Blood Pressure Fundamentals + Assessment Flashcards
What is blood pressure?
Pressure in the arterial wall
The 5 methods of blood pressure monitoring include:
Office
Office automated
Ambultatory
Home
Pharmacy
Why are home BP monitors the gold standard?
Highly accurate, and highly correlated with usual resting BP levels
What are optimal conditions when taking a BP measurement?
At rest, no stimulation or usage of stimulants/irritants
Take duplicate measures (3)
NO exercise, caffeine, full bladder
When should BP measurements be taken?
Before doses (troughs, change in drug concentration)
Morning and night
How often should BP measurements be taken?
One week blocks during times of interest
No need to measure everyday if stable
Times of interest = dose change, recent hospitalization
High blood pressure is beneficial during activity because…
Increases blood flow, increasing oxygen and glucose delivery to muscle
High blood pressure is harmful during rest because…
Increased energy to pump blood - waste of energy and fatigues tissues/cells, leading to adverse changes
Also damages specific tissues + cells
Hypertension is defined by:
Continuous high blood pressure readings at rest
Hypertension often results from two main physiological features:
Increased afterload and arterial damage
How does hypertension correlate with age?
Risk increases with age
How can fluid and electrolyte imbalances relate to HTN?
Malfunctions in RAAS, natriuretic hormone, electrolyte imbalances, or renal dysfunction
How can the SNS relate to HTN?
Increased SNS activity
What is metabolic syndrome?
Risk factors that often present together
How can vascular endothelial function be related to HTN?
Involvement of prostacyclins and nitric oxide production
What is essential/primary hypertension?
Chronically increased BP from MULTIPLE factors (no single factor predominates)
Commonly associated with metabolic syndrome
What is secondary hypertension?
HTN caused by significant dysfunction of a single system
Usually not recognized until resistant to conventional treatment
Treatment resistance in HTN is usually defined as:
Lack of BP control despite combination of 3 anti-HTN drugs, 1 of which is a diuretic
Non-adherence is ruled OUT
Secondary HTN usually involves one or more of these three:
RAAS, renal dysfunction, increased SNS activity
Why is screening HTN important?
Most CV risk factors, including HTN, are silent but lead to further disease development and bad outcomes
What diseases can HTN contribute to?
DM, atherosclerosis, cardiac dysfx, AFib
What are some modifiable risk factors for developing HTN
Lifestyle, other medical conditions?
Obesity
Poor diet (high sodium, alcohol)
Sedentary lifestyle
Diabetes/metabolic syndrome/DLD
Smoking
Stress?
What is the main goal of therapy regarding HTN?
Control blood pressure and prevent CV consequences
Improve health of blood vessels and myocytes
What is considered optimal BP?
<120/<80
What is considered normal BP?
<130/<85
What is considered high-normal BP?
130-139/85-89
What is considered Grade 1 HTN?
Mild
140-159/90-99
What is considered Grade 2 HTN?
Moderate
160-179/100-109
What is considered Grade 3 HTN?
Severe
> > 180/>110
What is considered isolated systolic hypertension (ISH)
> 140/<90
For diagnosis of HTN, BP must be…
High at rest + Consistent
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.
Masked HTN is when…
HTN is not identified in office/healthcare setting, but is evident at home/ambulatory
Worse prognosis
White coat HTN is when…
HTN is identified in office/healthcare setting, but is not evident at home/ambulatory
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
What are some non-modifiable CV risk factors?
Age 55+
Male
Family history of CV disease
What is target organ damage? What are some examples?
Damage that occurs from long standing HTN
CKD, CAD, HF
Currently, the best tool to assess overall CV risk is:
Framingham risk calculator
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
Risk factors involved in the framingham algorithm include:
Both modifiable and non-modifiable are measured
Age
HDL + total cholesterol
SBP
Smoker status
Diabetes
Physical assessments for CV commonly documented in medical include:
Pulses, heart rate, and BP
Edema
JVP
Swelling or accumulation of fluid in tissue is also known as:
Edema
Extracellular or interstitial fluid
Presence of edema encourages further assessment of:
Intravascular volume status
Possibly too much volume in vessels
What is preload?
