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CV Basics + Hypertension > Blood Pressure Fundamentals + Assessment > Flashcards

Blood Pressure Fundamentals + Assessment Flashcards

1
Q

What is blood pressure?

A

Pressure in the arterial wall

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2
Q

The 5 methods of blood pressure monitoring include:

A

Office
Office automated
Ambultatory
Home
Pharmacy

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3
Q

Why are home BP monitors the gold standard?

A

Highly accurate, and highly correlated with usual resting BP levels

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4
Q

What are optimal conditions when taking a BP measurement?

A

At rest, no stimulation or usage of stimulants/irritants
Take duplicate measures (3)

NO exercise, caffeine, full bladder

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5
Q

When should BP measurements be taken?

A

Before doses (troughs, change in drug concentration)
Morning and night

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6
Q

How often should BP measurements be taken?

A

One week blocks during times of interest
No need to measure everyday if stable

Times of interest = dose change, recent hospitalization

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7
Q

High blood pressure is beneficial during activity because…

A

Increases blood flow, increasing oxygen and glucose delivery to muscle

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8
Q

High blood pressure is harmful during rest because…

A

Increased energy to pump blood - waste of energy and fatigues tissues/cells, leading to adverse changes

Also damages specific tissues + cells

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9
Q

Hypertension is defined by:

A

Continuous high blood pressure readings at rest

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10
Q

Hypertension often results from two main physiological features:

A

Increased afterload and arterial damage

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11
Q

How does hypertension correlate with age?

A

Risk increases with age

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12
Q

How can fluid and electrolyte imbalances relate to HTN?

A

Malfunctions in RAAS, natriuretic hormone, electrolyte imbalances, or renal dysfunction

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13
Q

How can the SNS relate to HTN?

A

Increased SNS activity

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14
Q

What is metabolic syndrome?

A

Risk factors that often present together

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15
Q

How can vascular endothelial function be related to HTN?

A

Involvement of prostacyclins and nitric oxide production

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16
Q

What is essential/primary hypertension?

A

Chronically increased BP from MULTIPLE factors (no single factor predominates)

Commonly associated with metabolic syndrome

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17
Q

What is secondary hypertension?

A

HTN caused by significant dysfunction of a single system

Usually not recognized until resistant to conventional treatment

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18
Q

Treatment resistance in HTN is usually defined as:

A

Lack of BP control despite combination of 3 anti-HTN drugs, 1 of which is a diuretic

Non-adherence is ruled OUT

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19
Q

Secondary HTN usually involves one or more of these three:

A

RAAS, renal dysfunction, increased SNS activity

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20
Q

Why is screening HTN important?

A

Most CV risk factors, including HTN, are silent but lead to further disease development and bad outcomes

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21
Q

What diseases can HTN contribute to?

A

DM, atherosclerosis, cardiac dysfx, AFib

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22
Q

What are some modifiable risk factors for developing HTN

Lifestyle, other medical conditions?

A

Obesity
Poor diet (high sodium, alcohol)
Sedentary lifestyle
Diabetes/metabolic syndrome/DLD
Smoking

Stress?

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23
Q

What is the main goal of therapy regarding HTN?

A

Control blood pressure and prevent CV consequences

Improve health of blood vessels and myocytes

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24
Q

What is considered optimal BP?

A

<120/<80

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25
Q

What is considered normal BP?

A

<130/<85

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26
Q

What is considered high-normal BP?

A

130-139/85-89

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27
Q

What is considered Grade 1 HTN?

Mild

A

140-159/90-99

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28
Q

What is considered Grade 2 HTN?

Moderate

A

160-179/100-109

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29
Q

What is considered Grade 3 HTN?

Severe

A

> > 180/>110

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30
Q

What is considered isolated systolic hypertension (ISH)

A

> 140/<90

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31
Q

For diagnosis of HTN, BP must be…

A

High at rest + Consistent

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32
Q

A hypertensive urgency/emergency is classified as:

A

Asymptomatic diastolic BP >130 OR severe BP elevation in setting of acute condition (chest pain, severe headache, weakness, etc.)

ACS, AKI, encephalopathy, hemorrhage, etc.

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33
Q

Masked HTN is when…

A

HTN is not identified in office/healthcare setting, but is evident at home/ambulatory

Worse prognosis

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34
Q

White coat HTN is when…

A

HTN is identified in office/healthcare setting, but is not evident at home/ambulatory

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35
Q

An individual has metabolic syndrome contains at least 3 of the following risk factors:

5 - related to fats, BP, and sugars

A

Insulin resistance/high BG
Low HDL
Abdominal obesity
High TG
High BP

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36
Q

What are some non-modifiable CV risk factors?

A

Age 55+
Male
Family history of CV disease

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37
Q

What is target organ damage? What are some examples?

A

Damage that occurs from long standing HTN

CKD, CAD, HF

38
Q

Currently, the best tool to assess overall CV risk is:

A

Framingham risk calculator

39
Q

The framingham risk calculator is an algorithm used to:

A

Estimate individual’s 10 year risk of experiencing a major CV event or death

Accounting for risk factors

40
Q

Risk factors involved in the framingham algorithm include:

Both modifiable and non-modifiable are measured

A

Age
HDL + total cholesterol
SBP
Smoker status
Diabetes

41
Q

Physical assessments for CV commonly documented in medical include:

A

Pulses, heart rate, and BP
Edema
JVP

42
Q

Swelling or accumulation of fluid in tissue is also known as:

A

Edema

Extracellular or interstitial fluid

43
Q

Presence of edema encourages further assessment of:

A

Intravascular volume status

Possibly too much volume in vessels

44
Q

What is preload?

