Blood pressure conditions Flashcards
Blood pressure equation
BP= heart rate x stroke volume x total peripheral resistance (BP= HR x SV x TRP)
Orthostatic/ postural hypotension
abnormal drop in blood pressure with a change in position, usually moving from a recumbent (resting) to a standing position
What is orthostatic/ postural hypotension caused by
decreased venous return to the heart due to pooling of blood in the lower part of the body or inadequate circulatory reflexes
> 20mmhg systolic or 10mmhg diastolic and 10-20% increase in pulse pressure
Signs and symptoms of hypotension
syncope, dizziness, light headedness, poor concentrations, palpitations, anxiety, tremor, syncope,
Physiological effects of blood pressure: When a px shifts from as supine position to an upright position, the blood has shifted to the lower part of their body, there is a ____ in the central blood volume and arterial pressure.
decrease
What is the role of baroreceptors
in the thorax and the carotid sinus monitor blood pressure and note the decrease in BP, therefore reflexively cause vasoconstriction and increase the hearts rate to elevate BP
What is the physiological effects of orthostatic
BP does not regulate fast enough due to inadequate intravascular volume, decreased venous return, automatic nervous system dysfunction or lack of cardiac output to meet the demands placed on the heart
Causes of orthostatic hypotension
drug induced hyptoension (diuretics, antidepressants, antihypersensitives), decreased blood volume, altered vascular response or causes with neurogenic origins (ageing, bedrest, ANS dysfunction)
Hypotension is aggravated by
heat, humidity, heavy meals, exercise
Treatment protocols
gradual ambulation (walking) to allow circulatory system to adjust ie have patient turn to one side first, then use their hands to push up to seated position, then stand etc with a pause in between, ask the patient to avoid diuretics or caffiene before treatment
Postprandial hypotension
the result of a decrease in blood pressure right after eating a meal, as you digest a meal your intestines requre more blood flow to the area which causes a decrease in blood volume in the periphery of the body
Hypertension
blood pressure elevated above 90 diastolic and 140 systiolic, these are the values at which it was understood that damage to blood vessels, the heart and other vital organs begins to occur
What is the BP reading for an non automated office BP method tool that is considered an applicable threshold
140/90
What is the threshold reading for a person with diabetes
130/80
What is the normal BP reading for a healthy men in their 20s
120/80
What is considered the healthy reading for women in their 20s
110/70
What can increase blood preessure
stress, physical exercise, caffiene, sexual excitement, exams etc
What are the hypertension types: systemic hypertension
a condition of chronically elevated blood pressure affecting the systemic arteries
Primary/benign/essiential/idiopathic hypertension
causes are typically unknown, linked to genetics, poor diet, lack of exercise and obesity
Common theories: overly sensitive sympathetic N.S, overly sensitive renin-angiotensin response (kidneys react to pressure drop and release hormones that cause systemic vasoconstriction)
Secondary hypertension
5-10% of hypersensitive population
diastolic tends to be higher than in primary
Causes of secondary hypertension
atherosclerosis, kidney disease, renal artery stenosis, adrenal tumors, liver disease, respiratory disease, diabetes, eclampsia, use of oral contraceptives, certain chronic medication use
White coat hypertension
situations where the blood pressure elevates sometimes quite dramatically, when readings are being taken by medical professionals
Masked hypertension
Normal blood pressure readings at the clinic with periodically high readings at home
Malignant hypertension/ Hypertensive emergency
Dangerously high blood pressure that typically comes on suddenly and is a medical emergency. Often part of a secondary situation ex. kidney failure, liver cancer, unstable diabetes etc
Labile/ Borderline hypertension
Intermittent elevation of blood pressure interspersed with normal readings
Isolated systolic hypertension
ISH, most common hemodynamic form of hypertension in the elderly. Marked elevation of systolic pressure but normal diastolic, increased risk of stroke MI, dimentia, kidney disease
Risk factors of becomming hypertensive
Lifestyle factors such as stress, sedentary lifestyle, obesity, poor diets, nutriciency deficiency, aging (increased rigidity of BV when aging), race, african americans are 1/3 more likely to develop hypertension, chronic alcohol consumption, hormonal changes (womens blood pressure tends to be lower but after menopause the difference equals out), smoking, high cholesterol levels
Low density lipoprotein
aka bad cholesterol transports cholesterol particles throughout the body. LDL cholesterol builds up in the walls and arteries making them hard and narrow
High density lipoproteins HDL
good cholesterol picks up excess cholesterol and takes it back to the liver
What is almost always asymptomatic
Hypertension, silent killer
Signs and symptoms of Hypertension
-headaches
-nosebleeds
-dizziness
-fatigue/lethargy
-Mild edema
-Vertigo
-Flushed face
-Blurred vision
More severe symptoms:
-vision changes such as diplopia (double vision)
-nausea/vommitting
-Altered CNS functions such as irritablity, personality changes, confusion, disorientation, altered consciousness
-convulsions
-fainting
-evidence of cardiovascular and kidney distress
Risks of systemic hypertension
increased risk of arteriold rupture (AKA hemorrhagic infarction, often in the brain causing a stroke), damage to blood vessels, chronic ongoing damage to organs (lifespan can be shortened by 10-15 years), decreased tissue health, decreased perfusion
Hyalinization
addition of more squamous epithelial cells/layers to reinforce the tissue, a clear thick goopy inflexible material that looks like hyaline, can be described as heavy marshmellow
In hyalinization problems occur with decresed diffusion/transfer across _____ wall thus increasing the TRP
capillary wall, decreased elasticity of arteriole walls due to chronic distension
