Peripheral vascular resistance (PVR)
18
Q
BP =
A
HR x SV x PVR
19
Q
Usual symptoms other than elevated BP
A
None
20
Q
BP symptoms related to organ damage are seen
A
late and are serious
21
Q
BP symptoms related to organ damage:
A
Retinal and other eye changes
Renal damage
Myocardial infarction
Cardiac hypertrophy
Stroke
Angina
SOB
Alteration in speech or balance
22
Q
Temporary block of blood flow through coronary arteries when under stress
A
Angina
23
Q
Who is sometimes more helpful in identifying symptoms of high BP?
A
Patient’s partner
24
Q
Controlled or stable angina means
A
patient knows what sets it off
25
A major Risk Factors of hypertension
Microalbuminuria or GFR <60 mL/min
26
Age when most people are diagnosed
Men 45
Women 55
27
Optometrist knows if a patient has hypertension when
He sees broken vessels in eye
28
Tests that confirm hypertension
Urinalysis (hyperalbuminemia)
Blood chemistry (bun and creatinine)
ECG
29
Uncontrolled hypertension can cause damage to what parts of the body?
Brain= stroke
kidneys= failure
eyes= retinal damage
heart= MI, PVD
30
Medical Management:
For adults, maintain blood pressure at
<140/90 mm Hg
31
Medical Management:
For older adult patients, maintain BP at
<150/90 mm Hg
32
Pharmacologic therapy used for hypertension is the same for
Heart failure
33
Aim of pharmacologic therapy
Decrease peripheral resistance, blood volume
Decrease strength and rate of myocardial contraction
34
DASH diet should be followed at least
5 days a week
35
Alcohol consumption per day should be
1 or less for women/ light weight
2 or less for men
36
Stage I hypertension med for AA and patient's >60 yrs old
Calcium channel blocker or thiazide diuretic
37
Stage I hypertension med for non-AA and patients <60 yrs old
ACE inhibitors or ARB's
38
What population has 3x higher risk of angioedema and more cough attributed to ACE Inhibitors?
African Americans and Asians
39
SBP 140-160 mmHg or DBP 90-100 is
Stage I hypertension
40
SBP 160+ mmHg or DBP 100 mmHg is
Stage II hypertension
41
SBP 140-160 mmHg or DBP 90-100 is
Stage I hypertension
42
Med that decreases serum sodium levels and blood volume
Diuretic
43
Med that blocks the conversion of angiotensin I to angiotensin II; an angiotensin II receptor blocker; blocking effects of angiotensin on blood vessels
ACE Inhibitor
44
Med that leads to a decrease in heart rate and strength of contraction as well as vasodilatation
Beta-Blocker
45
Med that relaxes muscle contraction or other autonomic blockers
Calcium Channel Blocker
46
Med that acts directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilatation, and drop in blood pressure
Vasodilators
47
Patient teachings
Do not double dose if missed
Do not stop drug abruptly
Monitor BP weekly, weight
Check peripheral edema
Instruct patient to rise slowly minimize orthostatic hypotension
48
Difference between Apical and radial pulse is called
Pulse deficit
49
Hypertension meds:
The "-prils"
ACE inhibitors
50
Hypertension meds:
Causes decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid loss
ACE inhibitors
51
Hypertension meds:
Treatment of hypertension, congestive heart failure (CHF), diabetic nephropathy, left ventricular dysfunction following an MI
ACE inhibitors
52
Most common ACE inhibitor
Lisinopril
53
Hypertension meds:
Main adverse reactions are Angioedema and cough
ACE inhibitors
54
Cough caused by ACE inhibitors
bradykinin
55
Hypertension meds:
ARB's stands for
Angiotensin II Receptor Blockers
56
Hypertension meds:
Meds that end in "-sartan"
ARB's
57
Hypertension meds:
Most common ARB meds
losartan (Cozaar) and valsartan (Diovan)
58
Hypertension meds:
ARB's Caution:
Hepatic or renal dysfunction, and hypovolemia
Patient must be well hydrated
59
Hypertension meds:
Main adverse reactions with ARB's
increase in K+, hypotension, headache
60
Hypertension meds:
ARB's are less effective if taken with
phenobarbital (anti-seizure med)
61
Hypertension meds:
Med that lets the heart rest, slows HR, decreases strength of contraction, decreases PVD. Treats essential hypertension. extended release form
