Cardio 10 Flashcards
Regulation of blood pressure (BP)
Baroreceptors
Endothelial factors
Kidneys
Genetic influences
BP =
cardiac output (CO) x pulmonary vascular resistance (PVR)
Most essential: patients with hypertension
(HTN) have increased peripheral resistance and normal CO
Baroreceptor how do they work
Baroreceptor exerts control of mean arterial pressure as a negative feedback loop. Nerve impulses from arterial baroreceptors are tonically active; increases in arterial blood pressure will result in an increased rate of impulse firing.
Endotheial Factors how do they work
These endothelial factors modulate the effects of norepinephrine (NE) released by sympathetic nerves (SN), and the effects of tissue metabolites and humoral factors. The three most important endothelial-derived substances are: nitric oxide (NO), endothelin (ET-1), and prostacyclin (PGI2).
Most common cause of HTN
primary (95%) caused by atherosclerosis
other kind of HTN
secondar (5%) caused by adrenal, renal factors
BP relies on
balance of CO and PVR
HTN lab workup 7 items
Electrocardiography (ECG) Urine analysis Blood glucose Serum potassium, creatinine, calcium Lipid profile C-reactive protein Homocysteine
When can you dx HTN
HTN on two separate readings
Single high reading on one occasions
dx elevated BP
normal BP
less than 120 and less than 80
early HTN
120 to 139 and 80 to 89
stage 1
140 to 159 and 90 to 99
stage 2
greater than or equal to 160 or greater than or equal to 100
The old term “pre-hypertension” no longer used
Patients did not appreciate degree of risk or true impact of being outside of normal range
new term is early hypertension
Therapy adherence there an issue
National Guidelines Updates older adults
Changes definitions of control for older adults to allow higher values to avoid orthostatic falls and increase adherence
National Guidelines Updates medications (two items)
Beta blockers no longer first-line drugs
Emphasis on multiple therapeutic agents at lower doses rather than one agent at maximum dose
Goal of HTN treatment
Three items
Prevent the rise of BP with age.
Improve control of HTN to below 140/90 mm Hg
The primary focus should be on obtaining the systolic blood pressure (SBP) goal
In patients with concurrent HTN
and diabetes or renal disease, the BP goal is less than 130/80 mm Hg
There is a little correlation of ___ with HTN
Vit D3
Goals of Treatment Continued for HTN Two Items
Improve recognition of the importance of risk factors on the development of HTN.
Reduce ethnic, socioeconomic, and regional variations in HTN care.
Step one and two of treatment of HTN
lifesytle
medication
Benefits of Lowering BP
Storke reduced 35 to 50%
MI by 20% to 25%
Heart Faliure 50%
In stage 1 HTN and more cardiovascular disease risk factors, achieving a sustained 12 mm Hg reduction in SBP over 10 years will prevent
1 death/11 patients treated.
DASH diet
Dietary Approaches to Stop Hypertension (DASH) diet
Dietary sodium reduction (most consume too much; not a restriction, but conscious effort)
Limit alcohol consumption
Physical activity
For every 10% reduction in BMI over 30 you will see
a significant reduction in risk for cardiovascular disease
ETOH to recomendations
0 to 1 for women
0 to 2 for men
What is very important to lower BP
physical activity. This works even if you are overweight
physcial activity recomendation
150 min a week
Stepped Therapy (first 4 steps)
Set an appropriate minimum therapeutic BP goal: no longer less than 120/80. (under 140/90 RESTING)
Be patient, and work on attaining the BP goal over many weeks to months.
Titrate BP medications no more often than every 4 to 6 weeks.
Do not automatically assign to the drug symptoms reported by patients.
Lisinopril side effect
cough
Stepped therapy (5 through 7)
Plan at the beginning of therapy for the use of more than one drug.
Treat to achieve goal SBP in older adults even if diastolic blood pressure is normal, but go more slowly, allowing SBP of 150 to 160 mm Hg if asymptomatic.
Extracellular fluid volume must be controlled to achieve BP goals.
Initial therapy for HTN
Angiotensin-converting enzyme inhibitors (ACEIs), or calcium channel blockers (CCBs) if:
ACE or CCB is used if
BP is more than 20 mm Hg above the systolic goal or 10 mm Hg above the diastolic goal
early HTN you may want to
start with a mild diuretic or add on quickly to achieve goals
Drugs that work on cardiac output
Beta blockers
Calcium channel blockers
Diuretics
Drugs that work on total peripheral resistance
ACEIs Angiotensin II receptor blockers (ARBs) Direct renin inhibitors Beta blockers Alpha agonists CCBs Diuretics Sympatholytics Vasodilators
Drugs indicated for Heart Failure
Diuretics, beta blockers, ACEIs, ARBs, aldosterone antagonists
Drugs indicated post MI
Beta blockers, ACEIs, aldosterone antagonists
Drugs indicated for High coronary disease risk
Diuretics, beta blockers, ACEIs, CCBs
early hypertension probably will use
diuretic
stage one HTN will likely use
ACE or CCB
Drugs indicated for Diabetes and HTN
Diuretics, ACEIs, ARBs, CCBs
Drugs indicated for CKD and HTN
ACEIs, ARBs until stage 3 chronic kidney disease (CKD)
Drugs indicated with recurrent stroke prevention and HTN
Diuretics, ACEIs
