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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
What is considered normal BP?
<130/<85
26
What is considered high-normal BP?
130-139/85-89
27
What is considered Grade 1 HTN? | Mild
140-159/90-99
28
What is considered Grade 2 HTN? | Moderate
160-179/100-109
29
What is considered Grade 3 HTN? | Severe
>>180/>110
30
What is considered isolated systolic hypertension (ISH)
>140/<90
31
For diagnosis of HTN, BP must be...
High at rest + Consistent
32
A hypertensive urgency/emergency is classified as:
Asymptomatic diastolic BP >130 OR severe BP elevation in setting of acute condition (chest pain, severe headache, weakness, etc.) | ACS, AKI, encephalopathy, hemorrhage, etc.
33
Masked HTN is when...
HTN is not identified in office/healthcare setting, but is evident at home/ambulatory | Worse prognosis
34
White coat HTN is when...
HTN is identified in office/healthcare setting, but is not evident at home/ambulatory
35
An individual has metabolic syndrome contains at least 3 of the following risk factors: | 5 - related to fats, BP, and sugars
Insulin resistance/high BG Low HDL Abdominal obesity High TG High BP
36
What are some non-modifiable CV risk factors?
Age 55+ Male Family history of CV disease
37
What is target organ damage? What are some examples?
Damage that occurs from long standing HTN | CKD, CAD, HF
38
Currently, the best tool to assess overall CV risk is:
Framingham risk calculator
39
The framingham risk calculator is an algorithm used to:
Estimate individual's 10 year risk of experiencing a major CV event or death | Accounting for risk factors
40
Risk factors involved in the framingham algorithm include: | Both modifiable and non-modifiable are measured
Age HDL + total cholesterol SBP Smoker status Diabetes
41
Physical assessments for CV commonly documented in medical include:
Pulses, heart rate, and BP Edema JVP
42
Swelling or accumulation of fluid in tissue is also known as:
Edema | Extracellular or interstitial fluid
43
Presence of edema encourages further assessment of:
Intravascular volume status | Possibly too much volume in vessels
44
What is preload?
Backup of blood in the left ventricle
45
Several conditions can increase intravascular volume, such as:
HF, kidney disease, HTN
46
JVP stands for:
Jugular venous pressure | "Neck vein"
47
JVP is often assessed to gauge:
Volume/preload | Very important in HF patients
48
Peripheral pulses are important to measure, because if they are diminished...
May mean reduced stroke volume or peripheral artery disease (PAD) | Weak pedal pulses = possible narrowing of arteries toward extremities
49
Ankle-brachial index is measured by:
Dividing ankle pressure by arm pressure | Close to 1 is ideal (should be same)
50
Peripheral artery disease can be diagnosed if ABI is:
Less than 0.9
51
Normal amount of heart sounds is:
2
52
The first heart sound is...
The start of ventricular contraction (closure of mitral and tricuspid valves)
53
The second heart sound is...
Closure of aortic and pulmonic valves, during ventricular relaxation
54
If third or fourth heart sounds are present...
Not normal, and may indicate presence of problem
55
Heart murmurs result from:
"Turbulent flow" within the heart
56
Murmurs may indicate presence of cardiac issues, such as...
Pulmonic stenosis, aortic stenosis, cardiomyopathies
57
What is a bruit?
Representation of turbulent flow | Stethoscope can pick up bruit in some arteries
58
Flow through a healthy blood vessel should be...
Silent - unobstructed
59
Inflammation may be measured via:
CRP
60
Natriuretic peptides may be measured because:
May indicate ventricular wall stress + elevated in patients with HF
61
ECG may be measured in order to analyze:
Electrical conduction
62
Exercise stress-testing may be measured in order to analyze:
Exercise tolerance, and presence of ischemia
63
Nuclear imaging, CT, or PET scans may be done to:
Assess areas of myocardium for perfusion, activity, etc.
64
Baseline laboratory investigations for HTN patients include:
Urinalysis, electrolytes, creatinine, albumin, glucose, and cholesterol
65
NSAID's may increase BP by:
Inhibition of renal prostaglandin production, lowering renal perfusion
66
Corticosteroids may increase BP by:
Providing mineralocorticoid effect (aldosterone)
67
Hormonal contraceptives may increase BP by:
Triggering angiotensinogen production from the liver
68
Decongestants, some antidepressants, and stimulants may increase BP by:
Increasing SNS activity
69
Can alcohol increase BP?
In excess only - impairs ADH
70
A HTN high-risk patient is defined as:
50+, SBP of 130-180, and CV risk factor present (CV disease, CKD, high framingham)
71
A HTN moderate-to-high risk patient is defined as:
Target organ damage, or CV risk factors present
72
For a high risk HTN patient, initiation of antihypertensive therapy should be started when BP is...
When SBP is above 130 mmHg
73
A HTN low risk patient is defined as:
No target organ damage, or CV risk factors
74
BP treatment targets for a high risk HTN patient is...
SBP under 120
75
For a moderate-to-high risk HTN patient, initiation of antihypertensive therapy should be started when BP is...
140+/90+
76
BP targets for a moderate-to-high risk HTN patient is...
<140/<90
77
For a low risk HTN patient, initiation of antihypertensive therapy should be started when BP is...
160+/100+ ## Footnote Lifestyle modifications ALONE can be considered below 160/100, but if higher or TOD present, start drugs immediately
78
BP targets for a low risk HTN patient is...
<140/<90
79
For a patient with diabetes, initiation of antihypertensive therapy should begin when BP is...
130+/80+
80
BP targets for a patient with diabetes is...
<130/<80
81
Other than drug therapy, what is essential for BP lowering?
Non-pharmacologic - lifestyle changes (diet, exercise)
82
Hyperaldosteronism can cause treatment resistance by:
Unregulated aldosterone release | Need MRA's or K+ sparing diuretics
83
Pheochromocytoma can cause treatment resistance by
Unregulated SNS activity | Need a-blockers or b-blockers (surgery required)
84
CKD can cause treatment resistance by:
Causing fluid/electrolyte imbalances | Manage as recommended
85
Renovascular disease can cause treatment resistance by:
Causing insufficient blood flow to the kidney | CAREFUL with ACEI's and ARB's
86
Obstructive sleep apnea can cause treatment resistance by:
Causing insufficient oxygen concentrations | Correct underlying problem
87
Hyper/hypothyroidism can cause treatment resistance by:
Causing metabolic dysfunction | Correct underlying problem
88
Isolated systolic hypertension (ISH) is when:
Persistently high systolic BP, yet normal diastolic BP
89
ISH is often caused when:
Stiff arteries do not accomodate systolic pressure, creating high "pulse-pressure" (SBP - DBP)
90

CV Basics + Hypertension (3 decks)

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