Calcium Channel Blockers
62
Hypertension meds:
Most common Calcium channel blocker
Amlodipine
63
Hypertension Med:
Contraindications: digoxin because it increases contractility, Cyclosporine (immunosuppressant, anti-rejection med)
Calcium Channel Blockers
64
Hypertension Med:
SE: peripheral edema, dysrhythmias, atrial blocks, and impotence
Calcium Channel Blockers
65
Hypertension med:
Most common adverse effects: GI symptoms (constipation)
Calcium Channel Blocker
66
Hypertension med:
Should not be taken with grapefruit juice cause it inactivates the enzyme and leads to high levels of drug (lasts 4-5 days)
Calcium Channel Blockers
67
Hypertension med:
Least commonly used drug
Alpha1-blockers
68
Hypertension med:
block arterial vasoconstriction> decrease heart rate. Action causes higher blood flow to kidneys> decrease renin secretion>decrease Angiotensin II>vasodilation
Beta Adrenergic blockers
69
Hypertension med:
Most common Beta Adrenergic blocker
metropolol
70
Hypertension med:
Call doctor is BP is less that
100/60
71
Hypertension med:
Increase the excretion of sodium and water from the kidney to lower blood pressure
Diuretics
72
Hypertension med:
3 kinds of diuretics
Thiazides
potassium sparing
loop
73
Hypertension med:
name of a loop diuretic
furosemide (Lasix)
74
Hypertension med:
Common potassium sparing diuretic
spironolactone (Aldactone)
75
Hypertension med:
Common thiazide med
hydrochlorothiazide (HCTZ)
76
Hypertension med:
Potassium sparing and thiazide diuretics work at the
distal convoluted tubule
77
Hypertension med:
Loop diuretics work at
the ascending loop of henle
78
Hypertension med:
Can be used as monotherapy or adjunct
Thiazide
79
Hypertension med:
K+ wasting and dose dependant
Thiazide and loop
80
Hypertension med:
Caution:
Gout
Systemic lupus
Diabetes
Hyperparathyroidism
Thiazide
81
Hypertension med:
Contraindicated, causes lithium toxicity
Thiazide
82
Hypertension med:
Most commonly used diuretic; less powerful than new drugs; larger margin of safety for home use
Furosemide (Lasix)
83
Hypertension med:
Actions:
Block the chloride pump in the ascending loop of Henle
This causes reabsorption of sodium and chloride
Loop diuretics
84
Hypertension med:
Diuretic that decreases potassium and can lead to digoxin toxicity
Loop diuretics
85
Hypertension med:
Not as powerful as the loop diuretics, but they retain potassium instead of wasting it.
Potassium Sparing diuretics
86
Hypertension med:
If lasix and spironolactone are given together, which one is stronger?
Spironolactone
87
Hypertension med:
Must watch for hyperkalemia
Potassium Sparing diuretics
88
Hypertension med:
SE: breast tenderness, decrease in testosterone, decrease in sodium (hyponatremia)
Potassium sparing diuretics
89
Nocturia is cause by
ANS - kidneys are better perfused
90
Why is a BP of 150/90 ok for a person over 60 yrs?
Because of atherosclerosis
91
Daily sodium intake should be limited to
2g
92
Patient teaching:
Caution patient and caregivers that HTN meds can cause
Hypotension
93
reflexes can be compromised by
diuretics (decrease in extracellular volume) and adrenergic antagonists (inhibition of sympathetic nervous system).
94
Blood pressure >180/120 mm Hg is considered a
Hypertensive emergency and must be lowered immediately to prevent damage to target organs
95
Blood pressure is very elevated but no evidence of immediate or progressive target organ damage
Hypertensive urgency
96
Aim of care in hypertensive emergency
Reduce blood pressure 20% to 25% in first hour
Reduce to 160/100 mm Hg over 6 hours
Then gradual reduction to normal over a period of days
97
BP that is too low causes loss of
perfusion
98
Hypertensive emergency is usually managed in the
ICU with IV meds
99
Hypertensive urgency is seen with s/s of
nosebleeds, headache, anxiety
100
Hypertensive urgency is usually treated with what type of meds
PO meds
101
Hypertensive urgency is usually treated at
a med/surg floor