Backup of blood in the left ventricle
Several conditions can increase intravascular volume, such as:
HF, kidney disease, HTN
JVP stands for:
Jugular venous pressure
“Neck vein”
JVP is often assessed to gauge:
Volume/preload
Very important in HF patients
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
Ankle-brachial index is measured by:
Dividing ankle pressure by arm pressure
Close to 1 is ideal (should be same)
Peripheral artery disease can be diagnosed if ABI is:
Less than 0.9
Normal amount of heart sounds is:
2
The first heart sound is…
The start of ventricular contraction (closure of mitral and tricuspid valves)
The second heart sound is…
Closure of aortic and pulmonic valves, during ventricular relaxation
If third or fourth heart sounds are present…
Not normal, and may indicate presence of problem
Heart murmurs result from:
“Turbulent flow” within the heart
Murmurs may indicate presence of cardiac issues, such as…
Pulmonic stenosis, aortic stenosis, cardiomyopathies
What is a bruit?
Representation of turbulent flow
Stethoscope can pick up bruit in some arteries
Flow through a healthy blood vessel should be…
Silent - unobstructed
Inflammation may be measured via:
CRP
Natriuretic peptides may be measured because:
May indicate ventricular wall stress + elevated in patients with HF
ECG may be measured in order to analyze:
Electrical conduction
Exercise stress-testing may be measured in order to analyze:
Exercise tolerance, and presence of ischemia
Nuclear imaging, CT, or PET scans may be done to:
Assess areas of myocardium for perfusion, activity, etc.
Baseline laboratory investigations for HTN patients include:
Urinalysis, electrolytes, creatinine, albumin, glucose, and cholesterol
NSAID’s may increase BP by:
Inhibition of renal prostaglandin production, lowering renal perfusion
Corticosteroids may increase BP by:
Providing mineralocorticoid effect (aldosterone)
Hormonal contraceptives may increase BP by:
Triggering angiotensinogen production from the liver
Decongestants, some antidepressants, and stimulants may increase BP by:
Increasing SNS activity
Can alcohol increase BP?
In excess only - impairs ADH
A HTN high-risk patient is defined as:
50+, SBP of 130-180, and CV risk factor present (CV disease, CKD, high framingham)
A HTN moderate-to-high risk patient is defined as:
Target organ damage, or CV risk factors present
For a high risk HTN patient, initiation of antihypertensive therapy should be started when BP is…
When SBP is above 130 mmHg
A HTN low risk patient is defined as:
No target organ damage, or CV risk factors
BP treatment targets for a high risk HTN patient is…
SBP under 120
For a moderate-to-high risk HTN patient, initiation of antihypertensive therapy should be started when BP is…
140+/90+
BP targets for a moderate-to-high risk HTN patient is…
<140/<90
For a low risk HTN patient, initiation of antihypertensive therapy should be started when BP is…
160+/100+
Lifestyle modifications ALONE can be considered below 160/100, but if higher or TOD present, start drugs immediately
BP targets for a low risk HTN patient is…
<140/<90
For a patient with diabetes, initiation of antihypertensive therapy should begin when BP is…
130+/80+
BP targets for a patient with diabetes is…
<130/<80
Other than drug therapy, what is essential for BP lowering?
Non-pharmacologic - lifestyle changes (diet, exercise)
Hyperaldosteronism can cause treatment resistance by:
Unregulated aldosterone release
Need MRA’s or K+ sparing diuretics
Pheochromocytoma can cause treatment resistance by
Unregulated SNS activity
Need a-blockers or b-blockers (surgery required)
CKD can cause treatment resistance by:
Causing fluid/electrolyte imbalances
Manage as recommended
Renovascular disease can cause treatment resistance by:
Causing insufficient blood flow to the kidney
CAREFUL with ACEI’s and ARB’s
Obstructive sleep apnea can cause treatment resistance by:
Causing insufficient oxygen concentrations
Correct underlying problem
Hyper/hypothyroidism can cause treatment resistance by:
Causing metabolic dysfunction
Correct underlying problem
Isolated systolic hypertension (ISH) is when:
Persistently high systolic BP, yet normal diastolic BP
ISH is often caused when:
Stiff arteries do not accomodate systolic pressure, creating high “pulse-pressure” (SBP - DBP)
