chapter 31: hypertension Flashcards
arterial blood pressure (definitions)
Systolic pressure: height of pressure pulse
Diastolic pressure: lowest pressure (relaxed)
Pulse pressure: difference between systolic and diastolic
Mean arterial pressure: represent the average pressure in the arterial system during ventricular contraction and relaxation
Factors influencing mean arterial blood pressure
PHYSICAL:
-blood volume and the elastic properties of the blood vessels
PHYSIOLOGIC FACTORS:
- cardiac output
- peripheral vascular resistance
Most common causes of secondary hypertension
KAPCS
- kidney disease (renovascular hypertension)
- adrenal cortical disorders
- pheochromocytoma
- coarctation of the aorta
- sleep apnea
Factors determining systolick and diastolic
SYSTOLIC
- stroke volume being ejected from the heart
- the ability of the aorta to stretch and accommodate the stroke volume
DIASTOLIC
- Energy that is stored in the aorta as its elastic fibers are stretched during systole
- the resistance to the run off of blood from the peripheral blood vessels
arterial blood pressure
- Represents the pressure of the blood as it moves through the arterial system
- CO=HR x SR
- vascular resistance
- mean arterial pressure = CO x VR
Mechanisms of BP regulation
SHORT-TERM REGULATION: corrects temporary imbalances in blood pressure
- neural mechanisms
- humoral mechanisms
LONG-TERM REGULATION: controls the daily, weekly, and monthly regulation of blood pressure
-renal mechanism
Korotkoff sounds
- PHASE 1: marked by the first tapping sounds, which gradually increases intensity
- PHASE 2: period in which a murmur or swishing sounds is heard
- PHASE 3: period during which sounds are crisper and greater in intensity
- PHASE 4: period marked by distinct abrupt muffling or by a soft blowing sounds
- PHASE 5: point at which sounds disappear
Joint national committee on detection, evaluation, and treatment of hypertension
- normal: 120/80
- prehypertensive: 139/89
- hypertension: >140/90
- diabetes mellitus: 130/80
categories of hypertension
- PRIMARY HYPERTENSION: (essential hypertension) chronic elevation in BP that occurs without evidence of other disease
- SECONDARY HYPERTENSION: elevatino of BP that results from some other disorder, such as kidney disease
- MALIGNANT HYPERTENSION: accelerated form of hypertension
- SYSTOLIC HYPERTENSION: systolic is great than 140, but diastolic is less than 90
classificatinos of essential hypertension
- systolic/diastolic hypertension: both is high
- diastolic hypertension: diastolic is high
- systolic hypertension: systiloc is high
risk factors for hypertension
-family history, age, race, insulin resistance and metabolic abnormalities, circadian variations, lifestyle factors
lifestyle factors contributing to hypertension
high salt intake, obesity, excess alcohol consumption, dietary intake of potassium, calcium, and magnesium, oral contraceptive drugs, stress
factors affecting hypertension
- Age: more commin in younger men and elderly
- Race: more common in blacks than whites
- Socioeconomic group: More common in lower socioeconomic groups
Target organ damage
- The heart: hypertrophy
- Brain: dementia and cognitive impairment
- Peripheral vascular: atherosclerosis
- Kidney: Nephrosclerosis
- Retinal complications
Factors affecting treatment strategies for hypertension
The person’s lifestyle, demographics, motivation for adhering to the drug regimen, other disease conditions and therapies, potential for side effects
Drugs used in the treatment of hypertension
- Diuretics
- b-adrenergic blocking drugs
- angiotensin-converting enzyme (ACE) inhibitos
- angiotensin 2 receptor blockers
- calcium channel blocking drugs
- central a2-adrenergic agonists
- a1-adrenergic receptor blockers
- vasodilators
Types of hypertension in pregnancy
- Gestational hypertension
- chronic hypertension
- preeclampia-eclampsia
- preeclampsia superimposed on chronic hypertension
Diagnosis and treatment of hypertension in pregnancy
- Early prenatal care
- refraining from alcohol and tobacco use
- salt restriction
- bed rest
- carefully chosen antihypertensive medication
High BP in children in adolescence
- BP norms in children: age, height, gender-specific percentiles
- secondary hypertension is the most common in kids
- kidney abnormalities
- coarctation of the aorta
- pheochromocytoma and adrenal cortical disorders - hypertensino in infants: most commonly associated with high umbilical catheterization and renal artery obstruction caused by thrombosis
ORTHOSTATIC HYPOTENSION
DEF.: an abnormal disease in BP on assumption of the upright position
CAUSE:
- decrease in venous return to the heart due to pooling of blood in lower part of body
- inadequate circulatory response to decreased cardiac output and a decrease in BP
causes of orthostatic hypotension
- condition that decreases vascular volume: dehydration
- conditions that impair muscle pump function: bed rest & spinal cord injury
- condition that interfere with cardiovascular reflexes: medications, disorders of autonomic nervous system, & effects of aging on baroreflex function
Common causes of orthostatic hypotension related to hypovolemia
- excessive use of diuretics
- excessive diaphoresis
- loss of gastrointestinal fluids through vomiting and diarrhea
- loss of fluid volume associated with prolonged bed rest
complaints associated with orthostatic intolerance
- dizziness
- visual changes
- head and neck discomfort
- poor concentratino while standing
- palpitations
- tremor,anxiety
- presyncope, and in come cases syncope