Onion skinning
inner endothelial wall of blood vessel (tunica intima/interna) becomes damaged and repairs with scar tissue due to the force of blood pressure, decreased elasticy of arteriole walls
Treatment effects on blood pressure
Things that increase blood pressure
-prone, which puts pressure on the aorta
-cartoid artery compression (techniques, turning of the head)
-stimulating and or painful techniques and enviornment that is busy, noisy, cluttered and bright etc
-venous return = increased cardiac output which increases BP (drainage, strokes, hydro, PR ROM, especially elevation of limb, treating a chronically tight diaphragm
lymph drainage
Technniques that decrease blood pressure
decreasing sympathetic NS firing, leading to decreased skeletal muscle tone
- decrease muscle resting tension, leading to decreased TRP
- Heating through mx techniques and hydrotherapy- brings blood to surface for heat dissipation
Treatment planning considerations and adaptations for hypertension and CCHF
- consider treatment duration, a shorter treatment may be prudent for some cases
- consider partial or lighter full body treatments
- positioning adaptations may be needed: prone position, esp. with an abdominal pillow can decrease aorta expansion and place additional stress on the heart
- avoid activating the sympathetic NS (heavy tapotment, frictions, TRP work)
- modify techniques, focus on smaller more segmentak approaches
- body areas being treated
- hydrotherapy
- techniques
- medications
semi-/low Fowlers position
in supine consider elevating upper body, and also not elevating feet above heart level
with the upper body raised at approx 30-45 degrees and the knees supported
Medications used to reduce total blood volume: Diuretics/ Water pills
Act on kidneys (nephrons- functional unit) to increase production of urine/ decrease blood volume and therefore hydrostatic pressure
Thiazide diuretics
usually the first drug of choice for hypertension, generally well tolerated eg. hydrochlorothiazide, microzide, chlorthalidone
Aldosterone antagonists/ adolsterone receptor blocers (diuretics)
inhibit ability of aldosterone to signal the kidneys to retain sodium and water eg. spironolactone (aldactone), eplerenone (inspra)
Diuretics side effects/cautions
fluid and electrolyte imbalance, muscle weakness, and spasm, headaches, nausea and disorientation
Beta blockers
improve heart function, beta blocker modify sympathetic nervous system reactivity by competing with sympathetic nerotransmitters (adrenaline, noepinephrine) for the beta receptor sites of the heart, occupying them and blocking them. By preventing stimulation of these sites, the beta blocers relieve cardiac stress by slowing myocardia contractions and improving their rhythmicity. Slower myocardial contractions allows for longer refill time and increased strength of subsequent contraction, frank starlings law, also reduce BV constriction- lowering BP and easing stress on the heart
Beta blockers side effects
breathing difficulties, parathesia, decrease in sensation, dysrythmia, depression and fatigue
Gycosides
To improve heart function
Slow down the heart rate and increase the efficiency of contraction (which increases the force of contraction) and refilling phases of the cardiac cycle
Blocking the pumps function
Gycosides caustion/ side effects
toxicity (leading to visual disturbances, confusion, GI irritation, dysrythmia)
Medications to improve blood vessel diameter
Alpha blockers/ Alpha-adrenergic Antagonists: block sympathetic nerurotransmitters (catecholamines such as norpinephrine-NE) from synapsing on the smooth muscle of the arterial system or decrease the number of sympathetic neurotransmitter impulses emitted from the vasomotor center in the brain- goal decrease TRP
Calcium antagonists
to improve BV diameter - main category of improving BV diameter
Modifies/limits the uptake and use of calcium in smooth muscle cells in BV walls (in the tunica media layer) and some work in the cardiac muscle (in the AV node) thereby decreasing the tone of the smooth muscle in the blood vessel walls and improving contractile properties of cardiac muscle
ACE (Angiotensin converting enzyme) inhibitors
Modifies production of angiotensin by suppressing ACE and decreasing vasoconstriction. Renin (an enzyme) is produced in the kidneys and released into circulation when blood pressure decreases to initiate the renin-angiotensin system
Renin angiotensin system acts to ____ the BV and thus decrese excessive bleeding
constrict
Angiotensin is made in ____ and circulates in blood , clovers it to angiotensin I
Liver
In the lungs ACE converts angiotensin I into _____
angiotensin II
Angiotensin II is a strong vasoconstrictor, if you inhibit ACE you limit the amont of angiotensin II and reduce _____-
vasoconstriction
Angiotensinsin II receptor blockers (ARBs)
Block the action not the formation of angiotensin, the hormone that gets converted into angiotensin II in the lungs eg. Candestaran (atacand), losartan (cozaar), may be used instead of an ACE inhibitor
Renin inhibitors
Slows down production of renin, the enzyme produced by the kidneys that initiates the renin-angiotensin response eg. aliskiren (tekturna) cannot be taken with ACE inhibitors or ARBS
Direct vasodilators
work directly on tunica media mm in artery and arteriole walls to reduce contraction eg hydralazinge, minoxidil
Nitroglycerin
(medications to improve BV diameter) smooth muscle vasodilators with good targeting of coronary arteries used for angina pectoris (chest pain) in various formats (tablet, sublingual, patch, spray)
Medications to decrease platelet activation/blood coagulation
eg. antithrombotics, blood thinners
- Anticoagulants: slow down clotting, reducing fibrin formation preventing clots from forming and growing
- antiplatelets: prevent platelets from clumping and also prevent clots from forming and growing, most common is aspirin
Medical treatment for hypertension
- lifestyle modifications
- diuretics usually the first drug of choice
- regular massage can decrease blood pressure, a regular patient who is taking blood pressure medications may experience enough of a BP drop to make their medication does too high