A

Backup of blood in the left ventricle

45
Q

Several conditions can increase intravascular volume, such as:

A

HF, kidney disease, HTN

46
Q

JVP stands for:

A

Jugular venous pressure

“Neck vein”

47
Q

JVP is often assessed to gauge:

A

Volume/preload

Very important in HF patients

48
Q

Peripheral pulses are important to measure, because if they are diminished…

A

May mean reduced stroke volume or peripheral artery disease (PAD)

Weak pedal pulses = possible narrowing of arteries toward extremities

49
Q

Ankle-brachial index is measured by:

A

Dividing ankle pressure by arm pressure

Close to 1 is ideal (should be same)

50
Q

Peripheral artery disease can be diagnosed if ABI is:

A

Less than 0.9

51
Q

Normal amount of heart sounds is:

A

2

52
Q

The first heart sound is…

A

The start of ventricular contraction (closure of mitral and tricuspid valves)

53
Q

The second heart sound is…

A

Closure of aortic and pulmonic valves, during ventricular relaxation

54
Q

If third or fourth heart sounds are present…

A

Not normal, and may indicate presence of problem

55
Q

Heart murmurs result from:

A

“Turbulent flow” within the heart

56
Q

Murmurs may indicate presence of cardiac issues, such as…

A

Pulmonic stenosis, aortic stenosis, cardiomyopathies

57
Q

What is a bruit?

A

Representation of turbulent flow

Stethoscope can pick up bruit in some arteries

58
Q

Flow through a healthy blood vessel should be…

A

Silent - unobstructed

59
Q

Inflammation may be measured via:

A

CRP

60
Q

Natriuretic peptides may be measured because:

A

May indicate ventricular wall stress + elevated in patients with HF

61
Q

ECG may be measured in order to analyze:

A

Electrical conduction

62
Q

Exercise stress-testing may be measured in order to analyze:

A

Exercise tolerance, and presence of ischemia

63
Q

Nuclear imaging, CT, or PET scans may be done to:

A

Assess areas of myocardium for perfusion, activity, etc.

64
Q

Baseline laboratory investigations for HTN patients include:

A

Urinalysis, electrolytes, creatinine, albumin, glucose, and cholesterol

65
Q

NSAID’s may increase BP by:

A

Inhibition of renal prostaglandin production, lowering renal perfusion

66
Q

Corticosteroids may increase BP by:

A

Providing mineralocorticoid effect (aldosterone)

67
Q

Hormonal contraceptives may increase BP by:

A

Triggering angiotensinogen production from the liver

68
Q

Decongestants, some antidepressants, and stimulants may increase BP by:

A

Increasing SNS activity

69
Q

Can alcohol increase BP?

A

In excess only - impairs ADH

70
Q

A HTN high-risk patient is defined as:

A

50+, SBP of 130-180, and CV risk factor present (CV disease, CKD, high framingham)

71
Q

A HTN moderate-to-high risk patient is defined as:

A

Target organ damage, or CV risk factors present

72
Q

For a high risk HTN patient, initiation of antihypertensive therapy should be started when BP is…

A

When SBP is above 130 mmHg

73
Q

A HTN low risk patient is defined as:

A

No target organ damage, or CV risk factors

74
Q

BP treatment targets for a high risk HTN patient is…

A

SBP under 120

75
Q

For a moderate-to-high risk HTN patient, initiation of antihypertensive therapy should be started when BP is…

A

140+/90+

76
Q

BP targets for a moderate-to-high risk HTN patient is…

A

<140/<90

77
Q

For a low risk HTN patient, initiation of antihypertensive therapy should be started when BP is…

A

160+/100+

Lifestyle modifications ALONE can be considered below 160/100, but if higher or TOD present, start drugs immediately

78
Q

BP targets for a low risk HTN patient is…

A

<140/<90

79
Q

For a patient with diabetes, initiation of antihypertensive therapy should begin when BP is…

A

130+/80+

80
Q

BP targets for a patient with diabetes is…

A

<130/<80

81
Q

Other than drug therapy, what is essential for BP lowering?

A

Non-pharmacologic - lifestyle changes (diet, exercise)

82
Q

Hyperaldosteronism can cause treatment resistance by:

A

Unregulated aldosterone release

Need MRA’s or K+ sparing diuretics

83
Q

Pheochromocytoma can cause treatment resistance by

A

Unregulated SNS activity

Need a-blockers or b-blockers (surgery required)

84
Q

CKD can cause treatment resistance by:

A

Causing fluid/electrolyte imbalances

Manage as recommended

85
Q

Renovascular disease can cause treatment resistance by:

A

Causing insufficient blood flow to the kidney

CAREFUL with ACEI’s and ARB’s

86
Q

Obstructive sleep apnea can cause treatment resistance by:

A

Causing insufficient oxygen concentrations

Correct underlying problem

87
Q

Hyper/hypothyroidism can cause treatment resistance by:

A

Causing metabolic dysfunction

Correct underlying problem

88
Q

Isolated systolic hypertension (ISH) is when:

A

Persistently high systolic BP, yet normal diastolic BP

89
Q

ISH is often caused when:

A

Stiff arteries do not accomodate systolic pressure, creating high “pulse-pressure” (SBP - DBP)

90
Q
A

CV Basics + Hypertension (3 decks)

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